Case Presentation on Chronic Otitis Media

Nursing

1. CHRONIC OTITIS MEDIA Submitted by: Aasawari Sharma Akriti Anagha Raj Anakha Sekhar Anjali Anshu Yadav Asia Chinmayi Divya

2. DEFINITION Chronic otitis media is a long term inflammation or infection of the middle ear, typically lasting for several weeks or more. It is often characterised by persistent fluid accumulation behind the eardrum, sometimes accompanied by hearing loss, ear pain, and recurrent infections.

3. ANATOMY OF EAR

4. ANATOMY Ear has three parts : The outer ear - pinna (auricle), external auditory. canal The middle ear - tympanic membrane (eardrum), ossicles ( malleus, incus, stapes ), Eustachian tube The inner ear - cochlea, vestibular system ( semicircular canals, otolith organs - the utricle and the saccule), auditory nerve

5. PHYSIOLOGY Hearing Balance and equilibrium

6. PATHOPHYSIOLOGY Due to etiological factors Exudates and Edema in middle ear Increase retraction of tympanic membrane Pus formation Tympanic membrane perforation Acute otitis media Acute otorrhea Chronic otitis media

7. ETIOLOGY Family history Genetic disorder Poor hygiene of ear Anatomical abnormalities of ear Inappropriate treatment of acute otitis media Any other ear infection, injury to the ear Upper respiratory infection Bacterial and viral infection Eustachian tube dysfunction Smoking

8. RISK FACTOR Age Allergies Immunodeficiency Upper respiratory tract infections Gastroesophageal reflux Family history of recurrent acute otitis media Exposure to environmental smoke or other respiratory irritants Previous ear infection Seasonal factor

9. CLINICAL MANIFESTATION. OTALGIA. OTORRHEA. FEVER. RHINITIS. HEARING LOSS. IRRITABILITY. TROUBLE HEARING IN THE EAR THATS BLOCKED. A FELLING OF FULLNESS OR PRESSURE IN YOUR EAR. YELLOW , BROWN OR WHITE DRAINGE FROM YOUR EAR. TUGGING OR PULLING AT ONE OR BOTH EARS. DIFFICULTY SLEEPING.

10. DIAGNOSTIC EVALUATION. HISTORY. PHYICAL EXAMINATION. OTOSCOPIC EXAMINATION AUDIOMETRY. CT SCAN. TYMPANOMETRY. CULTURE.

11. Treatment of patient Antibiotic - injection ceftriaxone 1 gm BD Antihistamines - Tab levocitrizine 5mg HS Analgesics - injecting diclofenac 75 mg BD Proton pump inhibitor - Tab pantoprazole 40 mg BBF

12. Surgical Managment

13. Surgical management including tympanoplasty, ossiculoplasty and mastoidectomy are used if medical treatment are ineffective .

14. Tympanoplasty

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16. The user can demonstrate on a projector or computer, or print the presentation and make it film The user can demonstrate on a projector or computer, or print the presentation and make it film The user can demonstrate on a projector or computer, or print the presentation and make it film The user can demonstrate on a projector or computer, or print the presentation and make it film The user can demonstrate on a projector or computer, or print the presentation and make it film The user can demonstrate on a projector or computer, or print the presentation and make it film MASTOIDACTOMY

17. NURSING DIAGNOSIS Acute pain related to inflammation and pressure in the middle ear due to chronic otitis media. Impaired hearing related to fluid accumulation in the middle ear due to COM. Risk for injury (e.g., falls) related to dizziness or balance issues caused by otitis media. Risk for infection related to compromised immune system or exposure to pathogens. Impaired comfort related to inflammation and pain in the middle ear Risk for impaired communication related to decreased hearing and difficulty understanding speech. Risk for delayed development related to recurrent otitis media and potential hearing loss in children. Anxiety related to discomfort, uncertainty about treatment, or fear of complications. Deficient knowledge related to otitis media, its causes, treatment, and prevention.

