otitis media, notes and ppt

1. MRS. M.J. SYLVIA JOICE., M.SC (N),
LETURER,
DEPT OF MEDICAL SURGICALNURSIG,
GANGA COLLEGE OF NURSING.

2. MRS.SYLVIA JOICE.M.J.
LECTURER,
MEDICAL SRGICAL
NURSING.
OTITIS
MEDIA

3. DEFINITION:
Inflammation of the mucus membrane of the
middle ear, eustachian tube and the mastoid
bone.

4. TYPES OF OTITIS MEDIA:
1. SUPPURATIVE OTITIS MEDIA (SOM) :
a. Acute Suppurative otitis media
(ASOM)
b. Chronic Suppurative otitis media
(CSOM)
i. Atico – antral type
ii. Tubo-tympanic type

5. 2. NON SUPPURATIVE OTITIS MEDIA
3. ADHESIVE OTITIS MEDIA
4. BARO-TRAUMATIC OTITIS MEDIA
5. TUBERCULAR OTITIS MEDIA

6. 1. SUPPURATIVE OTITIS
MEDIA:
a. Acute Suppurative otitis media (ASOM):
It is an acute painful type of middle ear
infection and inflammation of the
mucosa of middle ear cleft with
suppuration usually lasting less than six
weeks

7. b. Chronic Otitis media (CSOM) :
 It is the long standing infection of the
middle ear with inflammation.
It lasts for more than six weeks.
It is characterized by ear discharge and
tympanic membrane permanent
perforation

8. i. Atico-antral otitis media : Inflammation
involves mastoid bone tympanic
membrane and ossicles
ii. Tubo-tympanic otitis medi: It is acute
inflammation with muco- purulent discharge
and permanent tympanic perforation.

9. 2. NON SUPPURTIVE OTITIS
MEDIA [NSOM]
It is also called as
Serous / Secretory otitis media (SOM)
Otitis media with effusion (OME)
Collection of fluid in middle ear due to negative
pressure produced by obstruction of eustachian
tube and tympanic membrane retraction

10. 3. ADHESIVE OTITIS MEDIA:
If fluid is present in the middle ear for a
prolonged period, the tympanic membrane
retracts and will become adhesive
. Tubercular otitis media:
Persons infected with mycobacterium tubercle
or suffering with tuberculosis will cause middle
ear infection and inflammation.

11. 4. TUBERCULAR OTITIS
MEDIA:
Persons infected with mycobacterium tubercle
or suffering with tuberculosis will cause middle
ear infection and inflammation.

12. 5. BARO-TRAUMATIC OTITIS
MEDIA:
 Normally, Eustachian tube opens by muscular action &
allows air pressure within middle ear adjusted with the
atmosphere
 Failure or inability- causes “Locked”. Due to ascent in
aircraft, the air pressure decreases and descent in
aircraft the air pressure increases
 It leads to difference in atmospheric and intra-tympanic
pressure ( >90mmHg)

13. ETIOLOGY
:
Bacteria
 Virus
Tumor
Polyps
Measles
Nasal pack
Cleft palate
Perforation
Trauma

14. ETIOLOGY CONT:
 Upper Respiratory tract infections
 Deviated nasal septum
 Palatal paralysis
 Short & wide eustachian tube
 Immunological disorders of middle ear mucosa
 Allergies: Dandruff, soaps, hair sprays, hair
dyes etc.

15. PATHOPHYSIOLOGY:
URTI, BACTERIA AND OTHER ETIOLOGY
EXUDATES & EDEMA IN MIDDLE EAR
ECREASE TERACTION OF TYMPANIC MEMBRANE
SEROUS EXUDATES IN MIDDLE EAR
PUS FORMATION
RUPTURE OF THE TYMPANIC MEMBRANE
OTITIS MEDIA

16. CLINICAL
MANIFESTATIONS:
 Otalgia (ear pain)
 Deafness (Unilateral & Bilateral)
 Tinnitus (ringing sound in ear)
 Vertigo (dizziness)
 Defect in language & speech
 Fever (>101- 103 degree F)
 Malaise , Vomiting

17. Otorrhoea (Profuse foul smelling discharge)
Tympanosclerosis
Scarring of tissues
After rupture results in
 Decreased pain
Reduced temperature
Decreased mastoid tenderness

18. DIAGNOSTIC
INVESTIGATIONS:
 Hearing assessment – reveals impairment in hearing
 Bacteriology – Culture represents the type of
bacterial infection
 Radiology- represents inflammatory process of
mastoid bone
 Allergic test- able to identify causative factor for
inflammation of ear and immunologic status
 Blood study- reveals elevated levels of leucocytes,
neutrophils, cholesterol

19. MEDICAL MANAGEMENT:
Aim – To control infection
To ensure complete resolution
Symptomatic relief
Ensure patency for drainage, ventilation

20. 1. ACTIVE STAGE:
 Antibiotics, decongestant, antihistamines to be
given
 Symptomatic relief- Bed rest, fluid increase,
analgesic, antipyretics, dry heat application
 Local treatment- if perforated
A. Aural Toilet (Dry mopping)-cleaning ear
with sterile cotton tipped probe/microscope
B. Culture sensitivity

21. TUBERCULAR OTITIS
MEDIA:
i. General treatment:
Anti tubercular drugs
ii. Local treatment:
 Aural toileting- cleaning ear with
sterile cotton tipped probe
 Insufflations of streptomycin
powder

22. 2. QUIESCENT STAGE:
Tetanus immunization
All inattentive and dull persons to be
investigated for middle ear effusion and
deafness
Sinusitis – to be controlled
Removal of adenoids
Immunological disorders to be corrected

23. FOLLOW
PRECAUTIONS:
Sniffing habits – to be stopped
Plug ear during hair wash
Avoid the following
entry of water in ear during swimming
and diving
cleaning with dirty cotton or linen

24. 3. IN ACTIVE STAGE:
If ear remains dry for 3-6 months
closure of perforation to be done
Adenoidectomy ( removal of adenoids)
Septoplasty (repair of septum)
Aural polypectomy (removal of polyp)
Myringoplasty (repair of tympanic membrane)

25. 4. HEALING STAGE:
Ensures complete resolution
Full auditory function

26. COMPLICATIONS:
1. Mastoiditis:
inflammation of the mastoid process
2. Petrositis:
inflammation of temporal bone
3. Facial nerve palsy:
paralysis of facial muscles

27. 4. Brain abscess:
collection of pus in cavity of brain cells
5. Labyrinthitis:
 inflammation of inner ear
6. Meningitis:
 inflammation of coverings of brain
7. Abscess:
It is the formation of cavity and collection of pus

28. NURSING MANAGEMENT:
 Collect health history including complete description
about ear problem
 Collect data about the duration, intensity of the
problem, its causes and previous treatments
 Obtain information about other health problems &
medications
 Physical assessment includes observation for
erythema, edema, otorrhoea, lesions and
characteristics such as odor and color of discharge.

29. NURSING DIAGNOSIS:
Pain in ear related to inflammation of middle
ear cavity or surgical procedure
Hyperthermia related to infection of the middle
ear
Ineffective individual coping related to impaired
hearing acuity, fluid collection
Altered auditory sensory perception related to
preoperative hearing loss, fluid in middle ear
Risk for infection related to tubal occlusion in
middle ear