otalgia.pptx ear disorder of bsc nursing

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1. INTRODUCTION OF OTALGIA Otalgia is a medical term for an ear pain that can be a sharp, dull, or burning pain in one or both ears. Otalgia may last a short time or be ongoing. Otalgia is a common complaint, especially in children and is generally caused by a middle ear infection (otitis media). Ear pain in adults is less likely to be from an ear infection.

2. Definition Otalgia:   It is ear  pain ;  earache . Otalgia can originate within the ear, the ear canal, or the external ear. Or Otalgia is defined as pain in the ear , o r ear ache. Or sensation of fullness or pain in the ear. It result of infection in the external ear /middle ear or trauma to the ear and head.

3. Types of otalgia

4. Primary otalgia :- ear pain can be caused by disease in the external ,middle or inner ear ,but three are distinguishable in terms of the pain experienced External ear pain may be :- Mechanical :- trauma , foreign bodies such as hairs ,insects or cotton buds Infective (otitis externa):- staphylococcus , pseudomonas, herpes zoster Middle ear pain may be

5. Mechanical :- barotrauma , eustachian tube obstruction leading to acute otitis media Inflammatory /infective :- acute otitis media ,mastoiditis Secondary otalgia :- Pain that you feel in the ear may be coming from another place, such as your teeth, the joint in your jaw (temporomandibular joint), or your throat. This is called secondary otalgia or referred ear pain .

6. PATHOPHYSIOLOGY

7. SIGN AND SYMPTOM The symptoms of an ear infection may include: Ear pain Fever Increased crying Irritability A young child might have otalgia if they: Rub or pull their ear Do not react to some sounds

8. Have a temperature of 100.4 °F (38 °C) or above Are irritable or restless Are off their food Keep losing their balance

9. DIAGNOSTIC EVALUATION Medical history:- When you see your doctor for ear pain, you can expect him to ask several questions related to the details of your pain: What does the pain feel like? Does the pain come and go or is it constant? Are there any associated symptoms present, such as fever, hearing loss, balance problems or dizziness,  ear drainage , or  tinnitus  (ringing in the ears)? Have you recently been ill or experienced any trauma to the face or ear?

10. Physical examination During your physical exam, your doctor will inspect the outer ear, ear canal, and tympanic membrane (eardrum) with an otoscope. Your doctor will also inspect your nose, mouth, and sinuses. He may also press on your TMJ, look at your back molars to check for signs of grinding or frequent clenching of the teeth, and examine your neck to look for enlarged lymph nodes or other masses.

11. TYMPANOMETERY In this small probe is placed in the ear and the air pressure in the ear canal is varied . the test tells the audiologist how well the eardrum and other structures in the middle ear are working .The ear canal volume indicate whether a perforation in the ear drum may be present . the middle ear pressure indicates whether any fluid is present in the middle ear space .

12. VESTIBULOCOCHLEAR TEST RINNE TEST WEBER TEST

13. Imaging Imaging is sometimes needed to sort out an ear pain diagnosis. For example, x-ray   may be ordered to evaluate a dental problem or to examine the jaw in TMJ disorder. A  computed tomography (ct) scan   may be necessary if mastoiditis is suspected, especially if a person is experiencing worry some complications of mastoiditis, like cranial nerve deficits or signs of meningitis

14. Magnetic resonance imaging (MRI)   may also be ordered if your doctor suspects a possible tumor, such as nasopharyngeal cancer or cholesteatoma, as the source of your ear pain. An MRI to examine your brain may be used to evaluate for a diagnosis of meniere's disease, as central nervous system conditions, like a  brain tumor  or  multiple sclerosis , may mimic the symptoms of meniere's disease.

15. Blood tests Blood tests may be used to help diagnose various ear pain conditions. For instance, if your doctor suspects a severe infection, especially mastoiditis, he may order a  white blood cell count  and inflammatory marker tests, namely  erythrocyte sedimentation rate (ESR)   and  c-reactive protein (CRP)

16. Management( medical management) Use antibiotics such as amoxicillin ,clarithromycin and ciprofloxacin in treating various types of infection Use antiviral such as acyclovir, valacyclovir if the causative agent is suspected to be viral such as in case associated with herpes zoster. Antifungal medication such as fluconazole and nystatin are indicated if the source is caused by fungus Administer analgesics such as ibuprofen, acetaminophen

17. SURGICAL MANAGEMENT Myringotomy  is sometimes needed to treat chronic middle ear infections or persistent eustachian tube dysfunction. With a myringotomy, a small hole is made in your eardrum to ease pressure and let the fluid drain. An ear tube may then be placed in the eardrum to allow airflow into the middle ear and to prevent fluid from re-accumulating. Surgery may also be indicated for other ear pain diagnoses like a tumor, severe mastoiditis, or abscess formation in perichondritis.

