2. Infection: Otitis Media and Conjunctivitis
Benita Beard & Brenda Stepp
2013

3. Infection:
Otitis Media

4. Infection: Otitis Media
An inflammation of the middle ear, usually caused by bacteria, that occurs when fluid builds up behind the eardrum.

5. 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.

6. 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.

7. Infection: Otitis Media
Eustachian 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.

8. Infection: Otitis Media Manifestations
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

9. Infection: Otitis Media
Medical Interventions:
80% of all ear infections will improve without antibiotics
Observe for 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)

10. 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

11. Infection: Otitis Media Post 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.

12. Infection: Otitis Media
Education
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.

13. Infection: Otitis Media Prevention
Institute 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

14. Infection:
Conjunctivitis

15. Infection: Conjunctivitis
Conjunctivitis (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
Conjunctiva - the transparent thin layer of tissue that covers the inner eyelid and the white part of the eye.
Tears contain proteins and antibodies that kill bacteria. Tears help protect the conjunctiva by washing away bacteria.
Often begins in one eye and then infects the other eye

16. 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.

17. Infection: Conjunctivitis
Signs 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

18. Infection: Conjunctivitis
Types:
Viral
Bacterial
Allergic (including irritant)
Neonatal

19. Infection: Conjunctivitis
Viral
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

20. 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

21. 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.

22. Infection: Conjunctivitis
Bacterial - Common bacterial causative organisms
Staphylococcus aureus
Haemophilus species
Streptococcus pneumoniae
Pseudomonas aeruginosa

23. Infection: Conjunctivitis
Interventions
Warm or cool compresses
Antibiotic eye drops or ointments
Acetaminophen or Ibuprofen for pain

24. Infection: Conjunctivitis
Allergic
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
Possible Allergens
Pollen from trees, plants, grasses, and weeds
Dust mites
Animal dander
Molds
Contact lenses and lens solution
Cosmetics

25. Conjunctivitis Improves when the allergen is removed Cool compresses
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

26. 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.

27. 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.

28. Infection: Resources http://www.mayoclinic.com/health/medical/IM02179