OTITIS MEDIA

BWALYA MUNJILI
(Msc. Nsg, Bsc. Nsg, RoTN, RN)

MUNJILI 1
 INTRODUCTION
 Behind the bones of the face there are some
hollow spaces, filled with air, which lead to the
nose cavity.
 These are known as the sinuses.
 Sinuses have the same mucous membrane
lining as the nose .
 The membrane produces a slimy secretion
(mucus), keeping the nasal passages moist.
 The mucus traps dirt particles and germs.
 SINUSITIS

 Sinusitis is the Inflammation of the mucous membrane

of any sinus, especially the paranasal.
 There are four main sets of sinuses, they are all paired.
 The inflammation could be caused by an infection from
a virus, bacteria or fungus.
 It may also be the result of an allergic or autoimmune
reaction.
 An autoimmune reaction is when the immune system
attacks the good parts of the body.
 PATHOPHYSIOLOGY
 Sinusitis causes the mucous membranes of the
nose, sinuses and throat (upper respiratory
tract) become inflamed.
 Swelling obstructs the sinus openings and
prevents mucus from draining normally,
causing facial pain and other sinusitis
symptoms.
 PATHOPHYSIOLOGY
 Blocked sinuses create a moist environment
that makes it easier for infection to take hold.
 Sinuses that become infected and can't drain
become pus filled, leading to symptoms such
as thick, yellow or greenish discharge and
other symptoms of infection.
 TYPES OF SINUSES
The maxillary sinuses
 These are found In each cheekbone.
 They are the largest sinuses, also the ones
that most commonly are affected when a
person has sinusitis.
 The frontal sinuses
 These are found above the eyes, either side of
the forehead
 Ethmoid sinuses
 These sinuses are found behind the bridge of
the nose, between the eyes
 Can also be broken down into anterior and
posterior - front and back
 Sphenoid sinuses
 These are found between the upper part of
the nose and behind the eyes.
 LOCATION OF SINUSITIS
 Maxillary sinusitis - the patient feels pain or pressure in the
cheek (maxillary) area. This can be experienced as toothache
or headache.
 Frontal sinusitis - the patient feels pain and/or pressure
behind or above the eyes (frontal sinus cavity). The pain will
generally be experienced as headache.
 Cont;d
 Ethmoid sinusitis - the patient feels pain
and/or pressure behind or between the eyes.
Usually as in the form of a headache.
 Sphenoid sinusitis - the patient usually feels
pain or pressure in the top part (vertex) of the
head.
 CLASSIFICATIONS OF SINUSITIS

Acute sinusitis (acute rhinosinusitis)

 A new infection that may last up to four weeks
 causes the cavities around the nasal passages
(sinuses) to become inflamed and swollen.
 This interferes with drainage and causes
mucus to build up.
 With acute sinusitis, it may be difficult to
breathe through the nose.
 The area around the eyes and face may feel
swollen, and client may have throbbing facial
pain or a headache.
 Most often caused by the common cold.
 Treatment of acute sinusitis depends on the
cause.
 In most cases, home remedies are all that's
needed.
 However, persistent sinusitis can lead to
serious infections and other complications.
 SIGNS AND SYMPTOMS

 Drainage of a thick, yellow or greenish

discharge from the nose or down the back of
the throat
 Nasal obstruction or congestion, causing
difficulty breathing through the nose
 Pain, tenderness, swelling and pressure
around the eyes, cheeks, nose or forehead.
 SIGNS AND SYMPTOMS CONT;d
 Aching in the upper jaw and teeth
 Reduced sense of smell and taste
 Cough, which may be worse at night
 Ear pain
 Headache
 Sore throat
 halitosis
 Fatigue
 Fever
 CAUSES OF ACUTE SINUSITIS

 Viral infection. Such as the common cold.

