focused in Nepal and children of nepal

1. Presented by :
Ekata karki
Bsn 3rd year

2. Otitis media
Otitis media is a group of inflammatory diseases
of the middle ear. It is most common infection of
infancy and early childhood (6 month and 2yrs of
age).study have shown prevalance of it is 27% in 3-8
age group.
Children are more prone due to
 Short wide and horizontally positioned Eustachian
tube.
 Poor develop cartilage lining.
 Enlarged lymphoid tissue
 Position during Breast feeding (supine position)

3. Types:
•Acute otitis media= <3mnth infection
 Otitis media with effusion (OME)=serous
discharge
 Chronic otitis media=>3mnth infection

5. Acute otitis media (AOM)
Acute inflammation of middle ear by
pyogenic organisms.
Aetiology
 Especially in infant and children usually following upper
respiratory tract infection
 Recurrent attack of common cold
 Tonsillitis
 Chronic rhinitis, sinusitis
 Cleft palate
 Packing of nose for epistaxis

7. Clinical features:
 Pain and discomfort (pull and rub infected ear)
 Fever
 Irritability ,restlessness ,crying, loss of appetite.
 Nasal congestion , cough ,vomiting& diarrhea.
 Ear discharge if perforated tympanic membrane.
 Hearing impairment.
Otoscopic examination
 Rough, red bulging tympanic membrane.
 Perforation of eardrum with discharge

8. Diagnosis
 Sensitivity test ( Suction) : To suck out any discharge, confirm
clinical findings and examination of the discharge for pus culture
and antibiotic sensitivity.
 Tuning fork tests
 Treatment
 Antibiotics
 Analgesic and Antipyretic
 Nasal decongestant- relieve Eustachian tube edema and
blockage.
 Local Heat application to relieve pain
 Myringotomy – incision to evacuate pus from middle ear when
tympanic membrane is bulging causing acute pain .

9. Otitis media with effusion(OME)
 Glue ear
 Inflammation of middle ear in which collection of
fluid is present in its space.
 May be serous , mucoid & purulent.
Cause:
ET tube obstruction & dysfunction (adenoids /neoplasm
of nasopharaynx)
URTI

10. Clinical features
 Mild to moderate hearing loss
 Feeling of blockage and pressure in the ear
 Sign of AOM may frequently present
Management
 Recover spontaneously after 3 month
 If exceed antibiotic therapy with myringotomy
insertion of tympanotomy tube ( ventilation tube)
 Amoxicillin (3-6 wks)
 Precaution during Swimming

11. Chronic suppurate otitis media
(CSOM)
 It is recurrent and persistent ear effusion due to
chronic infection
 May result due to neglected AOM & more common
among children with inadequate access to PHC.
Organism involved are
 Pseudomonas aeruginosa
 E.coli
 Streptococcal organism

12. Types:
 Non specific CSOM
 Tubo tympanic
 atticoantral
 Specific CSOM
 Tuberculous and allergic
 Tubo tympanic CSOM:
If the tympanic membrane fails to heal after AOM it is tubo
tympanic type
It is safe type because it usually doesnot produce
complication

13. Atticoantral CSOM:
chronic infection of mucosa of middle ear cleft
characterized by the presence of cholesteatoma.
Clinical feature:
 Recurrent ear discharge
 Hearing loss varying degree
 Perforation of TM
Diagnosis:
 Pus culture & sensitivity

14. Management:
 Medical management:
 Antibiotic: ( 7 days)
 Topical antibiotics ear drops with or without
steroids (7 to 10 days)
Management of URTI & allergy
Suction of discharge
 Surgical management:
Myringoplasty

15. FEATURES INDICATING COMPLICATION IN CSOM
Suggestive of intracranial complications
 Pain- uncommon in uncomplicated CSOM
 Vertigo , Persistent Headache
 Facial Weakness
 Feeding refusal by child and easily going to sleep
 Fever, Nausea and vomiting
 Irritability and neck rigidity

16. Nursing management:
 Assess the child for fever and pain and manage
accordingly.
 Administer prescribed medicine.
 Facilitate drainage and keep external ear clean and dry.
 Provide pt & family teaching.
 Give instruction about precaution to be apply to prevent its
reoccurrence
 Prevent water from entering ea
 Avoid swimming
 Avoid cleaning with hair clip bud
 Avoid blowing forcefully.
 Avoid bottle feeding
 Prompt management of acute URTI