D. E. SOCIETY’S SMT. SUBHADRA K.

JINDAL COLLEGE OF NURSING

OTITIS MEDIA
Ms. Ankita Rajput
First Year M.SC. Nursing
Specific objective:
 Define otitis media
 Explain related anatomy and physiology
 Explain etiology and risk factor of otitis media
 Enlist its classification of otitis media
 Explain pathophysiology of otitis media
 Enlist a clinical manifestation of otitis media
 Diagnostic test for otitis media
 Explain complications of otitis media
 Explain management of patient with otitis media
DEFINATION OF OTITIS MEDIA
◦ Otitis media is a general term that refers to inflammation of the
mucous membranes of the middle ear, eustachian tube and mastoid.
The mucous membranes are continuous with those of the
respiratory tract and infection can easily ascend to the ear.
INCIDENCE
1 in 10 children suffer from otitis media annually. This is 10
times the amount of adults who suffer from the same condition
annually.
Otitis media is one of the most common reasons for children
below the age of 4 with a fever to visit a general practitioner.
 It composes 8% of all childhood disease, and accounts for
1.3% of presentations to general practice.
Chronic otitis media with effusion interferes with the hearing
of approximately 5% of 5 year olds.
Related anatomy and physiology
Middle ear
◦Predisposing factors for otitis media are:
Age: This is the most important risk factor for developing otitis
media. Most commonly, it occurs between the ages of 6 and 18
months. The younger the child, the more severe the disease and
greater the risk of complications.
Daycare
Non-breastfed children
Tobacco smoke
Pacifier use
Genetic factors: Increased incidence among twins
Cont…
Social and economic conditions
Sleep position
Season: Increased incidence during autumn and winter.
Altered host defenses
Underlying disease (e.g. cleft palate, downs
syndrome, allergic rhinitis)
Ethnicity (e.g. Aboriginal and Torres Strait Islanders)
Children in developing areas
Family history of otitis media
Classification of otitis media
Otitis media

◦
suppurative Non suppurative

Acute chronic Acute chronic adhesive

Tubotympanic Atticoantral (unsafe

(safe tube) tube)
◦ Suppurative otitis media is a fluid buildup in the ear with
pus formation, while nonsuppurative lacks pus formation
◦ Chronic suppurative otitis media (CSOM) is the result of
an initial episode of acute otitis media and is characterized
by a persistent discharge from the middle ear through a
tympanic perforation. It is an important cause of
preventable hearing loss,
Pathophysiology of otitis media
◦ Due to the etiological factor

Exudates and edema in middle ear

Decrees retraction of tympanic membrane

Serous exudates in middle ear

Pus formation

Tympanic membrane rupture

Acute otitis media

Chronic otitis media

Clinical manifestation
Catarrhal stage (Stage of
congestion): 1
Oedema and hyperaemia of
nasopharyngeal end of Eustachian
tube blocks the tube, leading to
absorption of air and negative
intratympanic pressure.
Stage of Exudation2: As the
inflammatory process progresses,
exudate collects in the middle ear.
Tympanic membrane becomes
congested.
Symptoms: Deafness and earache Signs: Retracted tympanic
are the two symptoms but they are membrane, loss of light reflex.
not marked. There is generally no Tuning fork test shows conductive
fever. deafness
Symptoms: Marked earache Sign: The ear drum is congested
which may disturb sleep and is of and bulging.
throbbing nature. Deafness and
tinnitus are also present, but
complained only by adults.
Usually, child runs high degree of
fever and is restless.
Stage of Suppuration 3: This is
marked by formation of pus in the
middle ear and to some extent in
mastoid air cells. Tympanic
membrane starts bulging to the
point of rupture.
Stage of resolution4: The TM
ruptures with release of pus and
subsidence of symptoms.
Inflammatory process begins to
resolve. If proper treatment is
started early or if the infection
was mild, resolution may start
even without rupture of TM.
Symptoms: Earache becomes
excruciating. Deafness increases.
Child may run fever of 102-103oF.
This may be accompanied by
vomiting and even convulsions.
Symptoms: Earache becomes
excruciating. Deafness increases.
Child may run fever of 102-103oF.
This may be accompanied by
vomiting and even convulsions.
Signs: TM appears red and
bulging with loss of landmarks. A
yellow spot may be seen on the
TM where rupture is imminent.
Tenderness may be elicited over
the mastoid antrum.
Signs: TM appears red and
bulging with loss of landmarks. A
yellow spot may be seen on the
TM where rupture is imminent.
Tenderness may be elicited over
the mastoid antrum.
◦ Stage of complication 5:
If virulence of organism is high or resistance of patient poor, resolution may not take place and disease
spreads beyond the confines of middle ear. It may lead to acute mastoiditis, facial paralysis, labyrinthitis,
extradural abscess, meningitis or brain abscess
Diagnostic evaluation
Physical examination
Otoscopic examination
Culture
Audiometry
Other test( temporal bone CT and MRI )
Complications of otitis media
Aom can shift to Csom or Eom.
In addition, other complications of the chronic otitis media include.
Sensorineural hearing loss.
Facial nerve dysfunction.
Lateral sinus thrombosis.
Brain or subdural abscess.
Meningitis.
 In otitis media with effusion, patient complaints of a feeling of
fullness of the ear, “plugged feeling” or propping and decreased
hearing.
◦ MANAGEMENT:-
◦ PREVENTIVE MANAGEMENT
exclusive breastfeeding.
Pneumococcal conjugate vaccines (PCV) in early infancy decrease
the risk of acute otitis media in healthy infants.
 Avoid environmental exposure to tobacco smoke.
Avoid use of Pacifier.
Avoid a Long-term antibiotics and avoid antibiotic resistant
 use sugar substitute xylitol (kills the bacteria )may reduce
infection rates in those who go to day-care.
MEDICAL MANAGEMENT: -

