OTITIS MEDIA 2
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