18. NURSING MANAGEMENT Assessment: Conduct a thorough assessment of the patient’s medical history, physical examination focusing on the ears, checking for signs of inflammation, redness, or fluid behind the eardrum. Pain Management: Administer prescribed analgesics to relieve pain and discomfort associated with otitis media. Monitor the patient’s pain level regularly and adjust pain management strategies as needed. Antibiotic Administration: Administer antibiotics as prescribed by the healthcare provider for bacterial otitis media. Educate the patient and family about the importance of completing the full course of antibiotics to prevent recurrence and antibiotic resistance. Comfort Measures: Apply warm compresses to the affected ear to help relieve pain and promote drainage of fluid. Encourage rest and provide a quiet, comfortable environment for the patient. Promotion of Fluid Drainage: Encourage the patient to adopt positions that facilitate fluid drainage from the middle ear, like lying on the affected side or using gravity-assisted positions. Monitoring and Observation: Monitor the patient’s vital signs, temperature, and symptoms closely for any signs of worsening infection or complications. Document and report any changes to the healthcare provider promptly. Education: Provide patient and family education about otitis media, including its causes, symptoms, and treatment. Follow-Up Care: Schedule follow-up appointments to assess the patient’s response to treatment, monitor for recurrence of symptoms, and ensure resolution of the infection. Preventive Measures: Emphasize the importance of maintaining good ear hygiene and hand hygiene, avoiding exposure to cigarette smoke or other irritants, strategies to prevent recurrence, and ensuring vaccinations are up to date.

19. Assessment Diagnosis Gaol Intervention Implementation Evaluation Subjective Data:- Patient says “I am unable to hear properly” Objective data :-

Hearing ability is reduced Observed by hearing test at low voice. Impaired communication related to decreased hearing and difficulty in understanding speech. To improve or stabilize hearing and communication. →Assess the level of disturbed auditory sensory perception.

→Face the patient during speaking.

Speak dearly and distinctly without shouting In proper light.

→ Use non-verbal clues such as facial expression

→ Avoid environmental noise. →The level of disturbed auditory sensory perception is assessed.

→Patient is faced during communication

→ Communication is done by speaking clearly without Shouting.

→ measures such as non-verbal clues are used.

→Environmental noise such as Shouting reduced. →Patient is better at communication and can understand non verbal clues.

20. Assessment Diagnosis Gaol Interventions Implementation Evaluation Subjective Data:

Patient complains of pain in ears, and head.

Objective Data:

Patient’s face is looking dull or pale and his facial expressions confirm the pain Pain related to inflammation and increased pressure due to fluid accumulation To reduce or relieve the pain. • Assess the general condition of the pt.
• Assess the level of pain on pain scale.
.Assess the car for any drainage or bleeding.
• Assess for hearing loss and change in Speech.
• Implement strategies to manage pain effectively & promote comfort and rest.
• provide medication for if needed.
• Ensure proper positioning of the pt. To aid in drainage & recovery. • General condition of pt. is assessed. Patient’s face is looking dull, pulse is slightly increased. P.R-90/min.
• Pain level is assessed .Pain Score = 07/10.
.Ear is assessed.
Their is yellowish discharge from the ears.
• Hearing loss and change in speech is assessed. Pt. Is unable to follow instructions and faces problem in hearing
• Analgesics are administered Voveron 50mg.
• proper position is provided to the pt. Lateral position is provided. Pain level is reduced on pain scale from 7 to 4 on scale. Patient is feeling relieved.

21. Assessment Diagnosis Goal interventions Implementation Evaluation Subjective data: Patient complaint” I’m having foul smelling discharge from ear” Objective data: Observation shows pus accumulation in the ear. Infection related to compromised immune system or exposure to pathogens post operatively. To treat and reduce further complications 1.Advise family members on handwashing techniques and the importance of covering their mouths and noses when sneezing or coughing. 2. Encourage increased fluid intake, good nutrition, and adequate rest. 3.Eliminate allergens and airway irritants such as tobacco, smoke, and dust. 4.Administer antibiotics as prescribed. Instruct patient to take the full course of antibiotics 1.Advised family Members on handwashing techniques and the importance of personal hygiene
2. Encouraged increased fluid intake, good nutrition, and adequate rest.
3.Eliminated allergens and airway irritants such as tobacco, smoke, and dust.
4.Administed antibiotics as prescribed. Instructed patient to take the full course of antibiotics Amount of pus formation reduced

