Otitis media, or middle ear infection, is a common childhood illness that occurs when the middle ear becomes inflamed and infected. It can cause symptoms like ear pain, fever, hearing loss, and discharge from the ear. The document discusses the anatomy of the ear, signs and stages of otitis media, risk factors, potential complications, diagnosis, and treatment options which include antibiotics, surgery like myringotomy or tympanoplasty, and nursing care such as cleaning the infected ear and providing pain relief. Otitis media is usually treated with antibiotics but surgery may be needed in some cases to repair damage to the eardrum.

2. CONTENT
Otitis
Media
Introduction
&
Epidemiology
Definition &
Classification
Stages & Etiology
Pathophysiology
& Clinical
Features
Complications,
Diagnostic
Evaluation
Management,
Health Education
&
Conclusion

3. Anatomy Of Ear
The ear is the organ of hearing and
balance. The parts of the ear include:
•External or outer ear, consisting of:
1.Pinna or auricle. This is the outside
part of the ear.
2. External auditory canal or
tube. This is the tube that connects
the outer ear to the inside or middle
ear.

4. 3. Tympanic membrane (eardrum). The tympanic membrane
divides the external ear from the middle ear.
•Middle ear(tympanic cavity), consisting of:
A.Ossicles. Three small bones that are connected and transmit
the sound waves to the inner ear. The bones are called:
• Malleus
• Incus
• Stapes
B. Eustachian tube. A canal that links the middle ear with the
back of the nose. The eustachian tube helps to equalize the
pressure in the middle ear. Equalized pressure is needed for
the proper transfer of sound waves. The eustachian tube is
lined with mucous, just like the inside of the nose and throat.

5. •Inner ear, consisting of:
• Cochlea.This contains the nerves for
hearing.
• Vestibule.This contains receptors for
balance.
• Semicircular canals.This contains
receptors for balance.

6. Physiology Of Ear
Hearing starts with the outer ear.
When a sound is made outside the outer
ear, the sound waves, or vibrations, travel
down the external auditory canal and
strike the eardrum (tympanic membrane).
The eardrum vibrates. The vibrations are
then passed to 3 tiny bones in the middle
ear called the ossicles. The ossicles amplify
the sound. They send the sound waves to
the inner ear and into the fluid-filled
hearing organ (cochlea).
Once the sound waves reach the

7. Otitis Media (OM), inflammation of the middle ear, is one of
the most common pediatric medical problems even in India.
Children often experience OM as a continuum of symptoms. The disease
usually begins with an upper respiratory infection (URI). The infection then
spreads to the middle ear (ME). The ME infection may cause distressing acute
symptoms including fever, earache, ear drainage, hearing loss etc. or it may
continue for months with few symptoms. Often young children are unable to
communicate symptoms ; parents and caregivers must be on guard for the
signs of OM.

8. Epidemiology
In children <6 years
of age,
OM prevalence was
found to be
 9.2% in Nigeria,
 10% in Egypt,
 6.7% in China,
 9.2% in India,
 9.1% in Iran &
 5.1–7.8% in
Russia.

9. It is an inflammation of
middle ear that most
often occur in infant &
young children but can
occur at any age.

10. Otitis Media
Acute Otitis Media
(<3 Weeks)
Otitis Media with
Effusion
(3Weeks-3Months)
Chronic Otitis
Media
(>3Months)
Suppurative
Otitis Media
Acute Non-
Suppurative
Otitis Media

11. Inflammation of the middle ear that lasts for
more than 3months.
3. Chronic Otitis Media
1. Acute Otitis Media
AOM is defined as the first 3 weeks of a process in which the middle ear
shows the signs and symptoms of acute inflammation
2. Acute Suppurative Otistia Media
It is an acute suppurative inflammation of the
periosteal layer of the middle ear cleft by
Suppurative Organism.

12. Stages
Stage of Tubal
Occlusion
[Hyperemic]
Stage of
presuppuration
[Exudative]
Stage of
Suppuration
Stage of
Resolution

13. 1. Hyperemic Stage(Stage of Tubal Occlusion)
 TM Retracted
 Foreshortened Handle of malleus
 No cone of light
 Prominent lateral process of Malleus
2. Exudative Stage(Stage of Presuppuration)
 Cart Wheel appearance of the TM
 No cone of light

14. 3. Suppuration Stage
Bulging out Tympanic Membrane
Loss of anatomical landmarks
4. Stage of Resolution
 Ear ache relieved
 General condition
 Temperature decreases
 WBC count improves

15. Risk factors
 Age(Younger)
 Allergies
 Craniofacial Abnormalities
 Expose to environmental smoke or other respiratory irritants
 Family History
 Gastroesophageal Refulx Disease(GRD)
 Immunodefficiency
 No Breastfeeding
 Pacifier Use
 Upper Respiratory Tract Infections

