Otitis Media (common)

otitis media is the inflammation of the ear drum or tympanic membrane this topic include its definition , etiology, pathophysiology, clinical manifestation, diagnosis and its treatment which can be used by nursing students for taking care of the patient suffering from otitis media and for learning for their examination and knowledge purpose
and care of the child with acute otitis media and chronic otitis media and make their family aware about the complication of the otitis media like hearing loss meningitis

1. OTITIS MEDIA DEPARTMENT OF MEDICAL SURGICAL NURSING

2. Learning Objectives At the end of this lecture, students should be able to : define otitis media enlist the causes explain the pathophysiology enumerate the clinical manifestation describe the management

3. Introduction otitis media refers to an inflammation of the middle auditory canal which is normally filled with air behind the ear drum. It is an inflammation of middle ear that most often occur in infant but can occur at any age

4. Definition Otitis media (OM)is the inflammation of the middle ear, space between tympanic membrane and inner ear

5. Incidence Otitis media is the second most common disease in child hood after upper respiratory tract infection Repetitive episodes of otitis media can leads to a chronic otitis media which can occur in later life or at any age group

6. Classification of otitis media Sr. no. Otitis media Characteristic 1. Acute otitis media inflammation of the medial ear and can heal with shortly Rapid onset of symptom < 3 weeks 2. Chronic otitis media inflammation of the medial ear due to repetitive episode of AOM Symptom worsen with time > 3weeks to 3 month or more

7. Causes Age: due to shorter eustachin tube in child occurrence in childhood is most common water in the ear canal Trauma to the skin of the ear canal, pathogenic bacteria Sinusitis, Allergic reaction(rhinitis, pharyngitis ) streptococcus pneumoniae, haemophilus influenzae and moraxella catarrhalis

8. Trauma to the tympanic membrane Head injury Gender : boys are more affected then girls Craniofacial abnormalities (cleft palate) Passive smoking Down syndrome Poor air quality Seasonal factor

9. PATHOPHYSIOLOGY Due to infection inflammation occur and exudates edema in eustachian tube of middle ear Serious exudation in the middle ear. thickened, purulent and pus formation

10. Tympanic membrane perforation --------------------------------------(AOM) Increase pressure in middle ear cavity Nacrosis of tissue in ear Damage of tympanic membrane Conducting hearing loss, mastoiditis -------------------------------------(COM)

11. Sign and symptoms Pain in and about the ear( otalgia ), espacially when lying down Fever & drainage from the ear Tympanic membrane become erythematous Conductive hearing loss Change in behavior

12. Irritability Decrease appitite Noise in ear Fullness in ear Tugging or pulling at an ear Loss of balance Trouble sleeping Vomiting

13. Diagnostic evaluation History collection Physical examination Otoscopic examination Culture Audiometry Tympanometry (test used to measure the movement of the ear drum )

14. Acoustic reflectometry : test used to measure the sound reflection back to the ear drum Tympanocentesis : draining out fluid or pus from the middle ear with the help of small needle aspiration

15. Complication TM perforation Mastoiditis Meningitis Hearing loss Chronic ottitis media Facial nerve palsy Brain abscess

16. Medical Management Although most tympanic membrane perforations heal spontaneously Antibiotic :- Amoxicillin: 20-40 mg/kg/day, TDS, for 10-14 days or Augmentin : 45 mg/kg/day, BD, for 10-14 days or Broad spectrum antibiotic therapy (penicillin)

17. Analgesic (NSAIDs) Antipyratic Prevent entry of water in ear Drainage if fluid collection is max. Hearing aid

18. SURGICAL MANAGEMENT Perforations that do not heal on their own may require surgery. Tympanoplasty : surgical repair of tympanic membrane by grafting Myringotomy : incision through ear drum to create an artificial opening to drain fluid

19. Nursing management PREVENTION Prevent common cold and other illnesses Avoid second hand smoking Proper nutrition Avoid water irrigation of ear Protect ear during swimming

20. Nursing diagnosis Acute pain related to fluid filled in ear or infection Altered auditory sensation perception related to fluid accumulation in middle ear Imbalance nutritional status less then body requirement related to vomiting Risk for infection related to decrease immune response Knowledge deficit related to disease process and response

21. Nursing Interventions Apply hot water bag over the ear with the child lying on the affected side may reduce the discomfort (applied during the attack of pain) Put ice bag over the affected area may also be beneficial to reduce edema (between pain attacks) For drained ear : external canal may be frequently cleaned using sterile cotton swab (dry or soaked in hydrogenperoxide )

22. Excoriation of the outer ear should be prevented by frequent cleaning and application of zinc oxide to the area of oxidate Give special attention to the tympanostomy tube i.e. avoid water entering the middle ear and introducing bacteria Educate family about care of child & keep them aware with the complication of the acute otitis media e.g. hearing loss

23. Preventing from Altered Sensory Perception by providing all the needed article of objects near them Avoiding keeping patient alone as it leads to fall or head injury Promoting Wound Healing by giving all medication in time, dose, frequency and ear care Provide emotional support to the child and his family

24. Summary So far we have discussed about definition, etiology, physiopathology, clinical manifestations,, and managements of otitis media.

25. Bibliography Lewis et al, Medical Surgical Nursing, Mosby Elsevier,7 th edition. Joyce.M.Black et al, Medical Surgical Nursing, Saunders publication. Brunner and Siddhartha, Medical Surgical Nursing, Lippincott Williams and Wilkins.

26. Thank You