How to Spot a Possible Ear Infection in a Child

An otoscope is a medical tool used to visualize the inner ear structures such as the ear canal and tympanic membrane. This allows providers to rule out infection and other conditions. How do you know if the patient is at risk or showing signs and symptoms of an ear infection (Acute Otitis Media) Easy-by asking the appropriate questions during your triage.

𝐄𝐱𝐩𝐞𝐜𝐭𝐞𝐝 𝐟𝐢𝐧𝐝𝐢𝐧𝐠𝐬:
✨Usually follows a bacterial or viral respiratory infection
✨Frequent crying and irritability/ fussiness in infants.
✨Tugging or rubbing of ear due to ear discomfort or pain

𝐏𝐡𝐲𝐬𝐢𝐜𝐚𝐥 𝐟𝐢𝐧𝐝𝐢𝐧𝐠𝐬 𝐨𝐟 𝐚𝐧 𝐀𝐎𝐌:
✨Bulging yellow or red tympanic membrane
✨Purulent drainage in middle ear or from ear canal
✨Fever that can be as high as 104
✨Lymphadenopathy of the neck and head can also be seen (always advise the pediatrician of any swollen lymph nodes as this can indicate many different conditions). 

If you are suspecting otitis media, knowing these symptoms will make your triage assessment much easier since you will be able to ask specific questions.

𝐀𝐬𝐬𝐞𝐬𝐬𝐦𝐞𝐧𝐭:
As a nurse you can inspect the ear structures by
✨ Younger than 3 years » gently pulling the pinna down and back.
✨ Older than 3 years » gently pulling the pinna up and back.
🔎𝙏𝙞𝙥: you’ll never forget this if you remember 3 and lower… numbers are going DOWN = pull pinna DOWN and back. 3 and UP = pull pinna UP and back. 

An RN will not diagnose an AOM but can assess to see if there is discharge present, cerumen impaction or a foreign object in the ear. These are all things you will report to the physician if seen.

𝐍𝐮𝐫𝐬𝐢𝐧𝐠 𝐜𝐚𝐫𝐞:
✨Provide comfort measures such as pain meds, warm pack or diversional activities. Remember 🧠 this child will be in pain so alleviating it is key.
Not only will it help the patient but it will also put the parent at ease (making your job easier 🙃)
🔎warm pack to be placed over the ear with a skin barrier such as a cloth or napkin (never apply hot pack directly on skin)

Did you know lower incidence of otitis media occur in babies who are breastfed due to the transfer of IgA in breast milk?

⚠️ The above info is not intended as medical advice.