16. • Age-common among children due to shorter Eustachian tube
• Diseases-
1. Adenoiditis,
2. Tonsillitis,
3. Rhinitis,
4. Sinusitis,
5. Phyringitis,
6. infection secondary to cleft palate
• Trauma to the tympanic membrane
• Head injury
• Barotrauma

17. Due to etiological factor
Exudates & edema in
middle ear
Decrease retraction of
tympanic membrane
Cont.….

18. Serous exudates in middle
ear
Pus Formation
Tympanic membrane
rupture
ACUTE OTITIS MEDIA

19. Clinical Features
• Fullness or heaviness in the ear
• Severe ear-ache at night
• Deafness
• Tinnitus
• TM gets retracted
• Cart wheel appearance of ear drum
• Itching
• Otorrhea
• Tenderness & Swelling

20. Clinical Stages
Otitis
Media
Benign
Perforation
Dangerous
Perforation
 Active Stage: Discharge is
actively flowing
 Quicient Stage: Ear remains dry
for >6weeks
 Inactive Stage: Ear remains dry for
dry for >6months
Active Stage
Inactive Stage

21. oAdenoidectomy,Tonsillectomy;Treatment of
Sinuses & DNS
oAntibiotic Ear Drops
oChemical like using of 50% Trichloro acetic
Acid
oTT Injection
oTympanoplasty
oMyringoplasty

22.  Suction & Cleaning of Cholesteatoma(Non
Cancerous skin growth)
 Excision of Polyps Atticotomy (Limited
Mastoidectomy)
 Tympanoplasty

23.  Severe Ear ache
 Persistent Headache
 Facial Weakness
 Fever
 Nausea & Vomiting
 Irritability & Neck Rigidity

24. Complications
 External Abscess
 Subdural Abscess
 Meningitis
 Otogenic Brain Abscess
 Lateral SinusThrombophlebitis
 Otitic Hydrocephalus

25. Diagnostic Evaluation
I. History Collection
II. Physical Examination
III. Otoscopic
Examination
IV. Audiometry
V. Tympanometry
VI. Culture

26. Management
Medical Pharmacological Surgical Nursing
Management

27. Medical Management
• Otoscopy
• Provide warm therapy around the ear canal
• Cleaning of discharge
• Avoiding heavy noise/high frequency sound
• Aural Toilet—dry mopping,suctioning
• Provide Mitten restraint

29. Pharmacological Management
a) Amoxillin –
100mg/kg/day
b) Amoxillin-clavulanate-
- 90/6.4mg/day
c) Ceftriaxone—
50mg/kg/day
d) Azithromycin
e) Cerumenolytics

30. Surgical Management
• Tympanocentesis
• Myringotomy
• Myingoplasty
• Tympanoplasty
• Ossiculoplasty
• OtoLAM
• Adenoidectomy

31.  Tympanocentesis is the drainage of fluid from the
middle ear usually caused by otitis media, by using a
small-gauge needle to puncture the tympanic
membrane, also known as the eardrum.
 Main indication for tympanocentesis is failed
treatment with antibiotics.
Tympanocentesis
Myringotomy
Surgical incision into the
eardrum, to relieve pressure
or drain fluid

32. Myringoplasty
A Myringoplasty is a surgery
performed by an otolaryngologist
to repair a hole in the eardrum.
Tympanoplasty
Tympanoplasty is the surgical operation
performed for the reconstruction of the
eardrum (tympanic membrane).

33. Ossiculoplasty
Ossiculoplasty is the reconstruction
of the middle ear ossicular chain
which has been disrupted or
destroyed, by the use of some
interpositioned devices which helps
in regaining the original mechanics of
the ossicular chain to transfer the
sound energy to the inner ear.
Otolam
Laser assisted Myringotomy

34. Adenoidectomy
Adenoidectomy is the surgical removal of
the adenoid for reasons which include
impaired breathing through the nose, chronic
infections, or recurrent earaches.
 The effectiveness of removing the adenoids
in children to improve recurrent nasal
symptoms and/or nasal obstruction has not
been well studied.

35. Nursing Management
• Assess the condition of the patient
• Do overall physical exam. Especially of the right ear
• Check the vital signs
• Do blood investigations
• Assess the severity of pain
• Assess the odor of the otorrhoea
• Assess the color of the ear discharge
• Do proper massaging to the forehead & scalp of the patient
• Do gauze & pad bandaging at the right ear
• Assess the frequency of ear discharge
• Provide psychological support

36. Nursing Diagnosis
1) Acute ear ache related to infection & inflammation
,pressure on Tympanic Membrane as evidenced by dull
facial expression.
2) Risk of infection related to purulent discharge from the
ear as evidenced by redness of the ear.
3) Disturbed Sensory(Auditory) perception related to Ear
ache as evidenced by asking frequent questions.

