MEDICAL SURGICAL NURSING -II

1. Mr. Manikandan.T,
RN., RM., M.Sc(N)., D.C.A .,(Ph.D)
Assistant Professor,
Dept. of Medical Surgical Nursing,
VMCON, Puducherry.

2. DEFINITION
• It is inflammation of the middle ear caused by
bacterial and viral infection

3. CAUSES
• Bacterial or viral upper respiratory infection
• Allergic reaction
• Exposure to smoke & cold climate
• Use of pacifiers
• Immunity

4. RISK FACTORS
• Family history
• Bottle fed infants
• People with chronic respiratory infection
• Poor feeding practice

5. TYPES
ACUTE
SEROUSCHRONIC

6. Acute O.M
• Acute infection of the middle ear lasting less
than 6 weeks

7. Etiology
• Bacterial infection- s. pneumoniae, H.
Influenza
• Upper respiratory infection
• Inflammation of surrounding structure (rhino
sinusitis, allergic rhinitis)
• Cigarette smoking
• Age younger than 12

8. Clinical features
• Otalgia
• Drainage from ear
• Fever
• Hearing loss

9. Medical management
• Antibiotic – penicillin & amoxicillin for
H.Inmfluenza
• Analgesic – aspirin
• Nasal vasoconstrictor- 0.5% ephedrine nasal
drops

10. Surgical management
• Myringotomy (tympanotomy)- incision made
on T.M and relieve pressure & to drain serous
/ purulent fluid

11. Serous otitismedia
• Infection of the middle ear involves presence
of fluids without evidence of infection

12. Causes
• Eustachian tube dysfunction- Upper
respiratory infection, allergy, nasopharyngeal
cancer

13. Clinical features
• Hearing loss
• Fullness in ear
• Crackling noises – nasal congestion
• Air bubbles may be seen in middle ear

14. Management
• Myringotomy
• Corticosteroid
• Nasal decongestant

15. Chronic O.M
• Recurrent acute O.M that causes irreversible
tissue pathology, chronic infection of middle
ear damages the T.M, Destroys the ossicles &
mastoid
• It last for more than 6 weeks

16. Causes
• Late treatment of acute O.M
• Upper airway sepsis
• Virulent Infection

17. Clinical features
• Hearing loss
• Foul smelling otorrhea
• Vertigo
• Perforation
• Choleseatoma – white mass behind the
tympanic membrane

18. Management
• Antibiotic - drops/ powders
• Surgery: tympanoplasty (5 types – type I
Myringoplasty & type II-V – more extensive
repair of middle ear structure)
• Ossiculoplsty: surgical reconstruction of ossicles
or ear bone to restore hearing(teflon, stainless
steel)
• Mastoidectomy : it removes the cholesteatoma.
Infection is eliminated by removing mastoid air
cells.

19. NURSING DIANOSIS
• Impaired verbal communication R/T ear
disorder, surgery
• Anxiety
• Pain
• R/F infection
• R/F injury R/T impaired balance or vertigo
• Knowlegde deficit