2. DEFINITION
Chronic otitis media is a long term inflammation or
infection of the middle ear, typically lasting for several
weeks or more. It is often characterised by persistent
fluid accumulation behind the eardrum, sometimes
accompanied by hearing loss, ear pain, and recurrent
infections.
4. ANATOMY
Ear has three parts :
• The outer ear - pinna (auricle), external auditory.
canal
• The middle ear - tympanic membrane (eardrum),
ossicles ( malleus, incus, stapes ), Eustachian tube
• The inner ear - cochlea, vestibular system (
semicircular canals, otolith organs - the utricle and
the saccule), auditory nerve
6. PATHOPHYSIOLOGY
Due to etiological factors
Exudates and Edema in middle ear
Increase retraction of tympanic membrane
Pus formation
Tympanic membrane perforation
Acute otitis media
Acute otorrhea
Chronic otitis media
7. ETIOLOGY
Family history
Genetic disorder
Poor hygiene of ear
Anatomical abnormalities of ear
Inappropriate treatment of acute otitis media
Any other ear infection, injury to the ear
Upper respiratory infection
Bacterial and viral infection
Eustachian tube dysfunction
Smoking
8. RISK FACTOR
Age
Allergies
Immunodeficiency
Upper respiratory tract infections
Gastroesophageal reflux
Family history of recurrent acute otitis media
Exposure to environmental smoke or other respiratory irritants
Previous ear infection
Seasonal factor
9. CLINICAL MANIFESTATION.
1. OTALGIA.
2. OTORRHEA.
3. FEVER.
4. RHINITIS.
5. HEARING LOSS.
6. IRRITABILITY.
7. TROUBLE HEARING IN THE EAR THATS BLOCKED.
8. A FELLING OF FULLNESS OR PRESSURE IN YOUR EAR.
9. YELLOW , BROWN OR WHITE DRAINGE FROM YOUR EAR.
10. TUGGING OR PULLING AT ONE OR BOTH EARS.
11. DIFFICULTY SLEEPING.
21. NURSING DIAGNOSIS
■ Acute pain related to inflammation and pressure in the middle ear due
to chronic otitis media.
■ Impaired hearing related to fluid accumulation in the middle ear due to
COM.
■ Risk for injury (e.g., falls) related to dizziness or balance issues caused
by otitis media.
■ Risk for infection related to compromised immune system or exposure
to pathogens.
■ Impaired comfort related to inflammation and pain in the middle ear
■ Risk for impaired communication related to decreased hearing and
difficulty understanding speech.
■ Risk for delayed development related to recurrent otitis media and
potential hearing loss in children.
■ Anxiety related to discomfort, uncertainty about treatment, or fear of
complications.
■ Deficient knowledge related to otitis media, its causes, treatment, and
22. NURSING MANAGEMENT
■ Assessment: Conduct a thorough assessment of the patient’s medical history, physical
examination focusing on the ears, checking for signs of inflammation, redness, or fluid behind
the eardrum.
■ Pain Management: Administer prescribed analgesics to relieve pain and discomfort associated
with otitis media. Monitor the patient’s pain level regularly and adjust pain management
strategies as needed.
■ Antibiotic Administration: Administer antibiotics as prescribed by the healthcare provider for
bacterial otitis media. Educate the patient and family about the importance of completing the
full course of antibiotics to prevent recurrence and antibiotic resistance.
■ Comfort Measures: Apply warm compresses to the affected ear to help relieve pain and
promote drainage of fluid. Encourage rest and provide a quiet, comfortable environment for
the patient.
■ Promotion of Fluid Drainage: Encourage the patient to adopt positions that facilitate fluid
drainage from the middle ear, like lying on the affected side or using gravity-assisted positions.
■ Monitoring and Observation: Monitor the patient’s vital signs, temperature, and symptoms
closely for any signs of worsening infection or complications. Document and report any changes
to the healthcare provider promptly.
■ Education: Provide patient and family education about otitis media, including its causes,
symptoms, and treatment.
■ Follow-Up Care: Schedule follow-up appointments to assess the patient’s response to
treatment, monitor for recurrence of symptoms, and ensure resolution of the infection.
■ Preventive Measures: Emphasize the importance of maintaining good ear hygiene and hand
hygiene, avoiding exposure to cigarette smoke or other irritants, strategies to prevent
recurrence, and ensuring vaccinations are up to date.
23. Assessment Diagnosis Gaol Intervention
Implementation Evaluation
Subjective
Patient says “I
am unable to
hear properly”
Objective data:-
Hearing ability
is reduced
Observed by
hearing test at
low voice.
Impaired
communication
related to
decreased
hearing and
difficulty in
understanding
speech.
To improve or
stabilize hearing
and
communication.
→Assess the level
of disturbed
auditory sensory
perception.
→Face the patient
patient during
speaking.
Speak dearly and
distinctly without
shouting In
proper light.
→ Use non-verbal
verbal clues such
as facial
expression
→ Avoid
environmental
noise.
→The level of
disturbed
auditory sensory
perception is
assessed.
