Athorough patient history and physical assessment are required to develop a valid diagnosis. However, the focus of this course is the medical and surgical treatment of pediatric OM. Therefore the history & assessment will be restricted to only major points.
| History | Knowledge base | Nursing Assessment/Intervention |
| History of trauma to the ear? | Possible perforation of tympanic membrane or basilar skull fracture. | Check for discharge. Assess hearing deficit. |
| Does the child complain of ear pain? <2yrs. Pulling or rubbing the ear? | Pain can be related to external ear, middle ear or referred pain from another site | Gently move the pinna. Pain on movement of pinna is not usually associated with otitis media. Observe for discharge in canal. |
| Upper respiratory infection now or recently? Environmental allergies? | Oral, nasal, pharyngeal virus or bacteria can migrate along the eustachian tube. Virus infection can affect cilliary action and swelling causing obstruction and fluid build up in ME. | Check for nasal discharge, oropharyngeal redness. Nasal obstruction can cause fluid reflux into the eustachian tube. Decongestants are not shown to be effective! |
| Febrile? | Fever, irritability, pain are S&S of AOM | Take temperature. Have NSAIDs masked fever? |
| Vaccinations up to date? | Many vaccines require sequential dosing or boosters to develop immunity. |
Document immunization chronology. |
| Immunocompromised? | Normal symptoms of infection may be masked. Otitis can be life threatening. | Tympanocentesis may be required to accurately identify the organism(s). Expect atypical opportunistic species including fungi. |
| First episode? When was first? How many in last 6 mo.? Getting worse? Ever had surgery or tubes? | If 2 episodes by 1yr., child is "otitis prone"; will have twice the norm. | What meds have been used and which have worked? |
| Known Drug Allergies? | "Otitis prone" patients will have serial exposures to antibiotics. | Counsel importance of monitoring for true allergy symptoms. Assess level of parental understanding. |
| Ethnicity? | American indians & Inuits have the highest incidence of OM; blacks have the lowest incidence | Counsel regular medical evaluation during early years. Assess level of parental understanding. |
| Breast vs bottle fed? | Breast milk imparts enhanced resistance due to maternal antibodies. Bottle fed babies are often fed in a more horizontal position, while breast fed babies are held more vertical. | Counsel best feeding technique to avoid reflux. Assess level of parental understanding. |
| Gender? | Males have a higher incidence of AOM | Counsel regular medical evaluation during early years. Assess level of parental understanding. |
| Affected siblings? | Childen with affected siblings are at higher risk. | Counsel regular medical evaluation during early years. Assess level of parental understanding. |
| History of cranial/facial defects? | Defects can cause tube dysfunction (Trisomy 21, cleft palate, etc.) are "otitis prone" | Examine palate, uvula, ear placement |
| Exposure to secondhand smoke? | Secondhand smoke is a known risk factor for ear infections. | Counsel improving child environment. Assess level of parental understanding |
| Hearing loss? Sudden (trauma) or progressive loss? | Middle ear fluid, perforation, liver or kidney disease, inutero exposure to: rubella, syphilis, cytomeglovirus,ototoxic meds, birth hypoxia, mumps,measles and persistent high fever can all negatively affect hearing. | Assess for hearing deficit, age appropriate language skills. |
| Child enrolled in group day care >6 children? | 50% increase in repeated infections. | Counsel regular medical evaluation during early years. Assess level of parental understanding. |
| Familial History? | Additional hereditary links are being sought. | Counsel regular medical evaluation during early years. Assess level of parental understanding. |
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