The document provides a comprehensive overview of otitis media, including its definition, epidemiology, clinical manifestations, and management strategies for a 6-year-old male patient diagnosed with the condition. It outlines patient demographics, relevant history, and investigative procedures, such as otoscopic examination and tympanometry. Management recommendations emphasize the use of amoxicillin as the first-line treatment to address the primary pathogens involved.

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BY: -
CLIFFORD ACHOKA(BSCN)

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Table of Contents
1.Patient demographic Data.................................................................................................................4
2. Literature review.............................................................................................................................4
Definition.......................................................................................................................................5
Epidemiology .................................................................................................................................6
Predisposing factor .........................................................................................................................6
Pathophysiology .............................................................................................................................7
Clinical manifestation .....................................................................................................................8
Prognosis .......................................................................................................................................9
Differential diagnosis ......................................................................................................................9
3.Assessment of patient under study...................................................................................................11
History taking...............................................................................................................................11
Chief complaint.........................................................................................................................11
History of presenting illness.......................................................................................................11
Past medical history...................................................................................................................11
Past surgical history...................................................................................................................11
Family history...........................................................................................................................11
Personal history.........................................................................................................................12
4.Investigative procedures.................................................................................................................12
General Examination .................................................................................................................12
Vital signs.................................................................................................................................12
5.Management..................................................................................................................................15

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Prevention and control ..................................................................................................................18
NURSING CAREPLAN...................................................................................................................25

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1.Patient demographic Data
Name: J.O.O
Age: 6 years
Sex: Male
Ward: ENT clinic(out-patient)
Medical Diagnosis: Otitis media
Religion: Christian
Address: Railways
2. Literature review
OTITIS MEDIA
Basic anatomy review
Let’s start with a quick anatomic review. The ear is made of three distinct parts:

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• the external ear
• the middle ear
• and the inner ear.
The external ear is formed by the auricle and the external acoustic meatus. It is separated from
the middle ear by the tympanic membrane, or TM. Its function is to funnel sound waves to the
tympanic membrane.
The middle ear is a cavity filled with air. It contains three auditory ossicles: the malleus, incus,
and stapes. The middle ear acts like a “sound box” which amplifies sound waves so they are
detected by neurosensorial afferences. The Eustachian tube is a canal between the middle ear and
the nasopharynx. The Eustachian tube acts like a valve that has three main functions: to drain
middle ear fluids, to equalize pressures across the tympanic membrane, and to protect middle ear
from nasopharynx pathogens and chemical agents.
The inner ear contains two distinct structures: the cochlea and the semicircular canals. The semi-
circular canals are the sensory organs of balance while the cochlea is a sensory organ that
converts sound waves into electrical impulses.
Definition
Otitis media is a group of inflammatory diseases of the middle ear (Qurieshi A.l.,2014). It is
also known as Inflammation of the middle ear. May also involve inflammation of mastoid,
petrous apex, and peri labyrinthine air cells.
Classification
There are several subtypes of OM, as follows:
 Acute OM (AOM)
The most common bacteria isolated from the middle ear in AOM are Streptococcus
pneumoniae, Hemophilus influenzae, Moraxella catarrhalis, and Staphylococcus aureus. -
rapid onset of signs & symptoms, < 3 wks. course
 OM with effusion (OME)

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Otitis media with effusion (OME), also known as serous otitis media (SOM) or secretory
otitis media (SOM), and colloquially referred to as 'glue ear,'[25] is fluid accumulation
that can occur in the middle ear and mastoid air cells due to negative pressure produced
by dysfunction of the Eustachian tube. This can be associated with a viral URI or
bacterial infection such as otitis media (Rosenfeld RM., 2004).
 Chronic suppurative OM
Chronic suppurative otitis media (CSOM) is a chronic inflammation of the middle ear
and mastoid cavity that is characterized by discharge from the middle ear through a
perforated tympanic membrane for at least 6 weeks
 Adhesive OM
Adhesive otitis media occurs when a thin retracted ear drum becomes sucked into the
middle-ear space and stuck (i.e., adherent) to the ossicles and other bones of the middle
ear.
Epidemiology
Acute otitis media is very common in childhood. It is the most common condition for which
medical care is provided in children under five years of age in the US (John D.D., 2013). Acute
otitis media affects 11% of people each year (709 million cases) with half occurring in those
below five years (Monasta L.,2012) Chronic suppurative otitis media affects about 5% or 31
million of these cases with 22.6% of cases occurring annually under the age of five years. Otitis
media resulted in 2,400 deaths in 2013—down from 4,900 deaths in 1990(GBD.,2013).
Predisposing factor
The risk factors for OM include:
 being between 6 and 36 months old
 using a pacifier
 attending daycare
 being bottle fed instead of breastfed (in infants)
 drinking while laying down (in infants)
 being exposed to cigarette smoke

