Recurrence of Otitis Media

An 8-year-old girl comes to your ambulatory care clinic with complaints of left ear pain for the past 3 days. She had respiratory infection a week ago. On physical examination, the tympanic membrane is bulging.

Answer the following questions:

What else should you ask the client?

What teaching would you reinforce to prevent the recurrence of otitis media?

What expected outcomes would be specific to this situation?

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Questions to Ask the Client

1. Symptom Details:
   • Is the ear pain constant, or does it come and go?
   • Does the pain worsen at any particular time of the day or in certain positions?
   • Have you noticed any discharge from the ear?
   • Has there been any recent fever?
2. Hearing and Sensation:
   • Have you experienced any hearing loss or difficulty hearing in the affected ear?
   • Is there any ringing or buzzing in the ear?
3. Other Symptoms:
   • Are you experiencing headaches, dizziness, or nausea?
   • Have you had any recent changes in appetite or sleep patterns?
4. History:
   • Have you had any previous episodes of ear infections?
   • Do you have any known allergies?
   • Have you been exposed to secondhand smoke?
5. Current Medications and Treatments:
   • Are you taking any medications for your symptoms? If so, what are they?
   • Have you used any over-the-counter ear drops or remedies?

Teaching to Prevent Recurrence of Otitis Media

1. Proper Hygiene:
   • Encourage regular handwashing to prevent the spread of respiratory infections that can lead to otitis media.
2. Avoid Secondhand Smoke:
   • Explain the importance of avoiding exposure to tobacco smoke, as it can increase the risk of ear infections.
3. Manage Allergies:
   • If the child has known allergies, ensure they are well-managed with appropriate medications to reduce the risk of ear infections.
4. Ear Protection:
   • Advise keeping ears dry during swimming or bathing to avoid water entering the ear canal, which can lead to infections.
5. Vaccinations:
   • Reinforce the importance of staying up-to-date with vaccinations, particularly the flu vaccine and pneumococcal vaccine, which can reduce the risk of respiratory infections that can lead to otitis media.

Expected Outcomes

1. Symptom Relief:
   • The patient reports a decrease in ear pain within 48-72 hours after starting appropriate treatment.
2. Infection Resolution:
   • The tympanic membrane returns to a normal appearance (no bulging) within 7-10 days of treatment.
3. Hearing Preservation:
   • The patient experiences no further hearing loss and reports normal hearing function after the infection resolves.
4. Prevention of Recurrence:
   • The patient and family demonstrate understanding of preventive measures, such as avoiding secondhand smoke and managing allergies, leading to a reduced incidence of future ear infections.