History & Assessment


A thorough 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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Gently moving the pinna can help you differentiate between otitis externa and otitis media.
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