PATHOPHYSIOLOGY

A. Etiology I. Predisposing Factors Factors Age Present Mechanism/ Justification Children younger than 10 years, and especially between the ages of six months and two years, are most commonly affected.There are two reasons for the increased risk in infants and young children. First, the eustachian tube is shorter, more horizontal, and wider in this age group than in older children and adults. Second, the infection can spread more easily through the eustachian canal of infants who spend most of their day lying supine. Bottle-fed infants have a higher incidence because they are held in a more horizontal position during feeding, and swallowing while in the horizontal position facilitates the reflux of milk into the middle ear. Gender Race Boys tend to get ear infections more often than girls. The incidence is found to be higher among Canadian and Alaskan Eskimos, and Native Americans specifically because it is more common during the winter months, reflecting the seasonal patterns of upper respiratory tract infections. Hereditary The tendency to get ear infections can be hereditary (runs in the family). (Ehrlich, G. and Post, J.,2002)

II. Precipitating Factors

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Factors

Presen t

Mechanism/ Justification

Bacterial or viral infection of the throat, oropharynx and respiratory system

The eustachian tubes are open to the oropharynx. Bacteria and viruses can travel more easily to the middle ear, causing inflammation and infection. Some of the most common bacteria to cause this infection are Streptococcus pneumoniae, Haemophilus influenzae and moraxella catarrhalis.

Blockage of the eustachian tube

This obstruction can be a result of swollen tonsils or adenoids or problems involving the bones of the cranium, the temporomandibular joint (located at the jaw) or the cervical spine. The Eustachian tube normally prevents the accumulation of fluid by allowing fluid to drain through the tube. If there is bloackage, fluid cannot flow and this will often become contaminated with bacteria. Therefore, anything that disturbs the function of the Eustachian tube can lead to chronic otitis media.

Allergy

Studies have shown that food and airborne allergies can cause otitis media. Allergies cause inflammation of the nasal passages and upper respiratory tract, which can cause blockage of the Eustachian tube or enlargement of the adenoids.

Chronic illnesses

People with chronic illnesses are more likely to develop ear infections, especially patients with immune deficiency and chronic respiratory disease, such as cystic fibrosis and asthma.
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Nutritional deficiency

Researchers have found that people with vitamin A, zinc and iron deficiencies are more susceptible to upper respiratory and ear infections. Additionally, large amounts of prostaglandins (fatty acids found naturally in all people) and leukotrienes may also play a part.

Trauma

If the ear is struck directly or if an object (such as a bobby pin, Q-tip, or stick) is pushed too far into the ear canal, this may precipitate the patient to bacterial invasion and inflammation of the middle ear.

B. Symptomatology Signs and Symptoms Severe pain Pain develops from fluid pressure on the nerves. Present Mechanism/ Justification

Temporary Permanent Hearing Impairment

Although the hearing loss caused by otitis media is usually temporary, untreated otitis media may lead to permanent hearing impairment. Persistent fluid in the middle ear as well as chronic otitis media can reduce hearing. Unresponsiveness to quiet sounds, or other signs of hearing difficulty such as sitting too close to the TV or being inattentive, may be early signs of hearing loss.

Unusual

Due to the pain

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irritability Difficulty sleeping Fever Inflammation causes fever to develop. Due to ear pain

Tugging at ear

Pain that results may cause the patient to tug at the affected ear. This is a common sign for children

Fluid

draining

Fluid buildup behind the eardrum can cause rupture of the eardrum and fluid can then drain from the ear. Pain is usually relieved at this point; however, there is now a bigger opening for infection to enter the middle and inner ear

from the ear

Loss of balance Why

Fluid affects the cochlea and thus the balance

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