Infection:
Otitis Media and
Conjunctivitis
Benita Beard & Brenda Stepp
2013
Infection:
Otitis Media
Infection: Otitis Media
• An inflammation of the middle
ear, usually caused by bacteria,
that occurs when fluid builds up
behind the eardrum.
Infection: Otitis Media
• Three types:
• Acute otitis media - Parts of the middle ear are
infected and swollen and fluid is trapped behind
the eardrum.
• Otitis media with effusion - fluid is trapped
behind the eardrum following an ear infection.
• Chronic otitis media with effusion - fluid
remains in the middle ear for a prolonged
period of time or reoccurs after the infection has
resolved.
Infection: Otitis Media
• 2/3 of all children under the age of
one will experience an ear infection.
• Half of the children experiencing an
ear infection will then experience
three or more ear infections by the
age of three.
Infection: Otitis Media
Eustachian tubes connect the middle ear to the
nose.
In children, the Eustachian tube is smaller, shorter
and straighter than in adults. This makes it easier
for drainage from the eyes, throat or nose to enter
the middle ear.
Any swelling or fluid from colds, upper respiratory
infections, a sore throat or enlarged adenoids can
impair or prevent fluid drainage, creating an
environment for viral or bacterial infections.
Infection: Otitis Media
Manifestations
• Ear Pain,
• esp when reclining
• Irritability
• Anorexia
• Ear Drainage
• Fever
• Chills
• Malaise
• Pulling on Ear
• Tinnitus
• Impaired balance
• Hearing Loss
• Difficulty Sleeping
• Nausea, vomiting,
or diarrhea
Infection: Otitis Media
• Medical Interventions:
• 80% of all ear infections will improve without
antibiotics
• Observe for 48-72 hours - if condition does
not improve or worsens – antibiotics
(they can cause vomiting, diarrhea, allergic reaction)
• Acetaminophen or Ibuprofen for pain
• Ear Drops - antipyrine-benzocaineglycerin (Aurodex)
Infection: Otitis Media
• Three ear infections in six months or four infections in a
year with at least one occurring in the past six months —
or otitis media with effusion — meets criteria for surgical
interventions
Surgical Interventions:
• Myringotomy – a tiny hole in the eardrum that enables
the surgeon to suction fluids out of the middle ear.
• Tympanostomy – a miniscule tube is placed in the
tympanic opening to help ventilate and prevent the
accumulation of more fluids in the middle ear.
• Adenoidectomy – removal of adenoids
Infection: Otitis Media
Post myringotomy:
• It is normal for the tubes to drain fluid for 3-4 days after
surgery. Call doctor if fluid is noted after it has stopped.
• The tubes should remain in place for several months. They
will eventually fall out or will be removed by the physician in
his office.
• Antibiotic ear drops may be ordered to be placed directly into
the ear.
• It is imperative that water and fluids are not allowed to enter
the ear. If allowed to enter pain and infection can occur. Ear
plugs, bathing caps, etc. may be used for prevention.
• Call doctor if yellow or green fluid is draining from the ear or if
fever is present.
Infection: Otitis Media
Education
• Anything that blocks, causes swelling or fluid accumulation in
the Eustachian tubes can lead to otitis media.
• Avoid passive smoke
• Limit exposure to other children with colds or
allergies (esp. vulnerable if in day care)
• Avoid the reclining position when bottle feeding
• Avoid possible environmental allergens
• Poverty can lead to unavoidable exposure to
multiple factors that can lead to otitis media.
Infection: Otitis Media
Prevention
Institute measures to help protect the immature immune
system of young children and help prevent otitis media.
• Utilize good handwashing
• Breastfeed for at least 6 months-increases
immunity
• Obtain immunizations
• Xylitol (eat or chew) – a natural sugar in some
gums and candies that inhibits growth of
bacteria
Infection:
Conjunctivitis
Infection: Conjunctivitis
Conjunctivitis (pink eye) - an inflammation or
infection of the conjunctiva
• One of the most common and
treatable eye conditions in
children and adults.