22. COMPLICATIONS

23. Educate the patient about the use of antibiotics analgesics in the management of otitis media. Change your patient’s dressing every day after the surgery is done. Give patient diet plan such that he\she doesn’t have constipation. Adv them to have more liquids and high dietary fibre like fruits, whole grain breads, oats vegetables, green veggies. Constipation can lead to pressure on ears and tympanic membrane which can cause pain and complications after surgery is done. Do not listen to high volume sound. Encourage patient to lie laterally with the affected side up. Avoid touching your ear area unnecessarily. Do not wear any ornaments on ear or near ear. Seek medical help if any complications occur. - HEALTH EDUCATION

24. Teach patient or caregiver to administrate ear medication. Drop should be given at room temperature to avoid pain and dizziness. Instruct patient to clean his/her ear in safe techniques . Thin washcloth (cotton) or fingers are best for cleaning ears. Avoid sharp objects and earbuds. Instruct patient about the importance of routine examination. Washing hands properly and maintain proper hand and ear hygiene. Explains to patient that topical analgesics must not be used if the tympanic membrane ruptures.

25. IDENTIFICATION DATA Patient’s name:- ARCHANA Age:- 25YRS CR No:- 20240020357 D.O.A:- 16\03\24 Diagnosis:- B\L Chronic Otitis Media Ward:- E.ENT ward Bed no:- 7 Religion:- Hindu Qualification:- 12 th passed Marital status:- Married Occupation :- Homemaker Address:- House no.4141 awaas vikas , kalyanpur Kanpur uttar Pradesh.

26. Condition of the patient on admission Ms. Archana came to LHMC OPD with complaint of pain in both the ears and discharge from both the ears. She reports chronic ear pain , which is often accompanied by the by a whitish yellowish discharge from both the ears. She isn’t able listen properly and have auditory difficulties from both the years but not equally. R>L. When she was 8 years old she had this problem of discharge but neglected. When she turned 20 years old her pain and discharged increased with the time. Clinical manifestation of my patient:- Discharge from both the ears and pain. Hearing loss from both the ears.

27. CASE Name: Suresh Age/Sex: 24y/Male Ward/Bed no. : Eye-ENT ward/09 CR no. : 20240011816 Occupation: Student Diagnosis: Left chronic otitis media DOA : 14/03/2024 DOS : 16/03/2024 DOD : 20/03/2024

28. HISTORY OF PRESENT ILLNESS Came to the ENT OPD on 14/03/2024 with the c/o: Hearing loss from the past 1 year and From the past 2 to 3 months with the following complaints: left ear discharge (mucopurulent, foul smelling, blood tinged) Earache Itching

29. ETIOLOGY Inappropriate treatment of acute otitis media Environmental Factors RISK FACTORS Poor hygiene of ear Environmental Factors Recurrent Acute Otitis Media

30. CLINICAL MANIFESTATIONS Hearing loss Foul smelling otorrhea Pain DIAGNOSTIC FINDINGS Otoscopy Audiometry Tests HRCT

31. TREATMENT Inj. Augmentin 1.2g IV TDS Inj. Voveron 75mg IM BD Tab. Pantop 40mg OD Tab. Cetrizine 10mg HS Tab. Chymoral forte BD SURGICAL MANAGEMENT Tympanoplasty Mastoidectomy

32. Identification data Name - Mr Sneh Age- 29 Gender - Male Occupation - Delivery service ( flipkart) Religion - Hindu Education qualification - 12 passed CR no - 20245647 Diagnosis -chronic otitis media ( right ear) Date Of admission - 7 Feb 2024 Address - K 51 wazipur colony, North West Delhi

33. About Patient Condition Regarding Disease.... Patient is known case of otitis media since last 4 - 5 years He Complains of ear discharge , foul in smell, blood stained since last 4-5 year ago He Also complain of decreased hearing loss since 1-2 year ago He took medication and got relief for sometime but later there was reoccurence of symptoms.. So after not getting relief from medical management, he was opted for surgical management Tympanoplasty was done.... on 8 Feb 2024

