This document discusses different types of otitis media including acute otitis media, chronic otitis media, and serous otitis media. It covers the etiology, risk factors, clinical manifestations, diagnostic evaluations, and management for each type. The main types are acute bacterial infection of the middle ear (acute otitis media), chronic infection with tissue damage (chronic otitis media), and non-infectious fluid accumulation (serous otitis media). Diagnosis involves examination, tests to check for fluid/infection, and treatment involves antibiotics, drainage procedures, and addressing underlying causes.

1. OTITIS MEDIA
It is the inflammation of the middle ear and is characterized by the accumulation of fluid in the
middle ear, bulging of the eardrum and pain in the ear.
TYPES
1. Acute otitis media
2. Chronic otitis media
3. Serous otitis media
ACUTE OTITIS MEDIA
It is an acute of the middle ear, which appears suddenly and usually last for 6 weeks
ETIOLOGY
1. The primary cause of acute otitis media is usually Streptococcus pneumoniae,
Hemophilus influenzae and Moraxella catarrhalis, pneumococci, beta hemolytic
streptococci.
2. Viral pathogens such as:
a. Respiratory syncytial virus
b. Influenza virus
c. Parainfluenza virus
d. Rhinovirus
e. Adenovirus
3. Allergies
4. Position changes like holding the infant in supine position during feeding
RISK FACTORS
1. It is more commonly seen in children
2. It is more prevalent in male than females
3. Lack of breastfeeding and use of pacifiers in children
4. It is more common during winter months
5. Patient with cleft palate or Down’s syndrome
6. Decreased immunity due to:
a. HIV
b. Diabetes
c. Other immunodeficiencies
7. Cochlear implants
8. Vitamin A deficiency
9. Passive smoke exposure
10. Genetic predisposition
11. Family history of recurrent acute otitis media in parents or siblings.

2. PATHOPHYSIOLOGY
CLINICAL MANIFESTATIONS
1. Otalgia: severe deep throbbing pain
2. Local engorgement of the blood vessels
3. Swelling of the mucous membrane lining
4. Serous exudates develop
5. Sensation of fullness
6. Fever
7. Tinnitus may occur
8. Drainage/ discharge from the ear
9. Exudate may cause the eardrum to rupture
10. Hearing loss
In Children
1. Young children with otitis media may be irritable, fussy or have problems in feeding
or sleeping
2. Older children exhibit the pain and fullness in the ear
3. Fever
4. Signs of upper respiratory infection, such as runny or stuffy nose or a cough
5. Rupture of eardrum
6. The pus then drains from the middle ear into the ear canal
DIAGNOSTIC EVALUATION
1. History collection
2. Physical examination

3. 3. Tympanocentesis is used to detect presence of middle ear fluid. Ear drainage swab is
sent to laboratory for culture in order to identify pathogens
4. Computed tomography of the temporal bones may identify mastoiditis, epidural
abscess, sigmoid sinus thrombophlebitis, meningitis, brain abscess, subdural abscess,
ossicular disease.
5. Magnetic resonance imaging is helpful to confirm fluid collections in the middle ear
MANAGEMENT
Medical management
1. Administer analgesics and antipyretic to the patient.
2. Provide complete bed rest to the patient
3. Administer antibiotics to control infection
4. Administration of nasal vasoconstrictors to open blocked Eustachian tubes and
application of dry heat etc.
SURGICAL MANAGEMENT
1. Myringotomy and Tympanotomy
An incision in the tympanic membrane known as myringotomy or tympanotomy, may
be performed to permit fluid that has collected in the middle ear to drain
NURSING MANAGEMENT
1. Aspirate the fluid and send for culture following tympanotomy
2. Place cotton loosely in the outer ear to collect drainage
3. Change the cotton when it becomes moist to lessen the danger of secondary infection
4. Discharge may be infectious, so wash hands after changing cotton plugs or cleaning
the ear
5. Monitor vital signs
6. Antibiotics should be continued for several days even though symptoms have
subsided
7. Assess pain level, administer prescribed analgesics and divert the patient
COMPLICATIONS
1. Hearing loss
2. Tympanic membrane rupture
3. Cholesteatoma (cyst like mass in middle ear)
4. Tympanosclerosis
5. Mastoditis
6. Labyrinthitis
7. Facial paralysis
8. Cholesterol granuloma

