OTITIS MEDIA 2

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Antibiotics, antifungals, antivirals Nutrition, fluids and supportive cares

Treatment for INFECTION

Acute Otitis Media (AOM) - Otitis Media with Effusion (OME) Chronic Otitis Media with effusion - OME Otitis Externa

Types of Otitis Media

URI- Upper Respiratory Infection

______________frequently precedes acute OM. Or, OM occurs after URI

CULTURE & SENSITIVITY

____________send sample to identify wht bacteria are, & ________what medication to treat it

Antibiotic Resistance- Untreated or Unresponsive Infection Shock Inflammatory Response Compromise- Renal, Respiratory, Multisystem Failure

ISSUES with Infection

1) Physical barriers to infection- skin, mucous membrane, gastric acid, cilia 2) Cells of the immune system

Immune system response-Intruder Alert! - Players within the immune system:

Immunoglobulins

In the serum we have IgA, IgD, IgE, IgG, IgM and complements; IgG is the longest living IgA is prominent in openings from the environment

TIMING of DOSES and the LENGTH of TIME they continue to take the drug

It has proved to be difficult to convince people who are taking anti-infective drugs that the _______________&________________ are important.

Children >2 yrs old with no acute symptoms - wait for spontaneous resolution Antibiotic therapy Analgesics - antipyretic therapy Heat/cold - warm compress outside ear Myringotomy Position on AFFECTED side to promote DRAINAGE Family Education

MANAGEMENT OF OTITIS MEDIA

haemophilus influenza streptococcus pneumoniae

MOST COMMON CAUSATIVE agents for OM ear infection

Lymphocytes -

MVP of the immune system

Fever, chills, fatigue Weakness, redness, drainage from a wound Swelling, tenderness, pain Red streaks leading away from an injury- (IV site infected) Shock - increaed RR, HR, decreased bp, cadiac dysrrhtymia, cool, clammy skin

Manifestations of Infection

emergence of resistant strains

Many people stop taking a drug once they start to feel better and then keep the remaining pills to treat themselves at some time in the future when they do not feel well. This practice favors the _____________________

increased RR, HR decreased bp cardiac dysrrhymtia cool, clammy skin

SIGNS of SHOCK

BASOphils

STIMULATES the inflammatory response including the MAST CELLS & RELEASE of HISTMINE

visual inspection of TM

TM may be dull or opague, bulging, and red; sometimes pus is visible signs of fluid in the middle ear; inflammation immobile eardrum on inspection of canal

MYRINGOTOMY

TUBES for CHRONIC OM- EAR INFECTION

factor that can exacerbate this fluid accumulation in inner ear

bottle propping

implication of chronic otitis media

chronic otitis media is most frequent cause of conductive hearing loss in small children

reason for hesitance of antibiotic therapy

contributes to drug-resistant pathogens don't want to give antibiotics if it is viral and a fluid sample cannot be obtained unless the ear drum ruptures so the use of antibiotics depends on age, stage of infection, and/or number or ear infection

antibiotic therapy

depends on child's AGE, TIMING, PHASE in the infection process, if 1st ear infection or RECURRENT ear infection

AGRANULOCYTES- monocytes, macrophages

do not have the enymes to break down microorganims

CONDUCTIVE HEARING LOSS

fluid accumulates in inner ear space and affects their ability to hear and to speak

CHRONIC OTITIS MEDIA w/ EFFUSION (OME)

lasting longer than *3 MONTHS*

ACUTE OTITIS MEDIA (AOM)

acute infectious process of the MIDDLE ear that may produce a *RAPID ONSET* of ear pain and possibly *FEVER*

acute otitis media (AOM)

acute infectious process of the middle ear that may produce a rapid onset of ear pain and possibly fever

cause of effusion

after healing, fluid can remain behind the ear drum (OME) for several months due to the position of the Eustachian tubes which can lead to repeated episodes (COME)

GRANULOCYTES-

release enzymes capable of killing microorganisms & digest the debris thru phagocytosis

TRUE

we do not want to wait until the tympanic membrane ruptures

LYMPHOCYTES- B cells, T cells

-primary cells of IMMUNE RESPONSE - MVP

PARASITIC (protozoa)

-usually get from water- contaminated, soiled -places water stagnant

VIRUS

-work by BLOCKING the cell's ability to correctly replicate -damage the DNA replication process -inhibits the cell's metabolic processes

IgE

EOSINOPHILS - induced by

- acute infection -inflammation -malignancies -physiologic stresses -pregnancy

ESR- Erythrocyte Sedimentation Rate can be caused by: ______________

1) TRAVEL PRIOR to outward signs/symptoms (s/sx) of infection 2) Poor HAND HYGIENE 3) VACCINES!!! (or lack of) 4) ACQUIRED in health care setting 5) Characteristics of the infected host - Immunocompromised; chronic disease; environment; age; socioeconomic status 6) ANTIBIOTIC RESISTANCE