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 being exposed to high levels of air pollution
 experiencing changes in altitude
 experiencing changes in climate
 being in a cold climate
 having had a recent cold, flu, sinus, or ear infection
 Genetics also plays a role in increasing your child’s risk of AOM.
Causes
The common cause of all forms of otitis media is dysfunction of the Eustachian tube (Bluestone
CD.,2005). This is usually due to inflammation of the mucous membranes in the nasopharynx,
which can be caused by a viral URTI, strep throat, or possibly by allergies.
The eustachian tube can become swollen or blocked for several reasons:
 allergies
 a cold
 the flu
 a sinus infection
 infected or enlarged adenoids
 cigarette smoke
 drinking while laying down (in infants)
Pathophysiology
. The common cause of all forms of otitis media is dysfunction of the Eustachian tube. This is
usually due to inflammation of the mucous membranes in the nasopharynx, which can be
caused by a viral URTI, strep throat, or possibly by allergies. Because of the dysfunction of
the Eustachian tube, the gas volume in the middle ear is trapped and parts of it are slowly
absorbed by the surrounding tissues, leading to negative pressure in the middle ear.
Eventually, the negative middle-ear pressure can reach a point where fluid from the
surrounding tissues is sucked into the middle ear's cavity (tympanic cavity), causing a
middle-ear effusion.
1. Catarrhal stage: is characterized by occlusion of Eustachian tube and congestion of middle
ear.

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2. Stage of exudation: Exudate collects in the middle ear and ear drum is pushed laterally.
Initially the exudate is mucoid, later it becomes purulent.
3. Stage of suppuration: Pus in the middle ear collects under tension, stretches the drum &
perforates it by pressure necrosis & the exudate starts escaping into external auditory canal.
4. Stage of healing: The infection starts resolving from any of the stages mentioned & usually
clears up completely without leaving any sequelae.
5. Stage of complications: Infection may spread to the mastoid antrum. Initially it causes
Catarrhal mastoiditis [congestion of the mastoid mucosa], stage of Coalescent mastoiditis &
later empyema of the mastoid.
Clinical manifestation
1. Catarrhal stage (stage of congestion)
 Fullness or heaviness in the ear
 Severe ear pain at night
 Deafness
 Tinnitus (ringing or buzzing in the ear)
 Autophony (spoken words of patient echo in his
 ears)
 TM (ear drum) gets retracted
 Cart wheel appearance of ear drum
 Absence of light reflex
2. Stage of exudation
 All symptoms become more severe.
3. Stage of suppuration
 Perforation of Ear drum
 Otorrhoea with mucoid purulent discharge
 Pulsatile discharge (ear discharge with each arterial dilation) [Lighthouse sign]
4. Stage of healing

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 Healing starts in this stage
5. Stage of complication
 Spread of infection to mastoid
Prognosis
Death from AOM is rare in the era of modern medicine. With effective antibiotic therapy, the
systemic signs of fever and lethargy should begin to dissipate, along with the localized pain,
within 48 hours. Children with fewer than 3 episodes are 3 times more likely to resolve with a
single course of antibiotics, as are children who develop AOM in nonwinter months. Typically,
patients eventually recover the conductive hearing loss associated with AOM.
Middle ear effusion and conductive hearing loss can be expected to persist well beyond the
duration of therapy, with up to 70% of children expected to have middle ear effusion after 14
days, 50% at 1 month, 20% at 2 months, and 10% after 3 months, irrespective of therapy.
In most instances, persistent middle ear effusion can merely be observed without antimicrobial
therapy; however, a second course of either the same antibiotic or a drug of a different
mechanism of action may be warranted to prevent a relapse before resolution.
Differential diagnosis
Disease/Condition Differentiating
Signs/Symptoms
Differentiating Tests
Otitis media with effusion Typically the middle ear
effusion is asymptomatic
On otoscopy these patients
have an effusion of any color,
air fluid levels, or bubbles
with normal tympanic
membrane landmarks.
Myringitis These patients may have no
symptoms attributable to the
middle ear
On otoscopy there is
erythema and injection of the
tympanic membrane in the

