otitis media, an inflammation or infection of the middle ear, common in early childhood. Acute otitis media is most often caused by Haemophilus influenzae, Moraxella catarrhalis, or Streptococcus pneumoniae. Chronic otitis media is usually caused by gram-negative bacteria such as Proteus, Klebsiella, and Pseudomonas. Allergy, Mycoplasma, and several viruses also may be causative factors. Otitis media is often preceded by an upper respiratory infection. ▪ OBSERVATIONS: Organisms gain entry to the middle ear through the eustachian tube. The small diameter and horizontal orientation of the tube in infants predisposes them to infection. Obstruction of the eustachian tube and accumulation of exudate may increase pressure within the middle ear, forcing infection into the mastoid bone or rupturing the tympanic membrane. Symptoms of acute otitis media include a sense of fullness in the ear, diminished hearing, pain, and fever. Usually only one ear is affected. Squamous epithelium may grow in the middle ear through a rupture in the tympanic membrane; development of a cholesteatoma and hearing loss may occur if repeated infections cause an opening to persist. Pneumococcal otitis media may spread to the meninges. ▪ INTERVENTIONS: Treatment includes antibiotics, analgesics, local heat, nasal decongestants, needle aspiration of secretions collected behind the membrane, and myringotomy. ▪ PATIENT CARE CONSIDERATIONS: Parents are taught to recognize and watch for early warning signs of otitis media. The use of vaporizers and decongestants is often recommended during an upper respiratory tract infection as prophylaxis against otitis media. Chronic otitis media may result in hearing loss and delays in speech development.