Factors Effecting Spread of Disease

when is antibiotic therapy indicated

*children under two* *recurrent ear infections* along with myringotomy

BACTERIA

- cause infection by: attacking the OUTSIDE of host cell OR from WITHIN the host cell

Around-the-clock dosing

- eliminates the peaks and valleys in drug concentration and - helps to maintain a constant therapeutic level to prevent the emergence of resistant microbes during times of low concentration

ANTIBIOTIC RESISTANCE

- happens a lot of times to CYSTIC FIBOSIS pts (mucus sits on bases of lungs forever) bacteria constanly replicating to fight antibiotic given to them

VIRUS

- has nucleic acid -require a host to reproduce/duplication

CRP-

- indicator of INFLAMMATION -might mean or might not MEAN an infection

BACTERIA

-can release TOXIN fro outside of cell , or attack the host from within

NEUTROPHILS

-chief phagocytes for early inflammation -FIRST RESPONDERS - MOST PLENTIFUL

EOSINOPHILS

-ingest the antigen-antibody complexes -induced by IgE

ORAL AMOXICILLIN ; 10-14 days

ANTIBIOTIC used for OM

Otitis Media EFFUSION

After clearance of the infection, fluid remains in the middle ear space behind the tympanic membrane, sometimes for several months called _______________ (OME). This may occur because of the positioning of the Eustachian tubes, resulting in difficulty in draining fluid back to the nasopharyngeal area. OME may also occur because of the high frequency of upper respiratory infections in infants and young children, which again result in back-up of fluid from the nasopharyngeal area.

SUPERINFECTION

An infection that develops SECONDARY to another treated infection e.g. YEAST INFECTION from ANTIBIOTICS

diarrhea

Antibiotics KILL HEALTHY CELLS in intestines, causing

NORMAL FLORA

Antibiotics are NOT always specific to the type of bacteria that they attack, so they may attack the___________________________ of the host body system

short length and horizontal positioning of the Eustachian tube (smaller & flatter)- bottle propping limited response to antigens, lack of previous exposure to common pathogen

CAUSES for Increased susceptibility in infants and young children:

CONDUCTIVE HEARING LOSS

CHRONIC OTITIS MEDIA- most FREQUENT cause of ______________________ in small children

Irritability tugging at the ears Verbalized pain- from pressure Fever - 104 F cervical lymphadenopathy- swollne behimd ear to neck base of neck lots of URI sx- runny nose loss of appetite- chewing food aggravates the pain vomiting diarrhea difficulty sleeping cannot get head comfortable- repositing head a lot

CLINICAL MANIFESTATIONS of OM Otitis Media

*Hearing loss* Expressive speech delay Tympanosclerosis (scarring of the tympanic membrane; usually has no effect on hearing) Chronic otitis media (chronic drainage via perforation or tympanostomy tubes) mastoiditis (infection of the mastoid process) Intracranial infections, including bacterial meningitis and abscesses Tympanic membrane perforation (acute with resolution or chronic)

COMPLICATIONS of OTITIS MEDIA- ear infecitons

6-10 hrs

CRP C Reactive Protein: appears______________ after

48-72 hrs

CRP- C Reactive protein- peaks in ____________hrs

Monocytes - (Pac-man) macrophages, phagocytes; Includes basophils, eosinophils neutrophils (most plentiful)

Cells:

moist, warm dextrose-sugar- to reproduce

Characteristics of host to multiply bacteria::

Immunocompromised; chronic disease; environment; age; socioeconomic status

Characteristics of the INFECTED HOST-( factors spread of disease )

bacteria viral fungal Parasitic- protozoan

Classification of Pathogens

high enough; long enough

DRUG DOSING: Doses should be____________ and the duration of drug therapy should be _______________ to eradicate even slightly resistant microorganisms.

Culture and Sensitivity (C&S) C-Reactive Protein (CRP) Erythrocyte Sedimentation Rate (ESR) Complete Blood Count (CBC) Radiography

Diagnostics for INFECTION:

risk factors

Eustachian tube dysfunction; size and shape recurrent *upper respiratory infection* age, day care attendance (increases susceptibility to viruses causing URI) *diagnosis of OM before 3 months of age* craniofacial abnormalities (cleft palate) poor nutrition *passive smoking* (secondhand smoke) immunocompromise

smoking arthritis cardiovascular, peripheral disease hypertension

FACTORS affecting CRP level

risk of HEARING LOSS possible temporary hearing issues until infection resolves behavioral changes preventing recurrence- tubes, hand hygiene, daycare practices