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neutral position without other
features of otitis media
Mastoiditis There is edema, erythema,
and tenderness over the
mastoid process
Diagnosis is clinical based on
history and examination. A
CT scan may be warranted if
symptoms are severe (to
exclude abscess formation) or
if the diagnosis is uncertain
Cholesteatoma Patients may present with
painless otorrhea and hearing
loss. Opacification of the
tympanic membrane may lead
to a misdiagnosis of AOM.
Diagnosis is based on the
history and clinical findings.
Imaging is rarely necessary
COMPLICATIONS OF OTITIS MEDIA
The complications of otitis media include the following:
 Chronic suppurative otitis media
 Postauricular abscess
 Facial nerve paresis
 Labyrinthitis
 Labyrinthine fistula
 Mastoiditis
 Temporal abscess
 Petrositis
 Intracranial abscess
 Meningitis
 Otitic hydrocephalus
 Sigmoid sinus thrombosis
 Encephalocele
 Cerebrospinal fluid (CSF) leak

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3.Assessment of patient under study
History taking
Chief complaint
 Recurrent nasal discharge and stuffiness since he was 5 years
 Itchiness on the left ear in the last 15 days
 Mucoid discharge on the left ear
History of presenting illness
Patient was brought in the E.N.T clinic by the mother with the above complaints, patient was
well 3 weeks earlier. He was brought earlier to the clinic with complaints of cold, stuffiness and
rhinorrhea since he was 5 years. His mother complained 2 weeks back of an episode of left ear
ache followed by discharge which was profuse and mucoid. The discharge was insidious in onset
and gradually progressive. She also reported the child had difficulty in sleeping since the pain
was more severe at the middle of the night. Mother reported that the pain was relieved using
some over the counter medication like paracetamol. The child has no history of trauma. History
of hearing loss was not forthcoming. For the above complains antibiotic and decongestant
treatment was given by a local practitioner for 10 days. At the time of case taking the child only
has nasal complaints and itchiness on the left ear and general irritability.
Past medical history
Patient has had recurrent attacks of upper respiratory tract infection since he was 5 years old
which was mainly managed by local practitioner and also using OTC drugs. Patient has no
history of chronic illness like diabetes or hypertension. He was admitted once due to malaria. He
has no history of blood transfusion. He has no history of drug or food allergies.
Past surgical history
She has no surgical history
Family history
Both parents are alive. Mother is a known asthmatic patient. He is the only child. There is no
history of other chronic illness

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Personal history
Mother reports the child diet comprises of a variety food. Mother reports the child has a good
appetite. He reports to have a normal bowel movement and normal micturition. Mother reports
the child has disturbed sleep due to the severe pain in the middle of the night.
4.Investigative procedures
General Examination
The patient is well oriented to place, time and person, fully conscious and cooperative
He is well built and healthy looking.
He has no signs of pallor, jaundice, edema or clubbing.
Vital signs
Temp – 36.7
BP –mmHg
Pulse 100 bmin
RR – 20 breaths/min
Head
Head was rounded, normocephalic and symmetrical
The skull had no nodules or masses and depression when palpated
Face was smooth and had uniform consistency with absence of nodules and masses.
Ears
Bilaterally pinna normal, excoriation of the skin and external canal on the left side. External
canal on the right side was normal. Left tympanic membrane congested with a small central
perforation. Right tympanic membrane appeared normal. Patient did not respond to tuning fork
test. Facial nerve was normal bilaterally. There was no nystagmus.
Nose and Sinus

