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Acute Otitis Media-pathophysiology, symptoms, management, nursing management

Otitis media is an infection or inflammation of the middle ear usually caused by a viral or bacterial infection.

There are two types of middle ear infections

  • Acute otitis media usually follows a viral upper respiratory tract infection, such as a cold or flu.
  • Chronic otitis media is an ongoing middle ear infection that can occur after acute otitis media or because of a poorly healed ruptured eardrum

Pathophysiology otitis media


Acute otitis media is an acute infection of the middle ear, usually lasting less than 6 weeks. The primary cause of acute otitis media is usually Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis, which enter the middle ear after eustachian tube dysfunction caused by obstruction related to upper respiratory infections, inflammation of surrounding structures (eg, sinusitis, adenoid hypertrophy), or allergic reactions (eg, allergic rhinitis). Bacteria can enter the eustachian tube from contaminated secretions in the nasopharynx and the middle ear from a tympanic membrane perforation. A purulent exudate is usually present in the middle ear, resulting in a conductive hearing loss.

Clinical Manifestations

Some of the symptoms of middle ear infection include

  • Earache
  • Headache
  • Fever
  • Discharge from the ear
  • Mild deafness
  • Difficulties in sleeping
  • Loss of appetite

The symptoms of otitis media vary with the severity of the infection. The condition, usually unilateral in adults, may be accompanied by otalgia. On otoscopic examination, the external auditory canal appears normal. The patient reports no pain with movement of the auricle. The tympanic membrane is erythematous and often bulging.

Medical Management

The outcome of acute otitis media depends on the efficacy of therapy (ie, the prescribed dose of an oral antibiotic and the duration of therapy), the virulence of the bacteria, and the physical status of the patient. With early and appropriate broad-spectrum antibiotic therapy, otitis media may resolve with no serious sequelae. If drainage occurs, an antibiotic otic preparation is usually prescribed. The condition may become subacute (lasting 3 weeks to 3 months), with persistent purulent discharge from the ear. Rarely does permanent hearing loss occur. Secondary complications involving the mastoid and other serious intracranial complications, such as meningitis or brain abscess, although rare, can occur.

Surgical Management

Myringotomy or tympanotomy

An incision in the tympanic membrane is made and the tympanic membrane is numbed with a local anesthetic. The procedure is painless and takes less than 15 minutes. Under microscopic guidance, an incision is made through the tympanic membrane to relieve pressure and to drain serous or purulent fluid from the middle ear. Normally, this procedure is unnecessary for treating acute otitis media, but it may be performed if pain persists. Myringotomy also allows the drainage to be analyzed (by culture and sensitivity testing) so that the infecting organism can be identified and appropriate antibiotic therapy prescribed. The incision heals within 24 to 72 hours.

Ventilating tube

If episodes of acute otitis media recur and there is no contraindication, a ventilating, or pressure-equalizing, tube may be inserted. The ventilating tube, which temporarily takes the place of the eustachian tube in equalizing pressure, is retained for 6 to 18 months. The ventilating tube is then extruded with normal skin migration of the tympanic membrane, with the hole healing in nearly every case. Ventilating tubes are more commonly used to treat recurrent episodes of acute otitis media in children than in adults.


  • Encourage follow-up after treatment to ensure resolution.
  • Advise patient that sudden relief of pain may indicate tympanic membrane rupture. Do not instill anything in ear, and call health care provider.
  • Instruct patient to follow up for recurrence of symptoms, such as pain, fever, ear congestion.