OTITIS PPT nursing Management of patient suffering from ear disorders

Good

1. OTITIS MEDIA Otitis media is inflammation of the middle ear, or middle ear infection. Otitis means inflammation of the “ear” and “media” means middle. OR

2. Otitis media is an infection of the middle ear space, behind the eardrum (tympanic membrane). It is characterized by pain, dizziness, and partial loss of hearing.

3. CAUSES An ear infection is caused by a bacterium or virus in the middle ear. This infection often results from another illness — cold, flu or allergy — that causes congestion and swelling of the nasal passages, throat and eustachian tubes. Bacterial infection: - haemophilus influenzae, streptococcus pneumococcus. Viral infection : - rhinovirus, Adenovirus

4. RISK FACTOR Age.  Children between the ages of 6 months and 2 years are more susceptible to ear infections because of the size and shape of their eustachian tubes is shorter and because their immune systems are still developing Family history : The tendency to get ear infections can run in the family. Colds : Having colds often increases the chances of getting an ear infection

5. Allergies : Allergies cause inflammation (swelling) of the nasal passages and upper respiratory tract, which can enlarge the adenoids. Enlarged adenoids can block the eustachian tube, preventing ear fluids from draining. This leads to fluid buildup in the middle ear, causing pressure, pain and possible infection. Chronic illnesses : People with chronic (long-term) illnesses are more likely to develop ear infections, especially patients with immune deficiency and chronic respiratory disease, such as    asthma .

6. PATHOPHYSIOLOGY Due to any etiological factor inflammation in the nasopharynx it cause a obstruction in the eustachain tube negative pressure is generated

7. which pulls interstitial fluid into the tube and creates a serios effusion which yields the clinical sign and symptom of otitis media

8. SIGN AND SYMPTOM Ear pain:  this symptom is obvious in older children and adults. L ook for signs of pain like rubbing or tugging ears, crying more than usual, trouble sleeping, acting fussy/irritable. Loss of appetite:  this may be most noticeable in young children, especially during bottle feedings. Pressure in the middle ear changes as the child swallows, causing more pain and less desire to eat.

9. Irritability:  Any kind of continuing pain may cause irritability. Poor sleep : Pain may be worse when the child is lying down because the pressure in the ear may worsen. Fever:  Ear infections can cause temperatures from 100° F (38 C) up to 104° F..

10. Drainage from the ear:  Yellow, brown, or white fluid , Bloody discharge from the ears. Trouble hearing:  Bones of the middle ear connect to the nerves that send electrical signals (as sound) to the brain. Fluid behind the eardrums slows down movement of these electrical signals through the inner ear bones.

11. TYPES Acute otitis media-  This middle ear infection occurs suddenly. It causes swelling and redness. Fluid and pus become trapped under the eardrum (tympanic membrane). You can have a fever and ear pain.

12. Chronic otitis media-  This is a middle ear infection that does not go away, or happens repeatedly, over months to years. The ear may drain (have liquid coming out of the ear canal). It can often be accompanied by a  tympanic membrane perforation  and hearing loss. Usually chronic otitis media is not painful.

13. Otitis media with effusion-  Fluid (effusion) and mucus build up in the middle ear after an infection goes away. You may feel like your middle ear is full. This can continue for months and may affect your hearing. This is also sometimes called serous otitis media. Chronic otitis media with effusion-  Fluid (effusion) remains in the middle ear for a long time. Or it builds up again and again, even though there is no infection. It may also affect your hearing

14. DIAGNOSTIC EVALAUTION C omplete medical history and physical examination , In this doctor will inspect the outer ear and eardrum U sing an otoscope. The otoscope is a lighted instrument that allows the health care provider to see inside the ear

15. Pneumatic otoscope:- An instrument called a pneumatic otoscope is often the only specialized tool a doctor needs to diagnose an ear infection. This instrument enables the doctor to look in the ear and judge whether there is fluid behind the eardrum. With the pneumatic otoscope, the doctor gently puffs air against the eardrum. Normally, this puff of air would cause the eardrum to move. If the middle ear is filled with fluid, your doctor will observe little to no movement of the eardrum.

