Infection: Otitis Media and
Conjunctivitis
Otitis Media
Perry, pp. 13141317
Etiology
Most common in childhood—usually
in first 24 mos
 Infection of middle ear behind
eardrum with inflammation of canal
and eardrum from strep,
haemophilus, or moraxella.
 Types in Box 46-5
 Usually preceded by RSV or flu
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Pathophysiology
Infection travels thru nose or throat
and goes up eustachian tube
 Blocked eustachian tubes from
edema or enlarged adenoids fail to
drain middle ear
 Tubes can become contaminated
from reflux, aspiration, sneezing,
blowing nose
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Manifestations
Purulent matter and fluid collection
causes bulging and pain; popping
sensation, pressure. Sudden relief of
pain may indicate perforation
 See Box 46-6
 OME may have no overt sx
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Otoscopic Exam
Otoscopic exam reveals loss of light
reflex and bony landmarks; bulging,
red, immobile eardrum; bubbles
behind eardrum with serous (OME)
 Tympanogram is flat
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Risk Factors
Small, short airways and eustacian
tubes
 Family hx
 Second-hand smoke—causes
pathogens to attach to middle ear
 Day care or other crowded settings
 Hx allergies, cleft palate, Down
 Bottle feeding in supine position
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Antibiotic Treatment
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All children < 6 months old because of
immature immunity
All children 6 mos to 2 y.o. if fever and
severe pain are present.
Amoxicillin 80-90 mg/kg/d bid x 5-7d
If allergic—azithromycin, cephalosporins
IM Rocephin for resistance or
noncompliance (use with lidocaine)
“Watchful Waiting”
In children ages 6-24 mos, if fever
and pain are not present, then
observation is OK x 72h
 No antibiotics are needed if
improved
 Obs for 2-12 y.o. x 72h; no
antibiotics if improved
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Supportive Care
Analgesic/antipyretic
 Benzocaine or herbal ear drops
(Allium sativum, Verbascum
thapsus, Calendula flores,
Hypericum perforatum, lavender,
and vitamin E)
 Topical pain relief
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Complications
Repeated & resistant cases and
persistent perfusion and hearing loss
may require myringotomy with
placement of tympanostomy tubes
and possible adenoidectomy
 Meningitis
 Mastoiditis
 Hearing loss
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Nursing Responsibilities
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Pain relief
Manage ear drainage
Encourage parent to give child all of
medication
Encourage immunizations esp. PCV and
Hib
Follow orders and educate regarding
management of tubes
Refer children who have hearing loss
Parent Education
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Causes of infection
S/S of infection
Prevention—breastfeeding, no smoking,
no bottle propping, feeding in semireclining position
Recognition and prevention of
complications
Med administration
Avoid air travel
Conjunctivitis
p. 1194
Etiology & Pathophysiology
Most common eye disease
 Inflammation of the conjunctiva
 Viral, bacterial, allergic, foreign body
 Bacterial called “pink eye” and
caused by Staph or Haemophilus
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Manifestations
Redness
 Edema
 Pain, scratchy or itchy feeling
 Mild photophobia
 Watery or purulent drainage
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Diagnostics
C & S for bacterial or viral
 Conjunctival scrapings can also
detect microorganisms
 Fluorescein dye to detect FBs and
trauma
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Treatment
Eye drops for newborns to prevent
Chlamydia and gonorrhea
 Topical anti-infectives applied as eye
drops or ointments usually
erythromycin, gentamicin, or
penicillin, acyclovir
 Severe cases require systemic tx
 Antihistamines for allergic
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Supportive Care
Warm or cool compresses
 Cleaning away drainage
 Eye irrigations
 Analgesics
 Avoid bright lights, reading
 Sunglasses
 No contact lenses
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Parent Education
Prevent spread of bacterial—wash
hands, don’t share stuff, don’t
return to school until 24h of med
 Wash hands before eye drops
 Don’t contaminate eye dropper
 Reduce lighting
 No reading
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