FAMILY EDUCATION for OM includes:

yeast mold mushrooms

FUNGI includes:

antibiotics tubes- MYRINGOTOMY

GUIDELINES for RECURRING ear infections for OVER 2 yrs old

VIRUS

HARDER to treat

DRUG DOSING making sure using the correct antibiotic for the bacteria they have-SENSITIVITY (LAB) providing educatin to pt & families

HOW TO PREVENT ANTIBIOTIC RESISTANCE

bacteria & virus

OM ear infection is caused by either__________________

positioning of the Eustachian tubes

OME (EFFUSION) may occur because of th_______________ , resulting in difficulty in draining fluid back to the nasopharyngeal area.

chronic otitis media with effusion (COME)

OME lasting longer than 3 months

high frequency of upper respiratory infections (repeated severe URI)

OME may also occur because of the ____________________ in infants and young children, which again result in BACK-UP OF FLUID back-up of fluid from the nasopharyngeal area.

wait for SPONTANEOUS RESOLUTION

OTITIS MEDIA: Children >2 yrs old with NO ACUTE SX - no antibiotics -unless they RUPTURE, it's hard to get fluid sample; hard to know if it's viral or bacterial

types of otitis media

Otitis Media (OM) Acute Otitis Media (AOM) Otitis Media with Effusion (OME) Chronic Otitis Media with Effusion (COME) Otitis Externa (OE)

FECAL-ORAL

PARASITIC/FECAL-spread thru______________ route -not washing hands very well

VIRUS

PRESENCE of SX: not QUICK ACTING e.g. HIV, Shingles, Herpes

Pathogen must ENTER the host Host must be SUSCEPTIBLE to the pathogen Host provides a RESERVOIR Host must have a PORTAL OF EXIT Mode of TRANSMISSION ENTRY POINT on host

Process of INFECTION

TRUE

Q8 hrs is different from TID

Eustachian tube dysfunction; size and shape Susceptibility to recurring upper respiratory infection Age, day care status, craniofacial abnormalities Poor nutrition, *passive smoking* (SECOND HAND smoke); immunocompromised *OM diagnosis prior to 3 months of age*

RISK FACTORS of OTITIS MEDIA

IgM

The first immunoglobulin released which contains the antibodies produced at first exposure to the antigen.

dull or opaque, bulging and red; sometimes PUS visible Signs of FLUID in the middle ear: INFLAMMATION IMMOBILE EARDRUM on inspection of canal

VISUAL INSPECTION of TYMPANIC MEMBRANE

spontaneoulsy

Viral OM ear infections resolve ____________ - antibiotics do NOT help

WBC increase

WBC start to respond immediately to foreign invaders; go directly to site of involvement -______________________ when there' infection

therapeutic management

antibiotic therapy if indicated analgesics; antipyretics heat/cold myringotomy in chronic cases position on affected side to promote drainage family education

ANTIBIOTIC RESISTANCE

bacteria becoe UNRESPONSIVE to specific antibiotic

E.coli

bacteria that are helpful in small quantities

SUPERINFECTION

bacterial infection as a result of treating a viral infection

age of 6 - 46

best years of your INNATE IMMUNITY; strongest immune system

when is the immune system strongest

between 6 and 46

VIRUS

body cans still fight the virus once it has invaded the host cell; in order to defeat the virus, the host cell dies

FUNGI

can be DEADLY in an IMMUNOCOMPROMISED person.

ANTIBIOTIC RESISTANCE

can be either ACQUIRED or NATURAL

PARASITIC (protozoa)

can invade individual ORGANS & cause dysfunction in its ability to work in its usual healthy manner

TRUE

ear drum will heal on its own, appear normal other than the drainage heal spontaneulsy and cause no more prob for the child

Around the clock dosing

every 8 hrs

C.Diff mrsa

ex. superinfections - most of SUPERINFECTION can be prevent by hand hygiene

reason OM often occurs after URI

fluid and pathogens travel upward from the nose into the nasopharyngeal passage and into the middle ear and the short, flat Eustachian tubes can't drain the fluid inside the Eustachian tubes, bacteria/virus comes into contact with mucous, providing a warm, moist, dark environment for replication

OTITIS MEDIA with EFFUSION (OME)

fluid in the middle ear space *WITHOUT* symptoms of infection

otitis media with effusion (OME)

fluid in the middle ear space without symptoms of infection

conductive hearing loss

fluid in the the ear doesn't allow for the conduction of sound - may also lead to speech pathologies since they hear things differently

common complications

hearing loss expressive speech delays chronic otitis media mastoiditis intracranial infection (meningitis, encephalitis)

T-Cells -

help ORGANIZE the plan of attack, SNIPERS of the immune system, CLEAN UP THE MESS with the battle is over