16. Tympanometry:-   This test measures the movement of the eardrum. The device, which seals off the ear canal, adjusts air pressure in the canal, which causes the eardrum to move. The device measures how well the eardrum moves and provides an indirect measure of pressure within the middle ear.

17. Tympanocentesis :- Rarely, a doctor may use a special needle with a tiny tube that pierces the eardrum to drain fluid from the middle ear — a procedure called tympanocentesis. The fluid is tested for viruses and bacteria.

18. MANAGEMENT OF OTITIS MEDIA Antibiotic therapy: - amoxicillin, trimethoprim, sulfamethoxazole Antihistamine:- cetirizine, fexofenadine Decongestant:- Pseudoephedrine ,Ephedrine Corticosteroids:- Hydrocortisone, dexamethasone Analgesics:-N aproxen antipyretics :- Paracetamol

19. SURGICAL MANAGEMENT MYRINGOTOMY  An incision in the tympanic membrane is made and the tympanic membrane is numbed with a local anesthetic. The procedure is painless and takes less than 15 minutes. Under microscopic guidance, an incision is made through the tympanic membrane to relieve pressure and to drain serous or purulent fluid from the middle ear.

20. VENTILATING TUBE Ear tubes are tiny, hollow cylinders, usually made of plastic or metal, that are surgically inserted into the eardrum. An ear tube creates an airway that ventilates the middle ear and prevents the accumulation of fluids behind the eardrum. Ear tubes can also be called tympanostomy tubes, ventilation tubes, myringotomy tubes or pressure equalization tubes The ventilating tube, which temporarily takes the place of the eustachian tube in equalizing pressure, is retained for one year

21. NURSING DIAGNOSE Pain related to inflammation and pressure on tympanic membrane Risk for infection related to eustachian tube dysfunction Impaired verbal communication related to hearing deficit Altered auditory sensory perception related to middle ear infections Fear and anxiety related to progression of disease

22. MENIERE'S DISEASE Meniere's disease is a disorder of the inner ear that can lead to dizzy spells (vertigo) and hearing loss. In most cases, Meniere's disease affects only one ear. Or Meniere’s disease is an inner-ear condition that can cause  vertigo , a specific type of  dizziness   in which you feel as though you’re spinning.

23. CAUSES AND RISK FACTORS The cause of Meniere's disease is unknown. GENETIC Improper fluid drainage, perhaps because of a blockage or anatomic abnormality:- Too much pressure results in a high amount of fluid that doesn't drain properly, causing the dysfunction.. Abnormal development in the inner ear can also cause blockages, impeding fluid drainage.

24. VIRAL INFECTION- Some of the viruses suspected of causing Meniere's include rhinovirus, adenovirus, influenza, coronavirus, herpes simplex,  virus. The herpes virus is the most common type of viral infection f ound in patients with Meniere's, according to one study. Meningitis, which affects the brain, and labyrinthitis, which affects the inner ear, are some of the infections that can trigger Meniere's disease.

25. ALLERGY :- A past infection can interact with an existing allergy, which can cause decompensation of the endolymphatic sac. This interaction can then trigger  endolymphatic hydrops  (excess fluid in the ear), causing an imbalance in the drainage of fluid. An allergic reaction can result in inflammation of the inner ear, compromising the filtering capability, and consequently, blockages.

26. SIGN AND SYMPTOMS Reoccurring episodes of vertigo.  You have a spinning sensation that starts and stops spontaneously. Episodes of vertigo occur without warning and usually last 20 minutes to several hours, but not more than 24 hours. Severe vertigo can cause nausea. Hearing loss.  Hearing loss in Meniere's disease may come and go, Eventually, most people have some permanent hearing loss.

