otitis media is the inflammation of the ear drum or tympanic membrane this topic include its definition , etiology, pathophysiology, clinical manifestation, diagnosis and its treatment which can be used by nursing students for taking care of the patient suffering from otitis media and for learning for their examination and knowledge purpose and care of the child with acute otitis media and chronic otitis media and make their family aware about the complication of the otitis media like hearing loss meningitis

1. OTITIS MEDIA
DEPARTMENT
OF
MEDICAL SURGICAL NURSING

2. Learning Objectives
At the end of this lecture, students
should be able to :
• define otitis media
• enlist the causes
• explain the pathophysiology
• enumerate the clinical manifestation
• describe the management

3. Introduction
• otitis media refers to an inflammation
of the middle auditory canal which is
normally filled with air behind the ear
drum.
• It is an inflammation of middle ear that
most often occur in infant but can
occur at any age

4. Definition
• Otitis media
(OM)is the
inflammation
of the middle
ear, space
between
tympanic
membrane
and inner ear

6. Incidence
• Otitis media is the second most
common disease in child hood after
upper respiratory tract infection
• Repetitive episodes of otitis media can
leads to a chronic otitis media which
can occur in later life or at any age
group

7. Classification of otitis media
Sr.
no
.
Otitis media Characteristic
1. Acute otitis media
•inflammation of the medial ear and can heal
with shortly
•Rapid onset of symptom
• < 3 weeks
2.
Chronic otitis
media
•inflammation of the medial ear due to
repetitive episode of AOM
•Symptom worsen with time
• > 3weeks to 3 month or more

9. Causes
• Age: due to shorter eustachin tube in child
occurrence in childhood is most common
• water in the ear canal
• Trauma to the skin of the ear canal,
• pathogenic bacteria
• Sinusitis, Allergic reaction(rhinitis,
pharyngitis)
• streptococcus pneumoniae, haemophilus
influenzae and moraxella catarrhalis

10. • Trauma to the tympanic membrane
• Head injury
• Gender : boys are more affected
then girls
• Craniofacial abnormalities (cleft
palate)
• Passive smoking
• Down syndrome
• Poor air quality
• Seasonal factor

11. PATHOPHYSIOLOGY
Due to infection
inflammation occur and exudates edema
in eustachian tube of middle ear
Serious exudation in the middle ear.
thickened, purulent and pus
formation

12. Tympanic membrane perforation
--------------------------------------(AOM)
Increase pressure in middle ear cavity
Nacrosis of tissue in ear
Damage of tympanic membrane
Conducting hearing loss, mastoiditis
-------------------------------------(COM)

13. Sign and symptoms
• Pain in and about the ear(otalgia),
espacially when lying down
• Fever & drainage from the ear
• Tympanic membrane become
erythematous
• Conductive hearing loss
• Change in behavior

14. • Irritability
• Decrease appitite
• Noise in ear
• Fullness in ear
• Tugging or pulling at an ear
• Loss of balance
• Trouble sleeping
• Vomiting

17. Diagnostic evaluation
• History collection
• Physical examination
• Otoscopic examination
• Culture
• Audiometry
• Tympanometry (test used to measure
the movement of the ear drum )

18. • Acoustic reflectometry : test used to
measure the sound reflection back to
the ear drum
• Tympanocentesis : draining out fluid or
pus from the middle ear with the help
of small needle aspiration

19. Complication
• TM perforation
• Mastoiditis
• Meningitis
• Hearing loss
• Chronic ottitis media
• Facial nerve palsy
• Brain abscess

20. Medical Management
• Although most tympanic membrane
perforations heal spontaneously
• Antibiotic :-
1. Amoxicillin: 20-40 mg/kg/day, TDS, for 10-
14 days or
2. Augmentin : 45 mg/kg/day, BD, for 10-14
days or
3. Broad spectrum antibiotic therapy (penicillin)

21. • Analgesic (NSAIDs)
• Antipyratic
• Prevent entry of water in ear
• Drainage if fluid collection is max.
• Hearing aid

22. SURGICAL MANAGEMENT
• Perforations that do not heal on their
own may require surgery.
• Tympanoplasty: surgical repair of
tympanic membrane by grafting
• Myringotomy: incision through ear
drum to create an artificial opening to
drain fluid

23. Nursing management
• PREVENTION
• Prevent common cold and other
illnesses
• Avoid second hand smoking
• Proper nutrition
• Avoid water irrigation of ear
• Protect ear during swimming

24. Nursing diagnosis
• Acute pain related to fluid filled in ear or
infection
• Altered auditory sensation perception related
to fluid accumulation in middle ear
• Imbalance nutritional status less then body
requirement related to vomiting
• Risk for infection related to decrease immune
response
• Knowledge deficit related to disease process
and response

25. Nursing Interventions
• Apply hot water bag over the ear with the
child lying on the affected side may reduce
the discomfort (applied during the attack of
pain)
• Put ice bag over the affected area may also
be beneficial to reduce edema (between pain
attacks)
• For drained ear : external canal may be
frequently cleaned using sterile cotton swab
(dry or soaked in hydrogenperoxide)

26. • Excoriation of the outer ear should be
prevented by frequent cleaning and
application of zinc oxide to the area of
oxidate
• Give special attention to the
tympanostomy tube i.e. avoid water
entering the middle ear and introducing
bacteria
• Educate family about care of child &
keep them aware with the complication
of the acute otitis media e.g. hearing
loss

27. • Preventing from Altered Sensory Perception
by providing all the needed article of objects
near them
• Avoiding keeping patient alone as it leads to
fall or head injury
• Promoting Wound Healing by giving all
medication in time, dose, frequency and ear
care
• Provide emotional support to the child and his

28. Summary
So far we have discussed about
definition, etiology,
physiopathology, clinical
manifestations,, and managements
of otitis media.

29. Bibliography
• Lewis et al, Medical Surgical Nursing,
Mosby Elsevier,7th edition.
• Joyce.M.Black et al, Medical Surgical
Nursing, Saunders publication.
• Brunner and Siddhartha, Medical
Surgical Nursing, Lippincott Williams
and Wilkins.

30. Thank You