4. CHRONIC OTITIS MEDIA
It is a chronic inflammation of the middle ear with tissue damage
a. It is characterized by chronic purulent discharge from the middle ear. It is the result of
repeated episodes of acute otitis media causing irreversible tissue pathology, and a
persistent perforation of the tympanic membrane.
ETIOLOGY
It occurs as a result of inadequate treatment of acute otitis media. It is caused by:
1. Streptococcus-group A beta hemolytic streptococci
2. Staphylococcus
3. Proteus
4. Pseudomonas organisms are the most common.
RISK FACTORS
1. Bacteria more often affect children with chronic suppurative otitis media
2. Immunocompromised persons are at high risk
PATHOPHYSIOLOGY
CLINICAL MANIFESTATIONS
1. Deafness
2. Pain less or dull ache: pain occurs occasionally
3. Dizziness
4. Odorless or foul-smelling ear discharge
5. Tenderness of mastoid
6. Fever, post-auricular erythema and edema
7. Cholesteatoma (it is an ingrowth of skin of the external layer of the eardrum into the
middle ear)

5. 8. Decreased or absent tympanic membrane mobility(tympanosclerosis)
9. Conductive hearing loss.
DIAGNOSTIC EVALUATION
1. History collection
2. Ear examination, audiometric test to check for hearing loss, otoscopy to check tympanic
membrane
3. Culture and sensitivity test of ear discharge
4. X-ray to check mastoid
5. Computed tomography of the temporal bones may identify infection and cholesteatoma
6. Magnetic Resonance Imaging is helpful to confirm fluid collections in the middle ear.
MANAGEMENT
Medical Management
1. Local treatment consists of careful suctioning of the ear under microscopic guidance
2. Instillation of antibiotic and steroid drops or application of antibiotic powder is used to
treat a purulent discharge ear drops containing neomycin, tobramycin, ciprofloxacin are
instilled into middle ear.
3. Systemic antibiotics are usually not prescribed except in case of acute infection or when
mastoditis develops. IV antibiotics like ampicillin, sulbactam and cefuroxime.
NURSING MANAGEMENT
1. Explain the procedure to client and family members
2. Aspirate the fluid and send for culture following tympanotomy
3. Place cotton loosely in the outer ear to collect drainage
4. Change the cotton when it becomes moist to lessen the danger of secondary infection
5. Discharge may be infectious, so wash hands after changing cotton plugs or cleaning the
ear
6. Onitor vital signs
7. Antibiotics should be continued for several days even though symptoms have subsided
8. Assess pain level, administer prescribed analgesics and divert the patient
COMPLICATIONS
1. Hearing loss
2. Tympanic membrane rupture
3. Labyrinthitis
4. Temporal abscess
5. Meningitis
6. Intracranial abscess

6. SEROUS OTITIS MEDIA
It is also called otitis media with effusion or non-suppurative otitis media.
In this type of otitis media, no affected fluid accumulates in the middle ear. This condition is
found in primarily in children.
ETIOLOGY
1. Viral upper respiratory infection
2. Residual otitis media, inadequate treatment of acute suppurative otitis media
3. Allergy
a. Allergic rhinitis infection
b. Chronic sinus infection
4. Enlarged lymphoid tissue: adenoidal tissue growth
5. Pressure injury caused by an inability to equalize presume between environment and
middle ear.
PATHOPHYSIOLOGY

7. CLINICAL MANIFESTATIONS
1. Many patients are asymptomatic
2. Sensation of fullness in affected ear
3. Popping, cracking, bubbling or clicking sounds with swallowing and jaw movement
4. Hearing an echo while speaking
5. Having a vague feeling of top heaviness and tympanic membrane retraction
6. Slide conductive hearing loss ranging from 15 to 35 Db
7. Budging tympanic membrane without any redness on otoscopic examination.
DIAGNOSTIC EVALUATION
1. History collection
2. Physical examination
3. Audiometric studies, Rinne test, Weber test, whisper test to check hearing
4. Imaging tests may be done.
MANAGEMENT
1. Inflation of Eustachian tube several times per day using Valsalva maneuver may be the
only treatment required.
2. Nasopharyngeal decongestant therapy may be helpful
3. If medical management fails, then myringotomy and aspiration of middle ear fluid may
be needed.
4. Treat the underlying cause:
a. Treatment of allergies
b. Adenoidectomy for hypertrophied adenoids
c. Adequate treatment of upper respiratory infections and otitis media.
NURSING MANAGEMENT
1. Instruct the patient to perform Valsalva’s maneuver several times daily to maintain
Eustachian tube patency
2. Instruct patient to get prompt treatment of otitis media to prevent further complications
3. Instruct patient about medication, their correct administration
4. If a nasopharyngeal decongestant is prescribed teach correct instillation.
5. Instruct parents not to feed their infant in a supine position or put him/her to bed with
a feeding bottle.
COMPLIATIONS
1. Hearing loss
2. Speech impairment