→Patient is faced
during
communication
→
Communication
is done by
speaking clearly
without Shouting.
→ measures such
as non-verbal
clues are used.
→Environmental
noise such as
Shouting
reduced.
→Patient is better
better at
communication
and can
understand non
verbal clues.
24. Assessment Diagnosis Gaol Interventions Implementation Evaluation
Subjective
Data:
Patient
complains of
pain in ears,
and head.
Objective Data:
Patient’s face is
looking dull or
pale and his
facial
expressions
confirm the
pain
Pain related to
inflammation
and increased
pressure due to
fluid
accumulation
To reduce or
relieve the
pain.
• Assess the general
condition of the pt.
• Assess the level of
pain on pain scale.
.Assess the car for
any drainage or
bleeding.
• Assess for hearing
loss and change in
Speech.
• Implement
strategies to manage
pain effectively &
promote comfort
and rest.
• provide medication
for if needed.
• Ensure proper
positioning of the pt.
To aid in drainage &
recovery.
• General condition of
pt. is assessed.
Patient’s face is
looking dull, pulse is
slightly increased. P.R-
90/min.
• Pain level is assessed
.Pain Score = 07/10.
.Ear is assessed.
Their is yellowish
discharge from the
ears.
• Hearing loss and
change in speech is
assessed. Pt. Is unable
to follow instructions
and faces problem in
hearing
• Analgesics are
administered Voveron
50mg.
• proper position is
provided to the pt.
Lateral position is
provided.
Pain level is
reduced on pain
scale from 7 to 4
on scale.
Patient is feeling
relieved.
25. Assessment Diagnosis Goal interventions Implementation Evaluation
Subjective data:
Patient
complaint” I’m
having foul
smelling
discharge from
ear”
Objective data:
Observation
shows pus
accumulation in
the ear.
Infection related
to compromised
immune system
or exposure to
pathogens post
operatively.
To treat and
reduce further
complications
1.Advise family
members on
handwashing
techniques and the
importance of
covering their mouths
and noses when
sneezing or coughing.
2. Encourage
increased fluid intake,
good nutrition, and
adequate rest.
3.Eliminate allergens
and airway irritants
such as tobacco,
smoke, and dust.
4.Administer
antibiotics as
prescribed. Instruct
patient to take the full
course of antibiotics
1.Advised family
Members on
handwashing
techniques and the
importance of
personal hygiene
2. Encouraged
increased fluid intake,
good nutrition, and
adequate rest.
3.Eliminated allergens
and airway irritants
such as tobacco,
smoke, and dust.
4.Administed
antibiotics as
prescribed. Instructed
patient to take the full
course of antibiotics
Amount of pus
formation
reduced
28. Teach patient or caregiver to administrate ear medication. Drop
should be given at room temperature to avoid pain and dizziness.
Instruct patient to clean his/her ear in safe techniques . Thin
washcloth (cotton) or fingers are best for cleaning ears. Avoid
sharp objects and earbuds.
Instruct patient about the importance of routine examination.
Washing hands properly and maintain proper hand and ear
hygiene.
Explains to patient that topical analgesics must not be used if the
tympanic membrane ruptures.
30. Condition of the patient on
admission
• Ms. Archana came to LHMC OPD with complaint of pain in both the ears and
discharge from both the ears.
• She reports chronic ear pain , which is often accompanied by the by a whitish
yellowish discharge from both the ears.
• She isn’t able listen properly and have auditory difficulties from both the years
but not equally. R>L.
• When she was 8 years old she had this problem of discharge but neglected.
When she turned 20 years old her pain and discharged increased with the time.
• Clinical manifestation of my patient:- Discharge from both the ears and pain.
Hearing loss from both the ears.
31. CASE
Name: Suresh
Age/Sex: 24y/Male
Ward/Bed no. : Eye-ENT ward/09
CR no. : 20240011816
Occupation: Student
Diagnosis: Left chronic otitis media
DOA : 14/03/2024
DOS : 16/03/2024
DOD : 20/03/2024
32. HISTORY OF PRESENT ILLNESS
Came to the ENT OPD on 14/03/2024 with the c/o:
• Hearing loss from the past 1 year and
From the past 2 to 3 months with the following
complaints:
• left ear discharge (mucopurulent, foul smelling, blood
tinged)
• Earache
• Itching
33. ETIOLOGY
• Inappropriate treatment of acute otitis media
• Environmental Factors
RISK FACTORS
• Poor hygiene of ear
• Environmental Factors
• Recurrent Acute Otitis Media
35. TREATMENT
• Inj. Augmentin 1.2g IV TDS
• Inj. Voveron 75mg IM BD
• Tab. Pantop 40mg OD
• Tab. Cetrizine 10mg HS
• Tab. Chymoral forte BD
SURGICAL MANAGEMENT
• Tympanoplasty
• Mastoidectomy
36. Identification data
Name - Mr Sneh
Age- 29
Gender - Male
Occupation - Delivery service ( flipkart)
Religion - Hindu
Education qualification - 12 passed
CR no - 20245647
Diagnosis -chronic otitis media ( right ear)
Date Of admission - 7 Feb 2024
Address - K 51 wazipur colony, North West Delhi
37. About Patient Condition
Regarding Disease....