37. 1) Fear related to excessive ear-ache as well as ear
discharge as evidenced by changes in facial
expression.
2) Knowledge Deficit related to less information to the
family members as evidenced by asking Frequent
Questions
Cont.….

38. Nursing Diagnosis Objective Nursing interventions Rationale Evaluation
Acute ear
ache related
to infection &
inflammation
,pressure on
Tympanic
Membrane
as evidenced
by dull facial
expression.
To reduce the
level of pain
of the
patient
1. Assess the general
condition of the
patient.
2. Provide
comfortable
position to the
patient.
3. Check the vital
signs of the
patient.
4. Assess the
severity of ear-
ache & Otorrhea.
5. Administer
analgesics as per
doctor’s order.
1. To check for the
presence of any
abnormality.
2. To give comfort to
the patient.
3. To check the
changes in any
vital signs.
4. To check for any
abnormality in ear
discharge.
5. To release the
severity of pain.
The level of
pain of the
patient will
reduce to
some extent.

39. Nursing Diagnosis Objective Nursing interventions Rationale Evaluation
Risk of
infection
related to
purulent
discharge
from the
ear as
evidenced
by redness
of the ear.
To reduce
the
discharge
from the
ear.
1. Assess the condition
of the affected as
well as another ear.
2. Provide calm & cool
as well as crowd
free environment to
the patient.
3. Assess the colour,
content & odour of
the discharge.
4. Gently cleaning of
the discharge
coming from the
ear.
5. Administer ear
drops as per
doctor’s medication.
1. To check the
presence of any
abnormality.
2. To give comfort to
the patient.
3. To check the
presence of any
abnormality.
4. To clean the area as
well as to prevent
the spreading of
infection.
5. To prevent or
rehabilitate the
infective condition
of the patient.
The
quantity of
discharge
will be
reduced to
some
extent.

40. Nursing Diagnosis Objective Nursing interventions Rationale Evaluation
Fear related
to excessive
ear-ache as
well as ear
discharge
as
evidenced
by changes
in facial
expression.
To reduce
the level of
fear of the
patient.
1. Assess the level of
fear of the patient.
2. Provide calm & cool
as well as crowd
free environment to
the patient.
3. Give proper
explanation of the
each & every
procedure to the
patient.
4. Proper orientation
should be done of
the patient with the
other Health Team
members &
patients.
5. Give proper Health
Education to the
patient about the
disease condition.
1. To reduce the fear
of the patient.
2. To reduce the
anxiety level of the
patient.
3. To reduce the level
of fear of the
patient.
4. To feel free to
mingle & share
feelings with others.
5. For better
understanding
about the disease
condition.
The level of
fear of the
patient will
be reduced
to some
extent.

41. Diet :
Eat—
• Plenty of fruits,vegetables & whole grains
• Vitamin c riched foods
• Vitamin A & zink riched foods(Carrot ,Tomato)
• Include olive oil,fish oil,cocnut oil in daily diet
Avoid—
i. High-fat diet proven risk factor
ii. Body mass index category
iii. High protein
iv. More water
v. Sodium intake

42. Hygiene
A. The operated ear side should be cleaned
always.
B. The padded surgical area should be neat &
clean always(To prevent ear infection)
C. If the pad has been wet with
discharge(serous/purulent) consult & clean
the area at the earliest possible period.

44. 1. Which of the following representing Middle Ear Infection ?
a) b) c)
2. Which is not related with Otitis Media ?
a) Ear Drum Rupture c) Otorrhoeab) Rhinorrhoea

45.  Not all the cases of acute Otitis Media
need to be treated with antibiotics.
 Amoxicillin remains the first line choice of
drug for AOM
 Recurrent AOM within 3 months, or
recent antibiotic use, choose second line
antibiotics
 High dose amoxicillin for resistant cases
Conclusion

46. I. Rimple Sharma, ”Essentials of Paediatric Nursing”,Disorders of Skin,Eyes &
Ears,Second Edition,New Delhi:Jaypee Brothers Medical Publishers (P)
Ltd,2018,Page No.553-560.
II. Danishyar A, Ashurst JV. Acute Otitis Media. [Updated 2019 Jul 30]. In: StatPearls
[Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK470332/
III. Chonmaitree T., Trujillo R., Jennings K., Alvarez-Fernandez P., Patel JA., Loeffelholz
MJ., Nokso-Koivisto J., Matalon R., Pyles RB., Miller AL, and McCormick JP. (2016).
IV. https://en.wikipedia.org/wiki/Otitis_media
V. https://www.healthline.com/health/ear-infection-acute
VI. https://www.mayoclinic.org/diseases-conditions/ear-infections/symptoms-
causes/syc-20351616

47. Presented By
Dipankar Maiti
Cordially Thanks to
Mrs. Arathi Madam