Otitis Media

  1. General information
    1. Bacterial or viral infection of the middle ear
    2. More common in infants and preschoolers as the ear canal is shorter and more horizontal than in older children; also found in children with cleft lip/palate
    3. Blockage of eustachian tube causes lymphedema and accumulation of fluid in the middle ear
  2. Medical management
    1. Drug therapy
      1. Systemic and otic antibiotics
      2. Analgesics/antipyretics
    2. Surgery: myringotomy, with or without insertion of tubes (incision into the tympanic membrane to relieve the pressure and drain the fluid)
  3. Assessment findings
    1. Dysfunction of Eustachian tube
    2. Ear infection usually related to respiratory infection
    3. Increased middle ear pressure; bulging tympanic membrane
    4. Pain; infant pulls or touches ear frequently
    5. Irritability; cough; nasal congestion
    6. Diagnostic tests: C&S of fluid reveals causative organism
  4. Nursing interventions
    1. Administer antibiotics as ordered, for a full 10-day course. When administering ear drops pull earlobe up and back for older children and down and back for infants.
    2. Administer acetaminophen for fever and discomfort.
    3. Administer decongestants to relieve Eustachian tube obstruction as ordered.
    4. Provide care for child with a myringotomy tube insertion (day surgery)
      1. Child should wear earplugs when showering or having hair washed; do not permit diving.
      2. Be aware that tubes may fall out for no reason.
    5. Provide client teaching and discharge planning concerning
      1. Medication administration
      2. Post-op care, depending on the type of surgery