Overview
Otitis media is a group of infectious diseases accompanied by inflammation, which affects the middle ear (Qureishi, Lee, Belfield, Birchall, & Daniel, 2014). This condition could be caused by various infection agents:
- respiratory viruses (rhinoviruses, coronaviruses, bocaviruses, and metapneumoviruses) (Nokso-Koivisto, Marom, & Chonmaitree, 2015).
- bacteria from the respiratory tract (Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus, and Streptococcus pyogenes) (Qureishi et al., 2014).
- fungus (Candida albicans and Aspergillus niger) (Patel, Shrimali, & Thakor, 2016).
It is estimated that bacterial agents are the most common causes of otitis media, followed by viruses. Fungal infection is not frequent; however, it is possible (Nokso-Koivisto et al., 2015).
Otitis externa is an infection of the external ear canal, including pinna and/or tympanic membrane. Generally, it is a bacterial infection caused by Pseudomonas aeruginosa and Staphylococcus aureus (Rosenfeld et al., 2014). In the case of diabetic, immunocompromised, and elderly patients, a severe necrotizing otitis external could appear (Glikson, Sagiv, Wolf, & Shapira, 2017).
According to Rosenfeld et al. (2014) and Qureishi et al. (2014), common symptoms of ear infections are:
- ear pain and discomfort;
- hearing decline or loss;
- fever;
- pus discharge;
- the fussiness of young children.
The diagnosis should be based on the health history and physical examination.
Essential Health History
Ear infections are more frequent in children than in adults. Thus, children’s health history is usually based on their parents’ words (Uitti, Laine, Tähtinen, Ruuskanen, & Ruohola, 2013). According to Qureishi et al. (2014), an essential health history should include the following questions:
- the list of complaints;
- the duration of symptoms;
- hearing decline or loss presence;
- fever presence;
- parents’ description of children’s behavior;
- in children: poor attention, speaking difficulties presence;
- associated diseases presence: ARVI, influenza, dental inflammation, and others.
However, it is important to mention that symptoms and complaints could significantly vary among different patients (Uitti et al., 2013). Thus, it is important to provide a precise physical examination.
Physical Exam Findings
Myringotomy with the ear fluid analysis is considered to be the gold standard for these diseases diagnosis. However, visual diagnostic criteria are widely used with the purpose to avoid surgery (Qureishi et al., 2014). According to the authors, in the case of otitis media, physical examination findings might be the following:
- mild tympanic membrane bulging;
- intense membrane erythema or abnormal color;
- middle ear pus effusion;
- mobility of ear drum.
Rosenfeld et al. (2014) postulated the following results of patients with otitis externa examination:
- tenderness of tragus or/and pinna;
- ear canal erythema;
- ear canal edema;
- possible cellulitis of the pinna and adjacent skin;
- possible tympanic membrane erythema.
Assessment
Adults and children older than one year are checked in a similar way. An otoscope is held in one hand, and another hand is used for the outer ear moving up and back. This movement makes the ear canal straighter. In the case of children younger than one year, the outer ear should be gently moved down and back. Then, an otoscope should be carefully inserted into the canal. A physician should not move a tool without looking at it. It is also important to remember that skin inside the canal is sensitive. Therefore it is better to avoid putting pressure on it. A hand with an otoscope could be held on a baby’s face. In this case, it will move simultaneously with a spontaneous head movement, which might prevent a possible trauma (“How to use an otoscope,” n.d.).
References
Glikson, E., Sagiv, D., Wolf, M., & Shapira, Y. (2017). Necrotizing otitis externa: Diagnosis, treatment, and outcome in a case series. Diagnostic Microbiology and Infectious Disease, 87(1), 74-78. Web.
How to use an otoscope. (n.d.). Web.
Nokso-Koivisto, J., Marom, T., & Chonmaitree, T. (2015). Importance of viruses in acute otitis media. Current Opinion in Pediatrics, 27(1), 110-115. Web.
Patel, K. N., Shrimali, G. P., & Thakor, N. (2016). A study of fungi isolated from cases of otitis media diagnosed at tertiary care hospital of Gujarat, India. International Journal of Advances in Medicine, 3(4), 832-834.
Qureishi, A., Lee, Y., Belfield, K., Birchall, J. P., & Daniel, M. (2014). Update on otitis media–prevention and treatment. Infection and Drug Resistance, 7, 15-24.
Rosenfeld, R. M., Schwartz, S. R., Cannon, C. R., Roland, P. S., Simon, G. R., Kumar, K. A.,… Robertson, P. J. (2014). Clinical practice guideline: Acute otitis externa executive summary. Head and Neck Surgery, 150(2), 161-168. Web.
Uitti, J. M., Laine, M. K., Tähtinen, P. A., Ruuskanen, O., & Ruohola, A. (2013). Symptoms and otoscopic signs in bilateral and unilateral acute otitis media. Pediatrics, 131(2), 398-405. Web.