Otitis Media & Tonsillitis

Otitis media (OM) is the most common reason for antibiotic prescriptions in children, peaking between 6 months and 2 years. The eustachian tube in young children is shorter, wider, and more horizontal than in adults, allowing nasopharyngeal bacteria to migrate easily into the middle ear — especially after an upper respiratory infection. Acute OM presents with ear pain (tugging in preverbal children), fever, irritability, and a bulging, erythematous tympanic membrane with decreased mobility. Effusion may persist for weeks after treatment. Recurrent OM (3 episodes in 6 months or 4 in 12 months) may warrant tympanostomy tube placement. Tonsillitis shares the infectious pathway but targets the palatine tonsils. Bacterial tonsillitis (often Group A strep) requires a rapid strep test or throat culture before antibiotics. Key indicators for tonsillectomy include recurrent infections (7 in one year, 5 per year for two years, or 3 per year for three years), peritonsillar abscess, or obstructive sleep apnea. Post-tonsillectomy nursing priorities: monitor for frequent swallowing (earliest sign of hemorrhage), avoid red or brown liquids that mimic bleeding, position on the side to prevent aspiration, and offer cool clear fluids — never straws, which create negative pressure that can disrupt the clot at the surgical site.