34. Clinical Manifestation of patient Mixed hearing loss Foul smelling discharge ( ottorhea) Cholesteatoma Blood stained discharge Pain in right ear

35. Identification Name: Rudra Age: 17 years
Sex: Male
Religion: Hindu
Marital Status: Unmarried
CR No.: 2024002306
Address: Naviganj,kannauj,utter Pradesh, India.
Diagnosis: B/L Inactive mucosal Chronic Otitis Media.
Date of Admission: 18/03/2024

36. Condition of patient on admission Patient came to ENT ward for planned surgery. he was conscious, will oriented to time, place& person. he came with chief complain of hearing loss from both ear and discharge from Right ear
Her vitals are stable
T-98.2 °F
P-78/min
R-20/min
BP-106/78

37. IDENTIFICATION DATA Patient name : Babitha Age/ gender: 38/female CR no :. 20231107 Marital status: married Occupation: housewife Address: Rakesh marg ghazibad Uttarpradesh 201001 India Date of admission: 18/3/24 Diagnosis: acute otitis media Qualification:. Tenth pass Religion:. Hindu Ward:. ENT ward

38. My patient Babitha is admitted on 18/3/24 in LHMC ENT with severe ear pain and also puss is coming from her ear.she is suffering from headache and fluid discharge with sometimes blood also for past 3 to 4 days She can't able to sleep and also she have feel of lossing balnce while walking.she is also suffering from difficulty in hearing. Condition of patient on admission

39. IDENTIFICATION DATA Patient Name: Sunitha Rani Age/Sex: 36Y/F CR No.: 20230318351 DOA: 18/03/24 Diagnosis: Right Acute Otitis Media Ward: ENT Ward Bed No.: 7 Religion: Hindu Qualification: 10 th pass Marital Status: Married Occupation: Homemaker

40. CONDITION OF PATIENT Mrs Sunitha Rani came to the LHMC OPD with the complaint of continuous left ear pain and discharge for the past 1week. She reports experiencing intermittent ear pain, which is often accompanied by a foul-smelling discharge from the left ear. The discharge has a yellowish color and occasionally contains blood. This has been happening since past 1.5 years. She noted a gradual decrease in hearing ability in the affected ear for the past 6 months.

41. IDENTIFICATION DATA. NAME : MS NEHA GUPTA. AGE:27 YEARS. ADDRESS: VAISHALI COLONY, UTTAR PRADESH. EDUCATION QUALIFICATION: 12 TH PASSED. FAMILY INCOME: 10,000 PER MONTH. OCCUPATION: HOUSE WIFE. DIAGNOSIS:LEFT CHRONIC OTITIS MEDIA. SURGERY: LEFT TYMPANOPLASTY.

42. Patient chief complain on ADMISSION. PATIENT COME IN HOSPITAL WITH THE COMPLAIN OF . LEFT EAR DISCHARGE (4 MONTH) LEFT EAR DECREASED HEARING (5 MONTH). LEFT OTALAGIA ( 5 MONTH). EAR DISCHARGE ( YELLOWISH , NON BLOOD STAINED). PATIENT WAS CONSCIOUS TO TIME,PLACE AND PERSON AT THE TIME OF ADMISSION. VITALS AT THE TIME OF ADMISSION . SPO2 : 99 PERCENT. BP:120/ 80 MMHG. PR : 60 BEATS PER MINUTE.

43. IDENTIFICATION DATA Patient name :- sushma Age/sex :- 35/ F CR No. :- 20240000098 D.O.A :- 16/3/24 Diagnosis :- chronic otitis media Ward :- ENT ward Bed No. :- 11 Religion :- Hindu Qualification :- graduation Occupation :- house wife Surgery :- left tympanoplasty

44. CONDITION OF THE PATIENT Mrs sushma came to the LHMC OPD with the complaint ofcontinuous left ear pain and discharge for the last 10 years She is admitted in the ENT Ward after investigation was done for further treatment She has difficulty in hearing through left ear She was operated for the tympanoplasty on 17/3/24.

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