 Bacterial infection. When an upper
respiratory tract infection persists longer than
seven to 10 days.
 Fungal infection. Common in sinus
abnormalities or a weakened immune system.
 Causes Cont’d
 Allergies such as hay fever. Inflammation that
occurs with allergies may block the sinuses.
 Nasal polyps or tumors. These tissue growths
may block the nasal passages or sinuses.
 Deviated nasal septum— the wall between the
nostrils — may restrict or block sinus passages
 Tooth infection. A small number of cases of acute
sinusitis are caused by an infected tooth.
 Causes Cont’d
 Enlarged or infected adenoids in children.
Adenoids are located in the upper back part of
the throat.
 Other medical conditions. The complications
of cystic fibrosis, gastroesophageal reflux
disease (GERD) or immune system disorders
may result in blocked sinuses or an increased
risk of infection
 CHRONIC BACTERIAL SINUSITIS.

 Sinusitis that lasts more than 12 weeks, or

keeps coming back.
 can be caused by many different diseases that
share chronic inflammation of the sinuses as a
common symptom
 Develops when irreversible mucosal damage
occurs due to recurrent sinusitis or from
suppurative sinusitis being untreated.
 May be caused by S.aureus and H.influenzae
 SIGNS AND SYMPTOMS
 Nasal congestion with thick, green purulent
discharge for at least 3 months.
 Fever
 Facial pain
 Lightheadedness
 general malaise
 dizziness
 aching teeth
 halitosis
 DIAGNOSTIC TESTS
 Sinus aspirate for culture and sensitivity
 CT -scan of the sinuses to determine if there is
blockage of nasal sinus drainage system,polyps,
mucous plugs.
 Nasal endoscopy- involves inserting a flexible fiber-
optic tube with a light and camera at its tip into the
nose to examine the nasal passages and sinuses.
 Completely painless procedure which takes between
five to ten minutes to complete.
 FBC –leukocytosis is revealed of above 20,000/mm3
 SURGICAL MANAGEMENT

 Surgery is aimed at removing all diseased soft

tissue and bone.
 1. Functional Endoscopic Sinus Surgery- a
fiberoptic endoscope that illuminates and
magnifies to enter the sinus.
 Diseased tissue is located by CT-scan can be
dissected.
 The patient can either be under local or general
anaesthesia
 2. CALDWELL-LUC SINUS OPERATION

 Also known as Radical Antrum Operation

 Treated for chronic maxillary sinusitis that
cannot be treated with antibiotics.
 Local or general anaesthesia is used.
 An incision is made through the upper lip
 Part of the anterior bony wall of the antrum
producing a permanent window, and removes
all the diseased mucosa and periosteum
through the window.
 3. ETHMOIDECTOMY

 Removal of ethmoid air cells from ethmoid sinus

 Done to remove diseased mucosa and nasal
polyps
 General or local anaesthesia may be used.
 Removal of ethmoid cells creates a single large
cavity that is packed for 24 to 48 hours.
 The surgeon uses a headlight and operating
microscope or endoscope
 4.Antral irrigation/Maxillary antral puncture and
Lavage

 The client is put under local anaesthesia

 A large gauge needle is inserted into the maxillary
sinus on the affected side.
 Fluid or pus is drained from the sinus.
 The sinus is then irrigated with saline solution, an
antibiotic solution, or both.
 PREOPERATIVE PREPARATIONS

 Admit the patient and do pre-admission tests.

 Offer appropriate psychological care
 Find time for preoperative teachings
 Determine the patient’s understanding of the
surgical procedure and clarify any misconceptions
and answer patient’s and family questions.
 Starve patient 6 to 8 hours before surgery and
explain the reasons.
 PREOPERATIVE PREPARATIONS
 Remind the client that he will have a nasal
pack 24 to 48 hours after surgery which will be
slightly uncomfortable to him.
 Ensure patient has no fever prior to surgery
 On the day of surgery, the patient should have
all paperwork and meet the anesthesiologist.
 PREOPERATIVE PREPARATIONS
 The patient should only take the medication
approved by the surgeon and anesthesiologist.
 Obtain signed consent form prior to surgery.
 Prepare the patient physically such as shaving
moustache and cleansing the skin.
 POST OPERATIVE CARE

 If general anaesthesia is used ensure patent

airway.
 Position the client on the side to facilitate
drainage of secretions.
 This position also prevents swelling of the
surgical side and aspiration of bloody drainage
 Keep the mucous membrane moist and ensure
the room is humidified to prevent drying of oral
secretions.
 POST OPERATIVE CARE