EOSINOPHILS

help control inflammatory processes

Fluid and pathogens travel upward from the nasopharyngeal area, invading the middle ear space. A viral upper respiratory infection may cause AOM or may place the child at risk for bacterial invasion. Pathogens gain access to the Eustachian tube, where they proliferate and invade the mucosa. Fever and pain occur acutely. Increased pressure behind the tympanic membrane may result in perforation. This may result in decreased pain and yield drainage in the ear canal. Most perforations heal spontaneously and are completely benign.

how URI cause OM ear infections

do we wait for rupture

ideally, we don't want to wait for rupture due to associated pain so early dx is key

FUNGI

in the healthy person, __________________ are part of the body's NORMAL FLORA

pain goes away; quick relief of pain, and see drainage

inceased pressure in the ear drum cause it to rupture: what happens when ear drum ruptures?

spontaneous rupture of the ear drum

increased pressure inside of the ear can cause rupture that results in relief of pain and drainage of the fluid usually followed by spontaneous healing

OTITIS EXTERNA

inflammation of the *EXTERNAL* ear canal

OTITIS MEDIA - (OM)

inflammation of the *MIDDLE EAR* with presence of *FLUID*

otitis externa (OE)

inflammation of the external ear canal

otitis media (OM)

inflammation of the inner ear with the presence of fluid

AGRANULOCYTES- monocytes, macrophages

ingest DEAD/ defective host cells particularly BLOOD CELLS

what is a myringotomy

insertion of tubes into TM to drain fluid usually performed in chronic cases

clinical manifestations

irritability; pulling at the ears fever (low-grade or as high as 104) verbalized pain ("owie" or "hurts") swelling behind ears and around neck sx of URI runny nose or fluid draining from ears loss of appetite vomiting or diarrhea difficulty sleeping inability to get head in comfortable position (rolling head from side to side)

IgD

is another identified immunoglobulin whose role has not been determined.

Drug dosing

is important in preventing the development of resistance.

IgE

is present in small amounts and seems to be related to allergic responses and to the activation of mast cells.

IgA

is prominent in openings from the environment found in tears, saliva, sweat, mucus, and bile. It is secreted by plasma cells in the GI and respiratory tracts and in epithelial cells. These antibodies react with specific pathogens that are encountered in exposed areas of the body.

IgG

is the longest living immunoglobulin contains antibodies made by the memory cells that circulate and enter the tissue; most of the immunoglobulin found in the serum is

treatment for Otitis media

is the most common cuase of antibiotic use in ambulatory settings; thus contribute to DRUG RESISTANT PATHOGENS

B-Cells -

memory cells; release immunoglobulins

CHRONIC OTITIS MEDIA- OM

most FREQUENT case of CONDUCTIVE HEARING LLOSS

viral

most OM ear infections are_____________________

Eustachian tube dysfunction susceptibility to recurrent upper respiratory infections.

most significant RISK FACTORS for otitis media: are

etiology: viral vs bacteria, causative agents, and time of year

mostly viral (resolves spontaneously) but can be bacterial most common causative viral agents include Haemophilus flu and Streptococcus pneumoniae most common occurrence is winter

FUNGI

not as common as bacteria & viruses may be SINGLE-CELLED or MULTICELLULAR, or COLONIES

UNDER 2 yrs old- infants with acute sx of FEVER & PAIN

often treat with ANTIBIOTICS; EVEN if it's VIRAL!

type of antibiotic therapy

oral amoxicillin for 10-14 days

diagnostic evaluation

quick onset of sx visual inspection of TM

ESR- Erythrocyte Sedimentation Rate

rate at which blood cells settle in unclotted blood in a test tube -measure in mm / hr -non specific

EOSINOPHILS

responders in HYPERSENSITIVITY reactions

what is included in family education

risk of temporary loss of hearing until resolved

pathophysiology

shorter and flatter Eustachian tubes make it harder for fluid and bacteria/virus to drain; commonly is preceded by upper respiratory infection

BACTERIA

single-celled organisms WITHOUT a TRUE NUCLEUS - require a HOST to REPRODUCE

ESR- Erythrocyte Sedimentation Rate

something is binding to erythrocyte that's causing it to be heavier and affect the rate that it sinks to the bottom of the tube

STAGE of INFECTION

tell which WBC is higher at which point of infectious process

INFECTION

the presence and multiplication of a microorganism within another living organism, with subsequent injury to the host"

fungal infections

thrush, ringworm, yeast infection, athletes foot -easier to treat

PARASITIC (protozoa)

usually infect IMMUNOCOMPROMISED

CBC

vary in ranges from NEWBORN to ADULT

reason for increased susceptibility in children

young age causes limited antibody response


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