27. Ringing in the ear (tinnitus).  Tinnitus is the perception of a ringing, buzzing, roaring, whistling or sound in your ear. Feeling of fullness in the ear.  People with Meniere's disease often feel pressure in an affected ear (aural fullness).

28. DIAGNOSTIC EVALUATION Audiometry exam - This will find hearing loss in the affected ear.. Electrocochleography (ECoG).  This test looks at the inner ear in response to sounds. It might help to determine if there is an abnormal buildup of fluid in the inner ear .

29. Rotary chair testing.  This lets your doctor see how eye movement affects your inner ear. You sit in a turning chair that’s controlled by a computer Posturography.   This tests your balance and how well you can keep it. You stand barefoot on a platform that can move in several directions. You wear a harness that lets your doctor see how you respond when the platform moves in certain ways. 

30. MANAGEMENT Motion sickness medications,   such as meclizine or diazepam (Valium), may reduce the spinning sensation and help control nausea and vomiting. Anti-nausea medications ,  such as promethazine, might control nausea and vomiting during an episode of vertigo. Diuretics . To reduce fluid in your ear, your doctor might prescribe a diuretic -- medicine that keeps your body from retaining fluids. If you take a diuretic, your doctor probably also will ask you to cut the amount of salt in your diet.

31. Steroids,  such as dexamethasone can give to the patient . SURGICAL MANAGEMENT Endolymphatic sac procedure.  The endolymphatic sac plays a role in regulating inner ear fluid levels. During the procedure, the endolymphatic sac is decompressed, which can alleviate excess fluid levels. In some cases, this procedure is coupled with the placement of a shunt, a tube that drains excess fluid from your inner ear.

32. Labyrinthectomy.  With this procedure, the surgeon removes the balance portion of the inner ear, thereby removing both balance and hearing function from the affected ear. This procedure is performed only if you already have near-total or total hearing loss in your affected ear. Vestibular nerve section.  This procedure involves cutting the nerve that connects balance and movement sensors in your inner ear to the brain (vestibular nerve). This procedure usually corrects problems with vertigo while attempting to preserve hearing in the affected ear. It requires general anesthesia and an overnight hospital stay.

33. NURSING DIAGNOSIS Risk for injury related to altered mobility because of gait disturbed and vertigo. Impaired adjustment related to disability requiring change in lifestyle because of unpredictability of vertigo. Risk for fluid volume imbalance and deficit related to increased fluid output, altered intake, and medications. Anxiety related to threat of, or change in, health status and disabling effects of vertigo.

34. COMPLICATIONS The disease interrupts the natural cycle of your life and lead to anxiety, depression, fatigue, and emotional stress. It can also lead to: A loss in balance Increases your risk of falling Increases your risk of getting into an accident Driving problems

35. LABYRINTHITIS Labyrinthitis is an inner ear disorder. The two  vestibular nerves  in your  inner ear  send your brain information about your balance control. When one of these nerves becomes inflamed, it creates a condition known as labyrinthitis Or Labyrinthitis is an infection of the inner ear. It causes  inflammation  that can affect the structures of this part of the ear and disrupt the flow of sensory information from the ear to the brain. This disruption can result in a range of symptoms, including dizziness,  vertigo , and even  hearing loss .

36. CAUSES AND RISK FACTORS The exact cause of labyrinthitis (inner ear infections) is unknown. It may be caused by swelling or problems with the nerve inside the brain responsible for balance and hearing.  Labyrinthitis also may occur during or after a viral infection. Viruses associated with labyrinthitis include:-   influenza ,  herpes  viruses,  measles ,  mumps ,  rubella ,  hepatitis ,  Epstein-Barr virus , and  polio

37. B acterial infections- (OTITIS MEDIA ) can lead the labyrinthitis Rarely, other ear problems like barotrauma (injury due to abnormal pressure inside the ear) or otosclerosis (abnormal growth of bone impeding the middle ear) can cause labyrinthitis.

