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 MediaEustachian 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 MediaManifestations

• 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-benzocaine-

glycerin (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 MediaPost 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 MediaEducation• 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

PreventionInstitute 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: ConjunctivitisConjunctivitis (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: ConjunctivitisSigns 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: ConjunctivitisViral

•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: ConjunctivitisAllergic

• 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

• 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.htm• 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/health-issues/conditions/eyes/Pages/Conjunctivitis-Pink-Eye.aspx

• http://emedicine.medscape.com/article/994656-overview