Description
Respond to discussion below
Otitis Media
Pathophysiology
A child often has various body organs that are susceptible to infection. The eyes, ears, and mouth are the most common organs prone to infections in childhood; therefore, the parent or the healthcare providers should always check the children and ensure the health of these vital organs. The pathophysiology of otitis media often involves the inflammation of the middle ear, such that the changes range from acute, subacute to the chronic phase, where it causes irreversible damage to the middle ear
The changes in the early stages of this disease include lamina propria of the middle ear mucosa, increased permeability, edema, and leukocytic infiltration. Moreover, in the chronic phase, the patient may experience a shift in the population of infiltrating leukocytes that increase the numbers of mononuclear cells secreting substances that facilitate the destruction of tissues and fibrosis (De Corso et al., 2021). In the last stages, the granulation tissue matures, thus, becoming denser and less vascular, leading to permanent fibrosis and the formation of adhesions that compromise middle ear functions. Other problems associated with chronic otitis media are cholesteatoma, cholesterol cysts, and tymaponesclerosis, which are responsible for the permanent alterations of the middle ear structure.
Physical exam findings
The parents should always check and determine any anomalies in the ears of their children, especially at this age when the child cannot talk and address their concerns. In case of any anomalies, the parents should report to the doctors for a proper physical examination. The physical examination for otitis media will involve otoscopic examination to reveal the signs of this infection (De Corso et al., 2021). The examination will reveal erythema, bulging, cloud appearance, and immobility of the tympanic membrane.
A child with otitis media will have effusion from the ears. Moreover, the child may present partial hearing loss features, resulting from the buildup of fluid from the infected middle ear. Apart from effusion and partial hearing loss, a child with otitis media will always appear as usually sick, especially with low-grade fever and the common cold; however, if the otitis media is associated with effusion, the patient will always be well-appearing because it does not involve common cold symptoms.
Differential diagnoses and rationale
The differential diagnosis for any healthcare problem allows a healthcare provider to distinguish between the possible problems for every patient. The disorders and diseases may present similar or related signs and clinical manifestations; therefore, through a differential diagnosis, the healthcare provider will ventilate all the possible problems and remain with the exact cause or problem. Therefore, the differential diagnosis for otitis media includes otitis media with effusion, acute otitis media, tympanic membrane perforation, cholesteatoma, traumatic disruption of the ear ossicles, and hemotympanum (De Corso et al., 2021). the signs of otitis media with effusion include a nonpurulent effusion of the middle ear that may be mucoid or serous. A patient with otitis media with effusion may develop hearing loss; however, it does not involve pain or fever. On the other hand, a patient with acute otitis media will have pain and develop a fever.
Management plan to focus on pharmacotherapy agents based upon evidence-based practice guidelines
Depending on the type of ear infection, a physician can determine whether they can give antibiotics or leave the infection to go on its way (Hum et al., 2019). In the case of acute middle ear infections or secretory otitis media, the physician can provide no antibiotics and advise ear hygiene because they can go away without antibiotics.
References
De Corso, E., Cantone, E., Galli, J., Seccia, V., Lucidi, D., Di Cesare, T., … & Fetoni, A. R. (2021). Otitis media in children: Which phenotypes are most linked to allergy? A systematic review. Pediatric Allergy and Immunology, 32(3), 524-534. https://doi.org/10.1111/pai.13431
Hum, S. W., Shaikh, K. J., Musa, S. S., & Shaikh, N. (2019). Adverse events of antibiotics used to treat acute otitis media in children: a systematic meta-analysis. The Journal of pediatrics, 215, 139-143. https://doi.org/10.1016/j.jpeds.2019.08.043