38. PATHOPHYSIOLOGY Due to etiological factor Inflammatory mediators invade the membranous labyrinth It causes Inflammation of labyrinth It damage the vestibular and auditory end organs

39. It causes vertigo, hearing loss

40. SIGN AND SYMPTOMS dizziness vertigo loss of balance nausea and vomiting tinnitus , which is characterized by a  ringing or buzzing in your ear difficulty focusing your eyes

41. TYPES VIRAL LABYRINTHITIS:- Also known as  vestibular neuronitis,  this condition is often the result of a viral infection. The symptoms are typically vertigo, nausea and vomiting.  The symptoms are usually acute in the first 24 hours, after which they tend to gradually subside over the next few days.  

42. BACTERIAL LABYRINTHITIS This can happen in one of two ways: First, bacteria from a middle  ear infection  make toxins that get into the inner ear and cause  inflammation  and swelling. Or second, an infection in the bones surrounding the inner ear makes toxins that cause the same symptoms. A chronic, or ongoing, middle ear infection can cause it.

43. DIAGNOSTIC TEST History taking Physical examination Pneumatic otoscope A   CT  or  MRI scan   of your head to record images of your cranial structures E lectroencephalogram (EEG) , which is a brain wave test, during this test small sensors are attached to the scalp to pick up the electrical signals produced by the brain

44. MANAGEMENT M edications that can reduce dizziness and nausea, such as  meclizine   corticosteroids, such as  prednisone antihistamines , such as fexofenadine (Allegra), diphenhydramine ( Benadryl ), or loratadine (Claritin) ANTIBIOTIC ANTIVIRAL

45. VESTIBULAR REHABLITATION THERAPY:- Vestibular rehabilitation  ( VR ), also known as  vestibular rehabilitation therapy  ( VRT ), is a specialized form of physical therapy used to treat vestibular disorders or symptoms, characterized by dizziness,  vertigo , and trouble with balance, posture, and vision.

46. Habituation Exercises Habituation exercises are used to treat symptoms of dizziness that are produced because of head motion or visual stimuli. These patients typically report increased dizziness when they turn their heads quickly or with position changes like bending forwards to tie their shoes or looking upwards.

47. Gaze Stabilization Exercises Gaze stabilization exercises are used to improve visual acuity and steadiness during head movements.

48. Balance Training Exercises Balance training exercises are a staple of vestibular rehabilitation and used to improve steadiness so patients can more successfully participate in activities of daily living, work and leisure or physical activities.

49. SURGICAL MANAGEMENT :- In case of labyrinthitis resulting from otitis media ,perform myringotomy. A ventilating tube also may indicated Labyrinthectomy COMPLICATIONS Meningitis Permanent balance disability Permanent hearing loss

50. NURSING DIAGNOSIS Disturbed sensory perception related labyrinthitis Impaired verbal communications related to hearing loss Self esteem disturbance related to changes in body function Pain (acute or chronic ) related to labyrinthitis

51. DEAFNESS D eafness  is defined as a degree of hearing loss such that a person is unable to understand speech, even in the presence of amplification. OR A general deafness definition is a condition of extreme hearing loss. Deaf people have very little hearing or no hearing at all

52. CAUSES AND RISK FACTOR Conductive causes  include: Tumors or foreign objects in the ear canal and even impacted earwax Fluid in the ear Infections, including those that cause very high fevers or that can be passed from mother to baby during  pregnancy  or birth

53. Malformation of the outer or middle ear Perforated eardrum , which is a hole or tear in the eardrum Sensorineural causes  include: Diseases and illnesses, including viral infections, Meniere’s disease, and  autoimmune diseases , Drugs that damage hearing, or ototoxic drugs, such as some  antibiotics  and  cancer   chemotherapy  agents

54. Exposure to loud noise

55. LEVELS OF DEAFNESS Mild deafness or mild hearing impairment:  The person can only detect sounds between 25 and 29 decibels (dB). They may find it hard to understand the words other people are saying, especially if there is a lot of background noise. Moderate deafness or moderate hearing impairment:  The person can only detect sounds between 40 and 69 dB. Following a conversation using hearing alone is very difficult without using a hearing aid.