 Elevate the head of the bed to mid- Fowler’s

position to prevent oedema and promote
drainage as soon as the client recovers from
anaesthesia.
 Apply ice compresses over the nose or
maxillary or frontal sinuses for a few hours
after surgery to help reduce swelling in the
operative area,constrict blood vessels,reduce
bleeding and relieve pain.
 POST OPERATIVE CARE

 The nurse to monitor any excessive bleeding from

the nose i.e. frequent swallowing is a clue
 Monitor for decreased visual acuity especially
diplopia which indicates damage to the optic nerve
or muscles of the globe of the eye.
 POST OPERATIVE CARE
 Monitor for pain over involved sinus, which
may indicate infection or inadequate drainage
 Monitor for elevated temperature
 Encourage mouth washes to prevent halitosis
 POST OPERATIVE CARE

 Emphasize on the importance of bed rest with

the head elevated .
 use of an ice pack wrapped in a towel to stop
any bleeding that commonly occurs.
 Recovery may take about 3 to 5 days;
 POST OPERATIVE CARE

 Health teaching after surgery should include;

 Pain management due to swelling and secretions in
the sinus
 Advise client to use Fowler's position in bed
 Client to avoid blowing the nose usually 3 to 4 days
after surgery or 2 weeks if Caldwell-Luc operation
was done.
 If the client feels congestion or fluid in the nose he
can gently sniff back the fluid and spit it onto the
tissue.
 POST OPERATIVE CARE

 Advise client not to bend over and not to lift

heavy objects as these put excessive pressure
on the surgical site.
 Promote measures that prevent constipation
 as straining can cause bleeding.
 Advise client not to chew on affected side
until incision heals in caldwell-Luc operation
 Use caution with oral hygiene to avoid injury
to the incision.
 POST OPERATIVE CARE

 Patients should take their prescribed

medications and avoid any strenuous activities
until cleared to do so by the surgeon.
 Follow-up care is critical for recovery
 Client to keep all appointments and follow
instructions in regard to removing nasal
packing and especially instructions on nasal
irrigation
 POST OPERATIVE CARE

Notify the surgeon for;

 excessive bleeding
 fever greater than 38.6 C that persists even
with the use of antipyretics
 sharp pain or headache not responsive to
medications
 increased swelling of nose or eyes and thin
clear fluid draining from the nose.
 TAKING CARE OF DRAINAGE
 Drainage after surgery may increase
accompanied by small amount of bright red
bleeding.
 This is normal and may continue for a week.
 A small dressing will be placed beneath the
nose to absorb any drainage
 Advise the client to change the dressing
several times each day.
 TAKING CARE OF DRAINAGE
 After initial bloody drainage stops, a thicker
yellowish green drainage may continue for
several weeks.
 Counsel the client on breathing difficulties as a
result of swollen mucous membrane
 This position reduces swelling and allows
better drainage of nasal secretions.
 Self-monitoring at home

 Self-care and prevention of complications

include; maximizing moisture in the nose, avoid
allergens, colds and the flu.
 Report signs of infection such as fever and
purulent discharge to surgeon
 Expect tarry stools from swallowed blood for a
few days
 Client to take prophylactic antibiotics as
prescribed.
NURSING PROBLEMS/ DIAGNOSIS
1. Acute pain related to inflammation of the
nose evidenced by patient verbalising
2. Anxiety related to lack of client knowledge
about disease and medical procedures
evidenced by patient being restless
3. Ineffective airway clearance related to nasal
secretion build up evidence by labored
breathing
NURSING PROBLEMS/ DIAGNOSIS
1. Disturbed sleep pattern related to clogged
nose evidenced by patient being awake
during the night
2. Imbalance nutrition less than body
requirements related to dereased apetite
secondary to sinus inflammation evidenced
by weight loss
 Complications of surgery

• Numbness of the lip or upper teeth due to

damage to the infraorbital nerve.
• Haemorrhage
• Infection
• Optic nerve damage
• Cerebrospinal fluid leak