 The diagnosis of otitis media is usually made, based on the

patients’ symptoms of acute ear pain and fever. Otoscopic
examination of the ear canal readily reveals the inflamed bulging
tympanic membrane and perforator or drainage if present. Mastoid
x ray may be useful. The aim of treatment is to clear the middle ear
infection.
 Antibiotic therapy is the key to treatment of otitis media.
The common medication for treatment of otitis media include the
following:
ANTIBIOTICS
(e.g. Amoxicillin trimethoprim sulphate, methoxazole, amoxicillin clavulanate and cofactor.)

ANALGESICS
(e.g. analgesics, antipyretics, narcotic, acetaminophen with codes. )

ANTIHISTAMINES
(e.g., chlorpheniramine)

DECONGESTANTS
(Pseudoephedrine is used to relieve nasal or sinus congestion )

THE SYSTEMIC ANTIBIOTIC THERAPY

 SURGICAL MANAGEMENT: -

 Surgical interventions may be necessary if

attempts to control the infection medically are
unsuccessful. The ossicles become neurotic. Repairing the
damage of middle ear infection requires difficult
microsurgical procedure, which includes tympano-
ossiculoplasty and mastoidectomy. The surgical therapy for
chronic ear infected includes:
SURGICAL MANAGEMENT: -

Myringotomy
MYRINGOPLASTY
TYMPANOPLASTY
TYMPANOPLASTY WITHOUT MASTOIDECTOMY
Myringotomy
◦ With or without tubes are performed to regain a normal middle ear
and eustachian tube function. Myringotomy involves making tiny
incision in the tympanic membrane through which the fluid can be
suctioned.
◦ To keep the incision open and prevent re-accumulation
of fluid, various types of trans tympanic tube can be inserted with
incision. These tubes fall out by themselves in 3 to 12 months.
 Tympanoplasty
◦ Tympanoplasty
◦ The most common surgical procedure for chronic otitis media is a
tympanoplasty, or surgical reconstruction of the tympanic membrane.
Reconstruction of the ossicles may also be required.
◦ Purposes
◦ To reestablish middle ear function
◦ Close the perforation,
◦ Prevent recurrent infection, and
◦ Improve hearing.
There are five types of tympanoplasties.
Type I tympanoplasty is called myringoplasty and only involves the
restoration of the perforated eardrum by grafting.
Type II tympanoplasty is used for tympanic membrane perforations with
erosion of malleus. It involves grafting onto the incus or the remains of the
malleus.
Type III tympanoplasty is indicated when the incus and malleus are absent
with the stapes still intact and mobile. It involves placing a graft onto the
head of the stapes.
Type IV tympanoplasty: The superstructure of the stapes is absent. The oval
window is exposed to the exterior, while the round window and the
Eustachian tube opening are protected by the grafted ear drum (Baffle effect).
Type V tympanoplasty is used when the footplate of the stapes is fixed.
Myringoplasty: It is the repair of the defect in the TM. The middle
ear and the mastoid cavity are not inspected. Such a procedure may
be carried out when:
The perforation is small
Patching the perforation by a piece of cigarette paper improves the
hearing
The hearing loss is mild
Nursing management
The nurse will assist in all the aspects of management of otitis
media which include ear irrigation, instillation of otic drops,
powders, acetic acid drops, and administration of analgesics,
antiemetics systematic antibiotics and pre-operation and post-
operation care for patients who are under grave surgical trauma.
The nurse instructs the patient against having water in the ear
during treatment. This includes showering and shampooing as well
as swimming. Commercial plugs or other barriers may be used as
temporary protections during shampooing. If an ear wash is
prescribed, the nurse teaches the patient and designated family
caregiver how to perform ear wash safely at homes. It should be
noted that
Nursing management
Most patients undergoing for surgery have very short-term hospitalization.
The nurse teaches the patient what to expect after discharge and how to
promote healing during the recovery period. The nurse teaches the patient
what to expect after discharge and how to promote healing during the
recovery period. The nurse informs the patient that decreased hearing is
expected initially from the presence of swelling and packing in the ear.
Cracking or popping noises are commonly heard in the affected ear and are
expected. Minor earache and discomfort in check and jaw are common, but
should be managed effectively with mild analgesics.
Dizziness or light-headedness may also be present, initially the patient
should be cautious when getting out of the bed and walking. Bleeding and
drainage are negligible. A cotton ball frequently provides adequate dressing.
HEALTH EDUCATION AFTER SURGERY: -

sneezing or coughing, with the mouth open or needed for the first
week after surgery.
Blow the nose gently as needed, one side at a time.
Avoid the vigorous activity until approved by the surgeon.
Change the cotton ball dressing as prescribed.
Report any drainage other than a slight amount of bleeding to the
surgeon.
Keep ear dry for 6 weeks after surgery.
Balance ear pressure as needed by holding nose, closing mouth
and swallowing.
 Acute pain related to disease condition as
evidenced by patient verbalization.

Altered auditory sensation perception related

to fluid accumulation in middle ear as
NURSING evidenced by patient unable to respond.

DIAGNOSIS
Knowledge deficit related to disease process
and treatment as evidenced by patient is
having many doubts.

Risk for infection related to decreased

immune response
Assignment
Define otitis media.
Enlist types of otitis media.
write medical and surgical management for otitis media.