Analysis and Evaluation the Care: Otitis Media - Essay Example

Introduction Otitis media is referred to as the inflammation of the middle ear (Bluestone and Jerome 4). The illness can be diagnosed in various phases depending on patient’s health and the stage of the inflammation (Block and Christopher 47). Medical research has assisted in the decision-making processes on the symptoms, treatment and after care procedures that should be administered to patients. In Depth Evaluation on the Decision Making Process Required Diagnosing Otitis Media The decisions depend on various determinants and can be made by the doctors or patients. The factors include the stage of the otitis media, the age of the patient, and the symptoms registered in a patient. Currently, decision-making processes have to be approved by the patient due to the consequences that may arise during treatments. As for otitis, the decisions have to be controlled by the doctor due to the various determinants. Additionally, the doctors use the factors to assist the patients on the decisions they can make on their treatment. Notably, previous research has simplified decision-making processes by having connection between symptoms and specific treatment methods that can be applied. Acute otitis media (AOM) – it is caused by blockages in the Eustachian tube due to poor drainage and ventilation of the inner and middle ear cavity (Rosenfeld 102). It does not take long, and its symptoms are short-term. The symptoms include increased temperature, nausea, ear ache and irritability among others. However, they may vary based on age body resistance. Chronic otitis media – it involves the entry of bacteria into the middle ear leading to infections (Bluestone and Jerome 103). The excreted fluid may cause conductive hearing loss and takes place after a period of more than three months. It is also referred to as the glue ear. Chronic suppurative otitis media – it is also referred to as the runny ear due to the presence of an opening in the eardrum. There is consistent discharge of fluids that may affect the inner bones (Bluestone and Jerome 5). This stage may lead to permanent hearing loss if treatment is not administered. Factors affecting decision-making in the diagnosis process Age is a factor affecting the choice of diagnostic approaches (Block and Christopher 56). Otitis media is commonly found in children below the ages of ten (Bluestone and Jerome 4). Moreover, the approach styles in children are different from those in adults. For example, an adult can explain in detailed the symptoms that he/she is undergoing; hence making it easy for the decision-making process. Children will have different diagnosis styles whereby the doctor will have to carry out tests and monitoring in order to make decisions on whether the illness is an infection or otitis media. Consequently, the age will also affect decisions while issuing treatment. Time also affects the decision-making processes due to the incubation period (Block and Christopher 40). Adult patients may take longer before noticing symptoms due to assumptions that the disease is a minor ear infection. Time affects the stage of the otitis media ranging from mild to chronic. The longer the period a patient takes without medication reflects a persistent ear inflammation. The stage of the illness will also affect the decisions made by patients and doctors. The stages can also be used to refer to the different types of otitis media Symptoms The diagnosed symptoms have direct impacts on the decision-making process of the patient. Individuals register various symptoms depending on the age, health and resistance issues. Children are likely to present otitis media signs at a faster rate compared to the adults. Children require rational decisions due to the impacts caused by the symptoms. However, there are prevailing symptoms that can be found in both patients despite the determinants such as fever, difficulties in sleeping, pain, loss of balance and hearing difficulties. Diagnosis After the symptoms have been registered, the doctors make decisions on the different diagnosis approaches. An otoscope is used to observe inner parts of the ear. It is a lighted instrument; hence provides the doctor with a clear view of the ear. In case the doctor speculates presence of acute otitis media; he/she uses a pneumatic otoscope to blow small amounts of air to the eardrum. The process tests the eardrum movements; hence providing a detailed statement that will help in decisions for treatments. Tympanometry is also used to monitor changes in pressure between the inner, middle and outer ears. However, it is only suitable for adults due to the elimination of movement during the process. The method does provide data whether the patient has hearing problems. DETAILED KNOWLEDGE OF THE PATHO-PHYSIOLOGY OF PATIENT’S ILLNESS Otitis media patients register various conditions during and after the illness. The illness may register various symptoms depending on the approach of the infection. Most infections are caused by multi-factors ranging from environmental to genetic, to bacterial and viral infections among others. The causes may be direct or indirect. Cases of direct causes occur when the ear drum or Eustachian tube is affected by biological and environmental factors. Indirect cases are observed where other infections lead to the dysfunction of the Eustachian tube; hence triggering events for otitis media to take place (Rosenfeld 124). Eustachian Tube Function The tube contributes to most of the otitis media cases in children. It is horizontal, shorter and wider in infants; hence the cause for the increased rates. Most Eustachian tubes changes to adult mode at the age of seven. Their main physiologic roles are drainage, regulation of pressure and protection. However, the main function is regulation of pressure between the inner and middle ear. The pressure is from outside atmospheres and while moving of jaws and breathing. Infection process Otitis media can be caused by the Streptococcus pneumonia that is the commonly known bacterial pathogen. The bacteria were the first known causes of otitis media before other strains were discovered due to advanced technology. However, continued research revealed the virus such as influenza virus and adenovirus as major causes of the illness. Viral infections in children lead to upper respiratory tract mucosa that initiates a variety of events causing otitis. They include the swelling and congestion of the nasal passages and later the Eustachian tube (Block and Christopher 41). Consequently, the obstruction of the Eustachian tube leads to the accumulation of secretions in the middle ear. Viral infections on the other hand lead to effusion that contributes to the suppuration of acute otitis (Bluestone and Jerome 5). In most cases, the effusion lasts for longer periods until the infection resolves. A dysfunction in the Eustachian tube may cause differences in pressure that may fuel swelling of the middle ear. Secretions from the nasal nasopharynx may become infected with bacteria as it moves to the middle