18. M yringoplasty :- It is an operation to patch a hole in the eardrum. It is usually done under general anesthetic (while you are asleep).Depending on the size and position of the hole in your eardrum, the operation may be done through your ear canal, or sometimes through an incision (surgical cut) behind your ear. A small graft or patch is taken from underneath the skin behind your ear, or from the gristle at the front of your ear canal. This graft covers the hole in the eardrum

19. precautions after ear surgery Client must lye with operated ear up for several hours after surgery. Participation in water sports or activities is prohibited. Avoid physical activity for 1 week & exercise or sports for 3 weeks after surgery. Avoid heavy lifting.

20. 5. Change the cotton ball in the ear daily. 6. Keep the ear dry for 4-6 weeks. Do not shampoo for 1 week. Avoid airplane flights for the first week after surgery. For sensation of ear pressure , hold your nose, close your mouth and swallow to equalize pressure. Wear noise defenders in loud environments. Inform in case of bleeding from ear.

21. NURSING MANAGEMENT Acute pain  related to the inflammation of the middle ear. Impaired verbal communication  related to effects of hearing loss. Risk for injury  related to hearing loss, decreased visual acuity. Infection  related to presence of pathogens . Anxiety  related to health status .

22. COMPLICATIONS Untreated, ear infections can lead to more serious complications, including  mastoiditis  (a rare inflammation of a bone adjacent to the ear),  hearing loss , perforation of the eardrum,   meningitis , facial nerve paralysis , and possibly -- in adults -- Meniere's disease.

23. INTRODUCTION of foreign bodies in the ear Foreign bodies of the ear are relatively common in emergency medicines . Foreign bodies may lodge in ear canal intentionally or accidentally by the patient or other person (usually in children).

24. DEFINITION OF FOREIGN BODY IN THE EAR An ear foreign body is an object that is stuck in your ear. Foreign bodies are usually trapped in the outer ear canal. (e.g. cockroaches ,mosquitoes , moths, flies , household ants ) are the foreign bodies most commonly found in the ear.

25. CAUSES AND RISK FACTOR A foreign body in the ear most often occurs in toddlers who have placed something small in the ear canal. It can also be caused when an insect flies or crawls into the ear. Foreign bodies in the ear are common. Most foreign bodies in the ear lodge in the ear canal and become stuck .

26. Sign and symptoms Feeling like something is in your ear Trouble hearing Ear pain Redness, itching, or bleeding in your ear Thick drainage or a foul odor coming from your ear Nausea or dizziness

27. DIAGNOSTIC EVALUATION PHYSICAL EXAMINATION OTOSCOPE :- It is performed by gently pulling the auricle upward and backward. In children, the auricle should be pulled downward and backward . An otoscopic examination is a procedure that examine the auditory canal and tympanic membrane for infection or blockage due to the presence of a foreign object or build up of wax

28. FIRST AID Don't probe the ear with a tool such as a cotton swab or matchstick.  You risk pushing the object farther in and damaging the ear. Remove the object if possible.  If the object is clearly visible, pliable and can be grasped easily with tweezers, gently remove it. Try using gravity.  Tilt the head to the affected side to try to dislodge the object.

29. Treatment Treatment will depend on what kind of object is in your ear and how deep it is. You may need any of the following: Medicines  may be give to decrease pain, inflammation, or treat an infection.

30. Suction with a small catheter  is used to suck the object out. Suction is most often used when the object is round and smooth A balloon catheter  is when a small rubber catheter is inserted into your ear, past the object. The balloon at the end of the tube is filled with air. The balloon is pulled out of your ear and the object comes with it.