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• Nose; Tice nose appeared symmetric, straight and uniform in color. Bilaterally muco-purulent
discharge with pallor and oedema of turbinates’’. When lightly palpated, there were no
tenderness and lesions
Chest and abdomen
• Chest: The chest wall is intact with no tenderness and masses. There's a
full and symmetric expansion and the thumbs separate 2-3 cm during deep
inspiration when assessing for the respiratory excursion. The client manifested
quiet, rhythmic and effortless respirations.
• Heart: There were no visible pulsations on the aortic and pulmonic areas. There
is no presence of heaves or lifts.
• Abdomen: The abdomen of the client has an unblemished skin and rs uniform In
color. The abdomen has a symmetric contour. There were symmetric
movements caused associated with client’s respiration
Extremities
 The extremities were symmetrical in size and length
 Muscles: The muscles are not palpable with the absence of tremors_ They were normally
firm and showed smooth, coordinated movements.
 Bones: There were no presence of bone deformities, tenderness and swelling
 Joints: There were no swelling, tenderness and joints move smoothly.
TESTS
OTOSCOPIC EXAMINATION
 Left tympanic membrane congested with a small central perforation.

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Otitis media with purulent material seen behind the tympanic membrane
TUNING FORK TESTING
• Tuning fork should be 512 Hz (preferred) to 1024 Hz
• Weber
• Tuning Fork placed at midline forehead
• If Sound lateralizes to one ear, this indicates
1.Ipsilateral Conductive Hearing Loss OR
2.Contralateral Sensorineural Hearing Loss
• Rinne
• Bone Conduction: Vibrating Tuning Fork held on Mastoid; patient covers
opposite ear with hand and signals when sound ceases
• Air Conduction: Move the vibrating tuning fork over the ear canal; patient
indicates when the sound ceases
• Normal: Air Conduction is better than Bone Conduction
• Air conduction usually persists twice as long as bone; Referred to as
"positive test"
• Abnormal: Bone conduction better than air conduction

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• Suggests Conductive Hearing Loss; Referred to as "negative test
AUDIOMETRY
Hearing threshold levels are determined between 250 and 8000 Hertz (Hz) for pure tones and
measured in decibels (dB). The 0-dB level is “normalized” to young, healthy adults and doesn’t
mean there is absence of detectable sound. Some patients hear 0 dB, but reaching the threshold
of hearing usually requires louder test signals. The higher the threshold is, the poorer the
patient’s hearing. Thresholds higher than 25 dB are considered abnormal. During
the audiogram, independent thresholds are determined for each ear for both air conduction
(conductive hearing) and bone conduction (sensorineural hearing)
TYMPANOGRAM
Tympanometry is commonly used to evaluate the tympanic membrane (TM) and middle ear
status.
This test assesses the mobility of the TM and its response to pressure changes in the external
auditory canal
5.Management
MEDICAL MANAGEMENT
First line antibiotic
Amoxicillin is the first line antibiotic for AOM because it covers the dominant pathogen
Streptococcus pneumoniae, in addition to Group A strep. Given that most invasive infections are
due to streptococcus, amoxicillin is the ideal first line antibiotic.
Resistance to amoxicillin is higher among M. catarrhalis and H. influenzae populations, the two
other main pathogens in AOM. However, these organisms are less common and more likely to
resolve spontaneously.
Amoxicillin is also advantageous because it has excellent middle ear penetrance, is inexpensive,
has few side effects and has a relatively narrow antimicrobial spectrum.
Duration of therapy

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Antibiotic therapy duration depends on the patient’s age and clinical state. Children over two
years old can be treated for 5 days. A 10-day course is recommended in the following clinical
situations:
• In children between 6 months and 2 years of age;
• if there is tympanic perforation;
• if there is initial therapy failure;
• or with recurrent AOM.
Dose
For clinical cure, levels of amoxicillin in the middle ear should be sufficient for more than half of
the day. To do so, you can either administer amoxicillin from 45 to 60 mg/kg in three daily doses
or from 75 to 90 mg/kg in two daily doses.
Second line agents
Initial therapy failure occurs when the child does not get better after two days of adequate
antibiotic therapy. H. influenzae and M. catarrhalis are more commonly associated with
treatment failure because they are more likely to produce beta-lactamases. A 10-day course of
amoxicillin-clavulanate is recommended after initial treatment failure.
It the child still does not improve after two days of amoxicillin-clavulanate, escalation of therapy
includes:
• intramuscular ceftriaxone (50 mg/kg x one dose),
• referral to an otolaryngologist for tympanocentesis,
• or referral to an infectious disease specialist for other therapeutic options.
SURGICAL MANAGEMENT
MYRINGOTOMY
Myringotomy is a surgical procedure of the eardrum or tympanic membrane. The procedure is
performed by making a small incision with a myringotomy knife through the layers of tympanic

