Otitis media
Description
Inflammation of the middle ear associated with fluid accumulation
Peaks between ages 6 and 24 months
Subsides after age 3
Occurs most commonly during winter months
Can be suppurative or secretory (acute or chronic)
Pathophysiology
Suppurative otitis media occurs when nasopharyngeal flora reflux through the eustachian tube and colonize in the middle ear.
Risk factors of suppurative otitis media include:
respiratory tract infection
allergic reaction
nasotracheal intubation
positional changes.
Predisposing factors of suppurative otitis media include:
wider, shorter, more horizontal eustachian tubes and increased lymphoid tissue in children
anatomic anomalies.
Chronic suppurative otitis media results with inadequate treatment of acute otitis episodes, infections by resistant strains of bacteria, or, rarely, tuberculosis.
Secretory otitis media results from obstruction of the eustachian tube:
Buildup of negative pressure in the middle ear permits sterile serous fluid from blood vessels to pass through the membrane of the middle ear.
Effusion may be secondary to eustachian tube dysfunction from viral infection or allergy.
Effusion may follow barotraumas (pressure injury caused by inability to equalize pressures between the environment and the middle ear).
Occurs during rapid aircraft descent in a person with an upper respiratory tract infection.
Chronic secretory otitis media follows persistent eustachian tube dysfunction, possibly resulting from mechanical obstruction (adenoidal tissue overgrowth, tumors), edema (allergic rhinitis, chronic sinus infection), or inadequate treatment of acute suppurative otitis media.
Causes
Assessment findings
Suppurative otitis media
Severe, deep, throbbing pain (from pressure behind the tympanic membrane)
Signs of upper respiratory tract infection (sneezing and coughing)
Mild to very high fever
Hearing loss (usually mild and conductive)
Tinnitus
Dizziness
Nausea
Vomiting
Bulging of the tympanic membrane with erythema
Purulent drainage in the ear canal if tympanic membrane ruptures
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