NR 602 NEW UPDATED STUDY GUIDE LATEST SOLUTION, RATED A
Acute Otitis Media
AOM is an acute infection of the middle ear (Fig. 30-4). The AAP Clinical Practice Guideline requires the
presence of the following three comp
...
NR 602 NEW UPDATED STUDY GUIDE LATEST SOLUTION, RATED A
Acute Otitis Media
AOM is an acute infection of the middle ear (Fig. 30-4). The AAP Clinical Practice Guideline requires the
presence of the following three components to diagnose AOM ( Lieberthal et al, 2013):
• Recent, abrupt onset of signs and symptoms of middle ear inflammation and effusion (ear pain, irritability,
otorrhea, and/or fever)
• MEE as confirmed by bulging TM, limited or absent mobility by pneumatic otoscopy, air-fluid level behind
TM, and/or otorrhea
• Signs and symptoms of middle ear inflammation as confirmed by distinct erythema of the TM or onset of ear
pain (holding, tugging, rubbing of the ear in a nonverbal manner)
Characteristics of different types of AOM are defined in Table 30-4. AOM often follows eustachian tube dysfunction (ETD). Common causes of ETD include upper respiratory infections, allergies, and ETS. ETD leads
to 746functional eustachian tube obstruction and inflammation that decreases the protective ciliary action in
the eustachian tube. When the eustachian tube is obstructed, negative pressure develops as air is absorbed in
the middle ear (see Fig. 30-4). The negative pressure pulls fluid from the mucosal lining and causes an
accumulation of sterile fluid. Bacteria pulled in from the eustachian tube lead to the accumulation of purulent
fluid. Young children have shorter, more horizontal and more flaccid eustachian tubes that are easily disrupted
by viruses, which predisposes them to AOM. Respiratory syncytial virus and influenza are two of the viruses
most responsible for the increase in the incidence of AOM seen from January to April. Other risk factors
associated with AOM are listed in Boxes 30-1 and 30-2.
S. pneumoniae, nontypeable Haemophilus influenzae, Moraxella catarrhalis, and S. pyogenes (group A
streptococci) are the most common infecting organisms in AOM (Conover, 2013). S. pneumoniaecontinues to
be the most common bacteria responsible for AOM. The strains of S. pneumoniae in the heptavalent
pneumococcal conjugate vaccine (PCV7) have virtually disappeared from the middle ear fluid of children with
AOM ( Lieberthal et al, 2013). With the introduction of the 13-valent S. pneumoniae vaccine, the bacteriology of
the middle ear is likely to continue to evolve. Bullous myringitis is almost always caused by S. pneumonia.
Nontypeable H. influenza remains a common cause of AOM. It is the most common cause of bilateral otitis
media, severe inflammation of the TM, and otitis-conjunctivitis syndrome. M. catarrhalis obtained from the
nasopharynx has become increasingly more beta-lactamase positive, but the high rate of clinical resolution in
children with AOM from M. catarrhalis makes amoxicillin a good choice for initial therapy ( Lieberthal et al,
2013). M. catarrhalis rarely causes invasive disease. S. pyogenes is responsible for AOM in older children, is
responsible for more TM ruptures, and is more likely to cause mastoiditis.
Although a virus is usually the initial causative factor in AOM, strict diagnostic criteria, careful specimen
handling, and sensitive microbiologic techniques have shown that the majority of AOM is caused by bacteria or
bacteria and virus together ( Lieberthal et al, 2013)
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