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membrane. This surgical procedure permits direct access to the middle ear space and allows the
release of middle-ear fluid, which is the end product of otitis media with effusion (OME),
whether acute or chronic. A tympanostomy tube is inserted into the eardrum to keep the middle
ear aerated for a prolonged time and to prevent reaccumulation of fluid. Without the insertion of
a tube, the incision usually heals spontaneously in two to three weeks. Depending on the type,
the tube is either naturally extruded in 6 to 12 months or removed during a minor procedure
radical incision
• Indications
• Recurrent AOM (3-4 episodes in 6 months)
• Middle ear effusion lasting 3 months or more
• Speech or learning delays, possibly due to OME
• Benefits
• Corrects middle ear drainage problems due to horizontal ET
• AOM can be treated with topical antibiotics
PROCEDURE
Incision types

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Cutting type: given in posterior inferior quadrant, this is done in cases of acute otitis media.
Splitting type: given in anterior inferior quadrant, this is done in cases of serous otitis media
("glue ear"), this type of incision is suitable for grommet insertion.
Incision is either 'j'(hockey) shaped or curvilinear shaped and it is given from below upward so
as to ease the drainage
 Myringotomy is usually performed as an outpatient procedure
 General anesthesia is preferred in children, while local anesthesia suffices for adults
 After the anesthesia is administered, the procedure begins with the preparation of the ear.
The ear is prepared with a solution that minimizes the possibility of infection.
 Once the ear has been prepared, the surgeon will use either a laser or a sharp instrument
to create a tiny hole in the eardrum.
 Any fluid that is present is then aspirated
 A tympanostomy tube is then inserted in the hole, which would heal and close without
the tube.
 the ear packed with cotton to control any slight bleeding that might occur
Prevention and control
 Avoid contact with second-hand tobacco smoke, also known as passive smoking. Passive
smoking brings about more infections, and can cause more severe infections. Be sure no
one smokes in your home or at a day care. No one should smoke in the house or car,
especially when children are present.
 Control allergies. Inflammation caused by allergies can cause ear infection, especially if
you or your child have other allergies, such as eczema.
 Reduce your child's exposure to colds during the first year of life. Most ear infections
start with a cold. If possible, try to delay the use of large day care centers during the first
year.

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 Breastfeed your baby during the first 6 to 12 months of life. Antibodies in breast milk
reduce the rate of ear infections.
 Avoid bottle propping. If you bottle feed, hold your baby at a 45-degree angle. Feeding in
the horizontal position can cause formula and other fluids to flow back into the
Eustachian tubes. Allowing an infant to hold his or her own bottle also can cause milk to
drain into the middle ear. Weaning your baby from a bottle between 9 and 12 months of
age will help stop this problem.
 Watch for mouth breathing or snoring. Constant snoring or breathing through the mouth
may be caused by large adenoids. These may contribute to ear infections. An exam by an
otolaryngologist, and even surgery to remove the adenoids (adenoidectomy), may be
necessary.
 Immunizations: Make sure your child’s immunizations are up to date, including yearly
influenza vaccine (flu shot) for those six months and older. Preventing viral infections
and other infections help prevent ear infections

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PERIOPERATIVE CARE OF PATIENT UNDERGOING CATARACT OPERATION
PREOPERATIVE CHECKLIST
 History and physical examination
 Name of procedure on surgical consent
 Signed surgical consent
 Laboratory results
 Allergies have been identified
 Vital signs assessed
 Jewelry removed
 Client is wearing a hospital gown and hair cover
 Client has urinated
 The prescribe preoperative medication has been given.
 Hygiene
 Right position, affected ear should not be used for sleeping; Fowlers with soft pillow at
the back of the head
 Because children make up the vast majority of myringotomy patients, special care must
be taken to address the fears and anxieties that are naturally associated with any surgical
procedure.
 Parents should answer questions honestly, and reassure the child that they will be close
by before, during and after the procedure. Children also will be comfortable to know that