ear space. Viral infections may originate from common colds and other esophagus illnesses. Finally, the infections progress to different stages of the otitis media. Extreme cases include the perforation of a hole that leads to secretion of fluids from the infection. After-infection period Consequences of the Acute Otitis Media differ according to age differences. The young patients may lose their hearing ability if medical attention is not administered. The Eustachian tube is not in a position to maintain pressure differences between the atmosphere and the inner ears. Continued infection may lead to a change in the semi-circular canal that control the balance. Chronic otitis media may cause lack of balance in children due to the Eustachian tubes. Outcomes Membrane rupture happens during the perforation of an opening that causes the pus and secretions from the inner ear to drain to the cavities. The perforation may lead to the tear of the tympanic membrane if treatment is not administered. The flow of contaminated pus may cause infections in other parts of the ear. It may also cause accumulated pressure in the inner part of the ear causing the eardrum to rupture. The prolonged cases of chronic otitis media lead to hearing loss due to rupturing of the eardrum and the tympanic membrane (Bluestone and Jerome 6). Hearing loss may contribute to other factors in the development of children (Rosenfeld 126). It may lead to speech problems where children take long before learning how to communicate. Socially, otitis media may lead to poor academic performance, social skills and attention disorders. ANALYSIS AND EVALUATION OF CARE AND TREATMENT DELIVERED The treatment levels depend on the stage of the otitis media and the age of the patient. Since it is mostly found in children, the incubation period does not last for long before the symptoms are observed. Provided care also relies on the type of otitis media. The ear specialists should first weigh the symptoms because most of the acute otitis media in children does not require treatment. Such patients receive care due to external factors causing the illness. The acute disease may be triggered by a minor problem with the Eustachian tube. Treatment should depend on individual resistance or allergic reaction to the medications. However, for chronic illnesses, the doctor should administer treatment through various ways that include the following. Antibiotics An analysis on the seriousness of the symptoms shows that antibiotics are beneficial in children suffering from acute otitis media. They are mostly prescribed to children younger than two years classified as ‘bilateral acute otitis media patients’. The administration of the antibiotics depends on the symptoms, health and age of the children. For example, healthy children less than six months can also be prescribed to antibiotics. The antibiotics are used as counter measures for the bacterial infections in the inner and middle ear (Rosenfeld 127). High doses of amoxicillin are the widely used first line of antibiotic treatments. They include 80-90mg per day per kilogram of the body daily. The doses can last for ten days in children and five days in children older than six years. This treatment is safe, effective and inexpensive. Most doctors prefer its use because it does not react with body antigens. In the case of allergic reactions, the doctor can recommend a lactase inhibitor. Cases of chronic otitis media with discharge and secretions can be treated with topical antibiotics that are more powerful compared to regular ones. Topical quinolone antibiotics have proved to work better than oral antibiotics. The way of administration also matters in the treatment process. Oral antibiotics are not recommended in severe cases because they take long before absorption. Tympanostomy tube The tube is recommended for treatment of acute otitis media that has attacked a patient for more than four times in a year. The tube is inserted in the eardrum and reduces the recurrence rates in the chronic cases. However, this method has various complications such as otorrhea. It is the continuous discharge from the ear after the tube has been inserted. Alternative treatments Antihistamines may be used to treat nasal allergies and complications that prolong effusion of the middle ear. Nasal congestion may cause bacterial infections (Bluestone and Jerome 102). However, it can be treated using oral decongestants. It should be noted that the alternative treatments act as prevention strategies. They prevent the accumulation of bacteria and viruses in the nasal cavity that later lead to acute otitis media in children. The nasal infections may be caused by environmental factors such as cold and dust. Surgery may also be adopted in severe cases where the ruptured membranes are not responding to treatment. It also includes cleaning the discharge to prevent future infections. MANAGEMENT PLANS REFERENCES TO CURRENT RESEARCH Current research on otitis media has focused on children because of their vulnerability (Alper 166). However, there are fewer preventive measures for the illness. Additionally, most parents do not have access to the few measures (Rosenfeld 195). Otitis media originating from infections in the nasal cavities can be prevented through child cleanliness and attendance to other diseases such as flu. Environmental factors can be avoided, and research should be directed on these sectors to prevent most of the cases of acute otitis media. The research should also focus on technological advancements on tools of diagnosing the illness. Currently, the pneumatic otoscope is the widely used diagnostic tools. However, the research should also include other ultrasound imaging techniques. They will assist in analyzing activities in the inner and middle ears that are difficult to examine especially when patients are in pain. Faster treatment options also depend on research. Extensive medical research should be carried out to come up with faster healing methods. The techniques should also include the development of anti-viruses and immunizations that could be used to prevent otitis media (Alper 167). Conclusion Acute otitis media patients should be evaluated and monitored to prevent further persistence of the illness. Extreme care and rational approaches should be observed while diagnosis since most of the patients are children and may be suffering from other diseases with similar symptoms. Treatments should be administered with the help of a specialist. Finally, research will enhance studies of otitis media and come up with faster and efficient treatments. Works Cited Alper, Cuneyt T. Advanced Therapy in Otitis Media. Hamilton, Ont.: BC Decker, 2004. Print. Block, Stan L., and Christopher J. Harrison. Diagnosis and Management of Acute Otitis Media. 3rd ed. Caddo, OK: Professional Communications, 2005. Print. Bluestone, Charles D., and Jerome O. Klein. Otitis Media in Infants and Children. 4th ed. Hamilton: BC Decker;, 2007. Print. Rosenfeld, Richard M. Evidence Based Otitis Media. 2nd ed. Hamilton, Ont.: BC Decker, 2003. Print. Read More