56. Severe deafness:  The person only hears sounds above 70 to 89 dB. A severely deaf person must either lip-read or use sign language in order to communicate, even if they have a hearing aid. Profound deafness:  Anybody who cannot hear a sound below 90dB has profound deafness. Some people with profound deafness cannot hear anything at all, at any decibel level. Communication is carried out using sign language, lip-reading, or reading and writing.

57. TYPES OF HEARING LOSS CONDUCTIVE HEARING LOSS This means that the vibrations are not passing through from the outer ear to the inner ear, specifically the cochlea. This type can occur for many reasons, including: an excessive build-up of  earwax an ear infection with  inflammation  and fluid buildup a perforated eardrum malfunction of the ossicles a defective eardrum

58. SENSORINEURAL HEARING LOSS Hearing loss is caused by dysfunction of the inner ear, the cochlea, auditory nerve, or brain damage. This kind of hearing loss is normally due to damaged hair cells in the cochlea. As humans grow older, hair cells lose some of their function, and hearing deteriorates. Long-term exposure to loud noises, especially high-frequency sounds, is another common reason for hair cell damage Sensorineural total deafness may occur as a result of congenital deformities, inner ear infections, or head trauma.

59. MIXED HEARING LOSS This is a combination of conductive and sensorineural hearing loss. Long-term ear infections can damage both the eardrum and the ossicles. UNILATERAL AND BILATERAL DEAFNESS Single-sided deafness (SDD), or unilateral deafness, refers to hearing impairment in just one ear, while bilateral deafness is hearing impairment in both

60. SIGN AND SYMPTOMS Tinnitus Vertigo Dizziness Postural imbalance Difficulty understanding words Poor speech discrimination Withdrawal from conversations

61. DIAGNOSTIC EVALUATION PHYSICAL EXAMINATION :- The doctor will look into the ear using an otoscope. This is an instrument with a light at the end. The following may be detected during the examination: a blockage caused by a foreign object a collapsed eardrum an accumulation of earwax an infection in the ear canal

62. Audiometer test:  The patient wears earphones, and sounds are directed into one ear at a time. A range of sounds is presented to the patient at various tones. The patient has to signal each time a sound is heard. Tympanometry Weber test Rinne test

63. TREATMENT HEARING AID :-Hearing aids consist of a battery, loudspeaker, amplifier, and microphone. Today, they are very small, discreet, and can fit inside the ear. Examples of hearing aids include

64. Behind-the-ear (BTE) hearing aids:  Hearing aids sits in a hard plastic case behind your ear. A plastic ear mold fits inside the outer ear and direct sound to the ear. A different type called a mini BTE fits entirely behind your ear with a narrow tube that goes into your ear canal. This helps keep earwax from building up and make sure your own voice sounds clear In the ear (ITE):- H earing aids fit completely inside your outer ear . They have a hard plastic case that holds the electronic. They are best for people with mild to severe

65. hearing loss Completely in the canal (CIC) hearing aids:  These are tiny, discreet devices but not recommended for people with severe hearing loss. An invisible in canal:- IIC aid is nearly impossible for other to see. You may put it in every day or it may be a device you wear for several months at a time

66. Lip reading Lipreading is the art of being able to see speech sounds. It is often called speechreading because people use other clues, such as facial expressions, gestures and surroundings, to help them understand what is being said. Lipreading can help people who are hearing impaired to cope better with their hearing loss . Not every word needs to be understood for lipreading to be useful

67. Other skills can be developed that help a person understand better what is being said.  Sign language This is a language that uses signs made with the hands, facial expressions, and body postures, but no sounds. It is used mainly by those who are deaf.