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the procedure involves minimal discomfort and that their symptoms are likely to rapidly
improve after having the surgery.
 Patient must not eat or drink anything (including water, candy or chewing gum) for six
hours before the surgery.
 Patients who are sick with fever or other illness the day before or day of surgery may not
be good candidates for the procedure.
INTRAOPERATIVE CARE
The patient will be placed under a general anesthetic and will not be conscious during the
surgery. A gas anesthetic is generally used for younger children, while older patients may receive
a mixture of gas and an intravenous medication. Throughout the surgery, the patient's oxygen
saturation (via a pulse oximeter) and cardiac rhythm (via an electrocardiogram) will be
continuously monitored.
During the procedure, an otic speculum (an instrument used to widen an opening in the body) is
inserted in the external ear canal. The surgeon will then use an operating microscope to make a
small incision in the eardrum and fluid will be suctioned out. Ear tubes (also known as
tympanostomy tubes, or pressure equalization tubes) will then be inserted. These tubes are
shaped like a hollow spool and made of plastic, ceramic, gold, stainless steel or other materials.
They allow air to flow in to the middle ear and fluid to continuously flow out. The incision made
in the eardrum usually heals on its own and stitches are not needed.
The patient will then have drops placed in the ear, and cotton plugs will be inserted in the ear
canal to control bleeding. The procedure is done on an outpatient basis and usually takes 10 to 15
minutes. In most cases, the entire process lasts a few hours from the time patients enter the
hospital until the time they leave. Very young children or those with more significant medical
problems may stay in the hospital for a longer period of time.
Patients may resume a normal diet as soon as they have fully recovered from the anesthetic.
However, postoperative nausea is not unusual, so patients should eat carefully at first. Patients
can typically return to normal activities, such as school or work, the day after the procedure.
POSTOPERATIVE CARE

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A certain amount of post-surgical drainage is normal after myringotomy. Yellow, clear fluid or
mucus may drain from the ears for two to three days after surgery and it is not unusual for blood
to be mixed in with the drainage. Cotton can be used to cover the ear canal and ensure that
drainage does not seep out of the ear and onto pillow cases or clothing. It is important to change
this cotton regularly, so that it stays dry.
Patients may also experience a slight sensation of soreness in the ears for the first several hours
after the procedure. Prescription or over-the-counter pain relievers (e.g., acetaminophen) may be
used to control the discomfort
 Monitor vital signs
 Conduct hearing tests, audiometry tests
 patients are likely to receive two different types of ear drops from their physician:
Hydrocortisone and Vasocidin:
Hydrocortisone ear drops are used to prevent excess post-surgery drainage.
Patients use them for the first three days after surgery, usually in dosages of three
to four drops three times a day
Parents should contact their physician if the patient experiences severe ear pain or
a skin rash. Patients may be directed to discontinue use of hydrocortisone drops
and substitute with Vasocidin drops. Vasocidin drops can also be used if water
accidentally enters the ear canal. It is possible a patient will not have to use
Vasocidin drops at all following surgery
 Wearing earplugs when bathing (especially during hair washing) or swimming.
 Wearing a shower cap for several weeks after the procedure when showering.
 Not immersing the head in bodies of water where bacteria may be present, including
lakes, ponds, rivers and bathtubs. Chlorinated pools are generally safe.
 Patients should avoid cleaning their ears after the procedure
 patients should not place anything in the ear without the approval of their physician,
including ear drops and ear plugs
 regular follow-up visits to ensure the tubes are working properly
 Patient should keep the ear dry
 Teach [patient on signs and symptoms of infection