• Gives the eye a pink or reddish color.
• May affect one or both eyes
• Some forms are very contagious
Infection: Conjunctivitis
• Diagnosed from patient history and signs and
symptoms
Patient history:
• Runny nose
• Cold
• Respiratory infection
• Sore throat
• Spread through direct hand-to-eye contact
and by large respiratory tract droplets.
Infection: Conjunctivitis
Signs and Symptoms
• Redness or swelling of the eye
• Excessive tearing
• Swollen eyelids
• White, yellow or green discharge
• Itching or burning sensation
• Increased sensitivity to light
• Blurred vision
• Gritty feeling in the eye
• Crusting of eyelids or lashes
• Eye pain
Infection: Conjunctivitis
Types:
• Viral
• Bacterial
• Allergic (including irritant)
• Neonatal
Infection: Conjunctivitis
Viral
• Most common cause
• Produces a watery discharge
• Very contagious
• Usually lasts 7–14 days, but may last 2-3
weeks
• Adenoviruses - Most common causative
organism
• No longer contagious once tearing and
matting has resolved
Infection: Conjunctivitis
Viral - Interventions
• No specific treatment
• Warm compresses
• Antiviral medication – if caused by
viruses such as herpes simplex
or varicella-zoster
• Topical steroid drops
Infection: Conjunctivitis
Bacterial
• Has thicker usually yellow-green
discharge
• Very contagious
• More common in children than in
adults
• Occurs less often in children over the
age of 5.
Infection: Conjunctivitis
Bacterial - Common bacterial causative organisms
•
•
•
•
Staphylococcus aureus
Haemophilus species
Streptococcus pneumoniae
Pseudomonas aeruginosa
Infection: Conjunctivitis
• Interventions
• Warm or cool compresses
• Antibiotic eye drops or ointments
• Acetaminophen or Ibuprofen for pain
Infection: Conjunctivitis
Allergic
• Common Allergens & Irritants
Pollen from trees, plants, grasses, and weeds
• Dust mites
• Animal dander
• Molds
• Contact lenses and lens solution
• Cosmetics
• Swimming pool chlorine
• Smog
• Medications
•
Conjunctivitis
Allergic
• Improves when the allergen is removed
Interventions
• Cool compresses
• Artificial tears
• Non-steroidal anti-inflammatory medications
• Antihistamines/Allergy medications
• Topical antihistamine
• Vasoconstrictor eye drops
Infection: Conjunctivitis
• Neonatal
• Results from:
• Irritants
• Blocked tear duct
• Infection - Ophthalmia Neonatorum - a severe form that occurs
as a result of exposure to sexually transmitted infections (esp.
Chlamydia or gonorrhea) while passing through the birth canal.
• May lead to permanent eye damage unless treated immediately.
Infection: Conjunctivitis
• Education/Prevention
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•
•
•
•
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•
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Don't touch your eyes with your hands.
Wash your hands often.
Use a clean towel and washcloth daily.
Don't share towels or washcloths.
Change your pillowcases often.
Throw away your eye cosmetics, such as mascara.
Don't share eye cosmetics or personal eye care items.
Replace eye cosmetics regularly.
Wash pillowcases, sheets, washcloths, and towels in hot
water and detergent
• Stop wearing contact lenses while infected
• Use new disposable contacts or extremely clean hard
contacts once infection has cleared.
Infection: Resources
• http://www.mayoclinic.com/health/medical/IM02179
• http://www.nlm.nih.gov/medlineplus/ency/article/001010.ht
m
• http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002005/
• http://www.cdc.gov/conjunctivitis/
• http://www.aoa.org/conjunctivitis.xml
• www.nidcd.nih.gov/health/hearing/pages/earinfections.as..
• www.mayoclinic.com/health/ear-infections/DS00303
• http://www.healthychildren.org/English/healthissues/conditions/eyes/Pages/Conjunctivitis-Pink-Eye.aspx
• http://emedicine.medscape.com/article/994656-overview