Patient is known case of otitis media since last 4 - 5 years
He Complains of ear discharge , foul in smell, blood stained since last
4-5 year ago
He Also complain of decreased hearing loss since 1-2 year ago
He took medication and got relief for sometime but later there was
reoccurence of symptoms..
So after not getting relief from medical management, he was opted
for surgical management
Tympanoplasty was done.... on 8 Feb 2024
39. IDENTIFICATION
NAME: RUDRA
AGE: 17 YEARS
SEX: MALE
RELIGION: HINDU
MARITAL STATUS: UNMARRIED
CR NO.: 2024002306
ADDRESS: NAVIGANJ,KANNAUJ,UTTER PRADESH, INDIA.
DIAGNOSIS: B/L INACTIVE MUCOSAL CHRONIC OTITIS MEDIA.
DATE OF ADMISSION: 18/03/2024
40. CONDITION OF PATIENT ON
ADMISSION
• PATIENT CAME TO ENT WARD FOR PLANNED SURGERY. HE
WAS CONSCIOUS, WILL ORIENTED TO TIME, PLACE& PERSON.
• HE CAME WITH CHIEF COMPLAIN OF HEARING LOSS FROM
BOTH EAR AND DISCHARGE FROM RIGHT EAR
• HER VITALS ARE STABLE
• T-98.2 °F
• P-78/MIN
• R-20/MIN
• BP-106/78
41. IDENTIFICATION DATA
Patient name :Babitha
Age/ gender: 38/female
CR no :. 20231107
Marital status: married
Occupation: housewife
Address: Rakesh marg ghazibad
Uttarpradesh 201001 India
Date of admission: 18/3/24
Diagnosis: acute otitis media
Qualification:. Tenth pass
Religion:. Hindu
Ward:. ENT ward
42. My patient Babitha is admitted on 18/3/24 in LHMC
ENT with severe ear pain and also puss is coming
from her ear.she is suffering from headache and fluid
discharge with sometimes blood also for past 3 to 4
days
She can't able to sleep and also she have feel of
lossing balnce while walking.she is also suffering from
difficulty in hearing.
Condition of patient
on admission
43. IDENTIFICATION DATA
Patient Name: Sunitha Rani
Age/Sex: 36Y/F
CR No.: 20230318351
DOA: 18/03/24
Diagnosis: Right Acute Otitis Media
Ward: ENT Ward
Bed No.: 7
Religion: Hindu
Qualification: 10th pass
Marital Status: Married
Occupation: Homemaker
44. CONDITION OF PATIENT
Mrs Sunitha Rani came to the LHMC OPD with the complaint
of continuous left ear pain and discharge for the past 1week.
She reports experiencing intermittent ear pain, which is
often accompanied by a foul-smelling discharge from the left
ear. The discharge has a yellowish color and occasionally
contains blood. This has been happening since past 1.5
years.
She noted a gradual decrease in hearing ability in the
affected ear for the past 6 months.
45. IDENTIFICATION DATA.
NAME : MS NEHA GUPTA.
AGE:27 YEARS.
ADDRESS: VAISHALI COLONY, UTTAR PRADESH.
EDUCATION QUALIFICATION: 12TH PASSED.
FAMILY INCOME: 10,000 PER MONTH.
OCCUPATION: HOUSE WIFE.
DIAGNOSIS:LEFT CHRONIC OTITIS MEDIA.
SURGERY: LEFT TYMPANOPLASTY.
46. Patient chief complain on
ADMISSION.
PATIENT COME IN HOSPITAL WITH THE COMPLAIN OF .
LEFT EAR DISCHARGE (4 MONTH)
LEFT EAR DECREASED HEARING (5 MONTH).
LEFT OTALAGIA ( 5 MONTH).
EAR DISCHARGE ( YELLOWISH , NON BLOOD STAINED).
PATIENT WAS CONSCIOUS TO TIME,PLACE AND PERSON AT THE TIME OF
ADMISSION.
VITALS AT THE TIME OF ADMISSION .
SPO2 : 99 PERCENT.
BP:120/ 80 MMHG.
PR : 60 BEATS PER MINUTE.
47. IDENTIFICATION DATA
Patient name :- sushma
Age/sex :- 35/ F
CR No. :- 20240000098
D.O.A :- 16/3/24
Diagnosis :- chronic otitis media
Ward :- ENT ward
Bed No. :- 11
Religion :- Hindu
Qualification :- graduation
Occupation :- house wife
Surgery :- left tympanoplasty
48. CONDITION OF THE PATIENT
Mrs sushma came to the LHMC OPD with the
complaint ofcontinuous left ear pain and discharge for
the last 10 years
She is admitted in the ENT Ward after investigation
was done for further treatment
She has difficulty in hearing through left ear
She was operated for the tympanoplasty on 17/3/24.