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 Patient should avoid nose blowing for at least 7 days
 If the tube falls, not an emergency, He should walk back to the hospital to be reinstated.
Benefits and Risks with Myringotomy
Myringotomy has a high success rate. Patients generally experience restored hearing very
quickly, and usually report decreased feelings of pressure and pain in the ears. Because the tubes
clear fluid from the middle ear, the patient also may experience fewer ear infections.
Improved hearing is a major benefit of myringotomy in children. Children with decreased
hearing are at risk for slower language development and increased risk of learning disabilities.
Some patients who undergo a myringotomy procedure will experience minor complications.
These Typically Include: -
• Need to repeat surgery. Tubes that fall out too soon may need to be replaced by another
set.
• Scarring of the eardrum (tympanosclerosis). Not unusual for patients who undergo
myringotomy. Rarely, this can lead to minor hearing loss in some patients.
• Thickening of the eardrum. Over time, increased blood flow to the eardrum may cause a
thickening, which can affect hearing in a small percentage of patients.
• Recurrent inflammation of the middle ear space. This also can cause thickening of the
eardrum, affecting the hearing of the patient.
• Persistent pus (otorrhea) discharge from the ear. This is a common complication of
myringotomy and can be a recurrent problem in some patients. However, antibiotics
usually are an effective treatment for the infection.
• Tube blockage. Recurrence of ear fluid and subsequent infections is likely if a tube
becomes blocked.
• Tube slippage. Tubes sometimes slip out of place and fall into the middle ear. They then
must be surgically removed.
• Tissue formation behind the eardrum (cholesteatoma). This is a form of benign tumor that
can cause hearing loss if not treated. Surgery is the only treatment for removing this
tumor.

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• Permanent eardrum perforation. This occurs in a small number of patients, but can
usually be corrected via surgery to patch the perforation.
Myringotomy also carries the typical risks associated with any surgery, such as bleeding and
infection. Patients also may have a reaction to anesthesia, including breathing problems.
A Physician Should Be Contacted If Any of The Following Occurs After A Myringotomy:
• Drainage from the ear (more than a minimal amount after 72 hours)
• Increased ear pain
• Fever
• Swelling
• Redness
• Excessive bleeding
• Tube is displaced out of the ear

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NURSING CAREPLAN
Assessment data Nursing
diagnosis
Goal/expected
outcome
Interventions Rationale Evaluation
1.Patient is very
irritable and
crying
2.Patient
complains of
pain on the ear
and mastoid
area
3.Patient
guarding the
right ear on
palpation
4.Patient has
facial grimace
5.Patient
positions away
from the pain
6.Vital signs
Bp-130/82
mmHg
PR-120b/min
RR-26
TEMP-37.1
Pain related to
inflammation
and pressure on
tympanic
membrane
GOAL
The child or parent
will indicate
absence of pain by
the end of 4 hrs
EXPECTED
OUTCOME
1.Patient to report
pain reduction.
2.Patient to be
relaxed and able to
sleep.
3.Patient to be free
from facial grimace
4.Patient to be able
to sleep with any
position
5.Parent to
verbalize
nonpharmacological
methods to reduce
pain
1. Have the child sit
up, raise head on
pillows, or lie on
unaffected ear.
2. Apply heating
pad or warm hot
water bottle.
3. Have the child
chew gum or blow
on balloon to relieve
pressure in
ear.
4. Provide quiet
environment and
adequate rest.
5. Encourage to
listen to music, have
focused breathing,
socializing to others
or other diversional
activities.
6. Give analgesic
such as
acetaminophen. Use
analgesic eardrops.
1. Elevation
decreases
pressure from
Fluid.
2. Heat increases
blood supply
and
reduces
discomfort.
3. Attempts to
open the
eustachian
tube may help
aerate the
middle
ear.
4.External
stressors like
noise tend to
exaggerate
physiological
pain.
5. To distract
attention and
reduce tension
towards pain.
Goal was fully met
as evidenced by;
1.Patient reported a
reduction of pain of
2/10
2.Patient was
relaxed and was
able to sleep
comfortably
3.Patient was free
from facial grimace
and was now
smiling
4.Patient was able
to sleep in any
position
4.Parent verbalized
different
nonpharmacological
method to reduce
pain

