Infection: Otitis Media and Conjunctivitis

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 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

9. 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)

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 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.

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 MediaPrevention 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

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

25. 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

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 • 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