31. TYMPANIC MEMBRANE PERFORATION A ruptured eardrum is a tear in the thin membrane that separates outer ear from inner ear and when there is any abnormal opening or perforation in tympanic membrane, it is termed as perforated tympanic membrane. Or Tympanic membrane perforation is a medical term used to describe a ruptured ear drum. It is a condition where there is a tear or a hole in the thin tissue (ear drum) that separates the middle ear from the ear canal

32. ETIOLOGY A number of things can cause the eardrum to rupture; one of the most common causes is an ear infection. When the middle ear is infected, pressure builds up and pushes against the eardrum. When the pressure gets too high, it can cause the eardrum to perforate. Insertion of objects into the ear canal purposely : another common cause of a ruptured eardrum is poking the eardrum with a foreign object, such as a cotton-tipped swab or a bobby pin that is being used to clean wax out of the ear canal. Sometimes children can puncture their own eardrum by putting objects, such as a stick

33. Sudden negative pressure ( e.G. Strong suction applied to the ear canal) Barotrauma s: this happens when the pressure inside the ear and the pressure outside the ear are not equal. That can happen, for example, when an aeroplane changes altitude, causing the air pressure in the cabin to drop or rise. The change in pressure is also a common problem for scuba divers. Iatrogenic perforation during irrigation or foreign body removal

34. SIGN AND SYMPTOMS Sudden sharp ear pain or a sudden decrease in ear pain Drainage from the ear that may be bloody, clear, or resemble pus Ear noise or buzzing Hearing loss that may be partial or complete in the affected ear Dizziness

35. DIAGNOSTIC EVALUATION History taking Physical assessment Otoscopy : An otoscope helps to see inside the ear and visualize the eardrum WHISPER TEST RINNE TEST WEBER TEST

36. MANAGEMENT Ear kept dry Oral or topical antibiotics Often no specific treatment is needed. The ear should be kept dry, routine antibiotic ear drops are unnecessary. However, prophylaxis with oral broad-spectrum antibiotics or antibiotic ear drops is necessary .If the ear becomes infected, amoxicillin 500 mg is given for 7 days. Although most perforations close spontaneously, surgery is indicated for a perforation persisting.

37. SURGICAL MANAGEMENT Myringoplasty :. It is an operation to patch a hole in the eardrum. It is usually done under general anesthetic (while you are asleep).Depending on the size and position of the hole in your eardrum, the operation may be done through your ear canal, or sometimes through an incision (surgical cut) behind your ear. A small graft or patch is taken from underneath the skin behind your ear, or from the gristle at the front of your ear canal. This graft covers the hole in the eardrum

38. IMPACTED WAX Earwax, also called cerumen, is made by the body to protect the ears. The ear wax has both lubricating and antibacterial properties. Untreated buildup can lead to hearing loss, irritation, pain in the ear, dizziness, ringing in the ears and other problems. Or Earwax is a yellowish, waxy material inside the ear that comes from the sebaceous gland in the ear canal. It is also known as cerumen.

39. R ISK FACTOR Some people are more likely than others to have earwax problems. People who tend to collect more earwax in their ears include: I ndividuals whose ear canals are narrow or not fully formed P eople with very hairy ear canals P eople with, benign bony growths, in the outer part of the ear canal

40. Older people , because earwax tends to become drier and harder with age, which increases the risk of impaction

41. SIGN AND SYMPTOMS A feeling of fullness in the ear Pain in the ear Difficulty hearing, which may continue to worsen Ringing in the ear ( tinnitus ) A feeling of itchiness in the ear Discharge from the ear Foul odor coming from the ear Dizziness

42. DIAGNOSTIC EVALUATION PHYSICAL EXAMINATION OTOSCOPE :- It is performed by gently pulling the auricle upward and backward. In children, the auricle should be pulled downward and backward. An otoscopic examination is a procedure that examine the auditory canal and tympanic membrane for infection or blockage due to the presence of a foreign object or build up of wax

43. TREATMENT Ear drops The doctor will prescribe or recommend ear drops to soften the wax and make it easier to remove. People should use ear drops at room temperature. For eg. - Debrox The wax will typically soften within a few days and gradually come out on its own. Ear irrigation If ear drops do not work, the doctor may recommend a procedure known as irrigation.

44. The doctor will apply a high-pressure flow of water to the ear canal to dislodge and remove the plug. Manual removal If irrigation is not an option or is unsuccessful, the doctor may recommend either micro suction or manual removal to clear the ear canal. Micro suction uses a small instrument to suck earwax out of the ear. Manual removal may involve using a thin instrument with a small hoop at the end to clean the ear and scrape out any earwax.