Otitis Media Slides PDF

12/12/2022 ENT TOPICS- OTITIS MEDIA PREPARED AND PRESENTED BY K. SOPER, DNP, MS, RN, ANP-BC, AOCNP OBJECTIVES Upon completion of this lecture, student will be able to: List the risk factors associated with otitis media Understand the pathophysiology as...

12/12/2022 ENT TOPICS- OTITIS MEDIA PREPARED AND PRESENTED BY K. SOPER, DNP, MS, RN, ANP-BC, AOCNP OBJECTIVES Upon completion of this lecture, student will be able to: List the risk factors associated with otitis media Understand the pathophysiology associated with otitis media Describe the clinical presentation and work up of a person with otitis media Develop a medical plan for a person with otitis media 1  12/12/2022 INTRODUCTION Otitis media (OM) is any inflammation of the middle ear without reference to etiology or pathogenesis. It is very common in children. CLASSIFICATION OF OTITIS MEDIA Acute OM (AOM): rapid onset of Chronic suppurative OM is disease associated with one or more a persistent ear infection that of the following symptoms- Otalgia, results in tearing or Otorrhea, Headache, fever, irritability, loss of appetite, vomiting, diarrhea. perforation of the eardrum. OM with effusion (OME): follows Adhesive OM occurs when a an episode of AOM. thin retracted ear drum becomes sucked into the middle ear space and stuck. 2  12/12/2022 PATHOPHYSIOLOGY The most important factor in middle ear disease Esophageal contents regurgitated into is eustachian tube (ET) dysfunction (ETD), in which the mucosa at the pharyngeal end of the the nasopharynx and middle ear ET is part of the mucociliary system of the through the ET can create a direct middle ear. mechanical disturbance of the middle Interference with this mucosa by edema, tumor, ear mucosa and cause middle ear or negative intratympanic pressure facilitates direct extension of infectious processes from the inflammation. nasopharynx to the middle ear, causing OM. PRESENTING SYMPTOMS Otalgia- pulling on the affected Irritability ear. History of lethargy Otorrea- discharge from the middle ear. Anorexia Headache Nausea/Vomiting Concurrent symptoms of a URI Diarrhea Fever 3  12/12/2022 PHYSICAL EXAM Color: A normal TM is a translucent pale gray. An opaque yellow or blue Pneumatic otoscopy remains the standard examination TM is consistent with Middle Ear Effusion. Dark red indicates a recent technique for patients with suspected OM. When trauma or blood behind the TM. A dark pink or lighter red TM is consistent with AOM or hyperemia of the TM caused by crying, coughing, performed correctly, it is 90% sensitive and 80% specific or nose blowing. for diagnosis of AOM,. Position: In AOM, the TM is usually bulging. In OME, the TM is typically retracted or in the neutral position The exam should include the following: Mobility: A TM that moves only slightly with both positive and negative Color pressure applied indicates the probable presence of middle ear fluid. No movement occurs with a TM perforation or a TT. Position Perforation: Single perforations are most common, but some patients Mobility may have multiple perforations. Note the location and cause of the perforation. Perforations in the posterosuperior quadrant, which are the Perforation most difficult to detect, are important because they occasionally are associated with cholesteatoma. Pus or other fluid may drain through a perforation. Multiple perforations and otorrhea that does not yield pathogens on culture may indicate tuberculosis. DIFFERENTIAL DIAGNOSIS Acute Sinusitis Hearing impairment Bacteremia Nasopharyngeal cancer Cholesteatoma Otitis External Colic Parainfluenza Viruses Diarrhea Fever without a focus 4  12/12/2022 TREATMENT Antimicrobials: Many options!! Amoxicillin, Augmentin, Ceclor, Cefprozil, Ceftin, Suprax, Rocephin, Zithromax, Bactrim, Erythromycin Studies of other adjunctive therapy for acute OM (AOM) and OME have shown that NSAIDs, decongestants, and antihistamines provide no obvious benefits. CONSIDERATIONS FOR THE GERIATRIC POPULATION Otitis media in elderly doesn’t feature the classical presentation in children. Elderly patients experience otalgia with or without hearing loss or signs of inflammation. Infection may spread to either to adjacent structures leading to mastoiditis, petrositis, labyrinthitis, or facial nerve palsy, or intracranially leading to meningitis, subarachnoid abscess, subdural abscess, encephalitis, brain abscess, lateral or sigmoid venous sinus thrombosis, and otitis hydrocephalus. 5  12/12/2022 REFERENCES Buttaro, T. M., Trybulski, J., Bailey, P. P., & Sandburg-Cook, J. (2017). Primary care a collaborative practice. (5 ed.). St. Louis, Missouri: Mosby Elsevier. Waseem, M., Elluru, R. (2022, April 07). Otitis Media. Retrieved June 17, 2022, from https://emedicine.medscape.com/article/994656-overview 6