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6.Analgesics
like
Acetimonephen
by blocking
prostaglandin
production by
blocking COX 1
and 2 receptors
hence reduction
of pain.
Assessment data Nursing
diagnosis
Goal/expected
outcome
Interventions Rationale Evaluation
1.Child complains
of pain on the left
ear
2.Patient left ear
examination
shows swollen
perforated
tympanic
membrane.
3.Mothe reports
patient has
difficult in
hearing
sometime.
4.Patient looks
worried and
stressed.
Disturbed
sensory
perception:
Auditory related
inflammation
and edema of the
middle ear as
evidenced by
child not
responding when
spoken to, pain
in the left ear
GOAL
Patient auditory
sense to be
restored by the end
of 10 days.
EXPECTED
OUTCOME
1.Patient
understands that
progressive
hearing loss is
caused by the
disease.
2.Patient can
communicate.
1.Provide information
about the condition
and answer any
inquiries. Reassure
parents and child
that hearing loss is
not permanent and
will resolve with
treatment.
2. Reduce
unnecessary
environmental noise
3. Encourage parents
to speak in a loud and
clear voice and look
at the child when
talking.
1. Decreases
anxiety over a
sensory loss.
2. The child may
be confused
and startled by
sounds he or she
cannot hear
properly.
3. Assists the
client to hear
what is being
said.
4. When
indicated for
bacterial
infection, a full
Goal was fully
met as evidence
by:
1.Patient
understood that
the hearing loss
was due to the
disease
2.Patient was
able to
communicate.
3.Patient
reported no pain.
4.Mother
reported the
child was able to
hear.

27. 27 | P a g e
5.Child sometime
doesn’t respond
when spoken to.
3.Pain reports a
decrease in pain or
no pain
4.Mother to report
child able to hear.
5. Patient to be
come and free
from worry.
6.Child to be able
to respond when
spoken to.
4. Administer
antibiotics as
prescribed.
5. Notify caregiver of
changes in hearing
ability or drainage
from the affected ear.
10-day course of
an antibiotic is
given to resolve
otitis media and
regain hearing.
5.Complications
of OM may
include
perforation of
the eardrum,
mastoiditis or
conductive
hearing loss.
5.Patient was
calm and free
from worry.
6.Child was able
to respond when
spoken to.
Assessment data Nursing
diagnosis
Goal/expected
outcome
Interventions Rationale Evaluation
1.Mother doesn’t
know the cause of
the illness.
2.Mother doesn’t
understand the
disease process.
3.Mother isn’t
aware of different
management
options
4.Mother uses
OTC to manage
some of the
symptoms.
Knowledge
deficit related to
lack of
information as
evidenced by
Mother does
understand the
disease
pathogenesis and
prevention.
GOAL
Parents will gain
knowledge about
prevention of
Otitis Media.
EXPECTED
OUTCOME
1.Mother to have
knowledge on the
causes of the
disease.
2.Mother do
understand the
disease process.
1. Assess the client’s
current level of
knowledge about
otitis media.
2. Describe the
disease process as
needed.
3. Give info about
therapies and
treatment options and
the benefits of each
option.
4. Provide praise for
decisions that will
1. the data will
provide a basis
for counseling.
2. assist clients
in understanding
the disease
process
3. to assist
clients in making
treatment
decisions.
4. Positive
reinforcement
supports the
Goal was fully
met as evidenced
By;
1.Mother had
knowledge on
the cause of the
disease.
2.Mother
understood the
disease process.
3.Mother was
kept aware on
the variety of
management

28. 28 | P a g e
5.Mother doesn’t
know the
preventive
measure of the
disease.
3.Mother to
appreciate
different options of
management of the
disease.
4.Mother not to be
overdependent to
OTC.
5.Mother to be
aware of the
different
preventive
methods.
promote wellness for
the child and
lifestyle.
5. Teach parents (and
child if
age- appropriate)
about OM using an
ear model for
demonstration. Ask
parents to verbalize
their understanding of
teaching.
6. Provide privacy for
discussion, promote
trust, remain
nonjudgmental, and
support parents.
decision to
improve family.
5. Provides
information
by auditory and
visual means
and assesses
understanding.
6. Shows respect
for the
parents and
opens
communication.
options and was
able to make a
informed
decision.
3.Mother was
not dependent on
OTC
4.Mother was
aware of the
different
preventive
methods.

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