Good

2. OTITIS MEDIA
Otitis media is inflammation of the middle
ear, or middle ear infection. Otitis means
inflammation of the “ear” and “media”
means middle.
OR

3. Otitis media is an infection of the middle ear space, behind
the eardrum (tympanic membrane). It is characterized by
pain, dizziness, and partial loss of hearing.

4. CAUSES
An ear infection is caused by a bacterium or virus in the
middle ear. This infection often results from another
illness — cold, flu or allergy — that causes congestion and
swelling of the nasal passages, throat and eustachian tubes.
Bacterial infection: - haemophilus influenzae,
streptococcus pneumococcus.
Viral infection: - rhinovirus, Adenovirus

5. RISK FACTOR
Age. Children between the ages of 6 months and 2
years are more susceptible to ear infections because
of the size and shape of their eustachian tubes is
shorter and because their immune systems are still
developing
Family history: The tendency to get ear infections
can run in the family.
Colds: Having colds often increases the chances of
getting an ear infection

6. • Allergies: Allergies cause inflammation (swelling) of the
nasal passages and upper respiratory tract, which can
enlarge the adenoids. Enlarged adenoids can block the
eustachian tube, preventing ear fluids from draining. This
leads to fluid buildup in the middle ear, causing pressure,
pain and possible infection.
• Chronic illnesses: People with chronic (long-term)
illnesses are more likely to develop ear infections,
especially patients with immune deficiency and chronic
respiratory disease, such as asthma.

7. PATHOPHYSIOLOGY
Due to any etiological factor
inflammation in the nasopharynx
it cause a obstruction in the eustachain tube
negative pressure is generated

8. which pulls interstitial fluid into the tube and creates
a serios effusion
which yields the clinical sign and symptom of otitis
media

9. SIGN AND SYMPTOM
• Ear pain: this symptom is obvious in older children
and adults. Look for signs of pain like rubbing or
tugging ears, crying more than usual, trouble
sleeping, acting fussy/irritable.
• Loss of appetite: this may be most noticeable in
young children, especially during bottle feedings.
Pressure in the middle ear changes as the child
swallows, causing more pain and less desire to eat.

10. • Irritability: Any kind of continuing pain may
cause irritability.
• Poor sleep: Pain may be worse when the child is
lying down because the pressure in the ear may
worsen.
• Fever: Ear infections can cause temperatures
from 100° F (38 C) up to 104° F..

11. • Drainage from the ear: Yellow, brown, or white
fluid , Bloody discharge from the ears.
• Trouble hearing: Bones of the middle ear
connect to the nerves that send electrical signals
(as sound) to the brain. Fluid behind the eardrums
slows down movement of these electrical signals
through the inner ear bones.

12. TYPES
• Acute otitis media- This middle ear infection
occurs suddenly. It causes swelling and redness.
Fluid and pus become trapped under the
eardrum (tympanic membrane). You can have a
fever and ear pain.

13.  Chronic otitis media- This is a middle ear
infection that does not go away, or happens
repeatedly, over months to years. The ear may
drain (have liquid coming out of the ear canal). It
can often be accompanied by a tympanic
membrane perforation and hearing loss. Usually
chronic otitis media is not painful.

14.  Otitis media with effusion- Fluid (effusion) and mucus
build up in the middle ear after an infection goes away.
You may feel like your middle ear is full. This can
continue for months and may affect your hearing. This is
also sometimes called serous otitis media.
 Chronic otitis media with effusion- Fluid (effusion)
remains in the middle ear for a long time. Or it builds up
again and again, even though there is no infection. It may
also affect your hearing

15. DIAGNOSTIC EVALAUTION
 Complete medical history and physical
examination, In this doctor will inspect the outer
ear and eardrum
 Using an otoscope. The otoscope is a lighted
instrument that allows the health care provider to
see inside the ear

16.  Pneumatic otoscope:- An instrument called a pneumatic
otoscope is often the only specialized tool a doctor needs
to diagnose an ear infection. This instrument enables the
doctor to look in the ear and judge whether there is fluid
behind the eardrum. With the pneumatic otoscope, the
doctor gently puffs air against the eardrum. Normally,
this puff of air would cause the eardrum to move. If the
middle ear is filled with fluid, your doctor will observe
little to no movement of the eardrum.

18. • Tympanometry:- This test measures the movement
of the eardrum. The device, which seals off the ear canal,
adjusts air pressure in the canal, which causes the
eardrum to move. The device measures how well the
eardrum moves and provides an indirect measure of
pressure within the middle ear.

20.  Tympanocentesis:- Rarely, a doctor may use a
special needle with a tiny tube that pierces the
eardrum to drain fluid from the middle ear — a
procedure called tympanocentesis. The fluid is
tested for viruses and bacteria.

22. MANAGEMENT OF OTITIS MEDIA
 Antibiotic therapy: - amoxicillin, trimethoprim,
sulfamethoxazole
 Antihistamine:- cetirizine, fexofenadine
 Decongestant:- Pseudoephedrine ,Ephedrine
 Corticosteroids:-Hydrocortisone, dexamethasone
 Analgesics:-Naproxen
 antipyretics :-Paracetamol

23. SURGICAL MANAGEMENT
MYRINGOTOMY
An incision in the tympanic membrane is made and the
tympanic membrane is numbed with a local anesthetic.
The procedure is painless and takes less than 15
minutes. Under microscopic guidance, an incision is
made through the tympanic membrane to relieve
pressure and to drain serous or purulent fluid from the
middle ear.

25. VENTILATING TUBE
Ear tubes are tiny, hollow cylinders, usually made of plastic
or metal, that are surgically inserted into the eardrum. An ear
tube creates an airway that ventilates the middle ear and
prevents the accumulation of fluids behind the eardrum. Ear
tubes can also be called tympanostomy tubes, ventilation
tubes, myringotomy tubes or pressure equalization tubes
The ventilating tube, which temporarily takes the place of
the eustachian tube in equalizing pressure, is retained for
one year

27. NURSING DIAGNOSE
 Pain related to inflammation and pressure on tympanic
membrane
 Risk for infection related to eustachian tube dysfunction
 Impaired verbal communication related to hearing
deficit
 Altered auditory sensory perception related to middle
ear infections
 Fear and anxiety related to progression of disease

28. MENIERE'S DISEASE
Meniere's disease is a disorder of the inner ear that can
lead to dizzy spells (vertigo) and hearing loss. In most
cases, Meniere's disease affects only one ear.
Or
Meniere’s disease is an inner-ear condition that can
cause vertigo, a specific type of dizziness in which you
feel as though you’re spinning.

30. CAUSES AND RISK FACTORS
The cause of Meniere's disease is unknown.
 GENETIC
 Improper fluid drainage, perhaps because of a
blockage or anatomic abnormality:-
Too much pressure results in a high amount of fluid that
doesn't drain properly, causing the dysfunction.. Abnormal
development in the inner ear can also cause blockages,
impeding fluid drainage.

31. VIRAL INFECTION-Some of the viruses suspected of
causing Meniere's include rhinovirus, adenovirus,
influenza, coronavirus, herpes simplex, virus. The herpes
virus is the most common type of viral infection found in
patients with Meniere's, according to one study.
Meningitis, which affects the brain, and labyrinthitis,
which affects the inner ear, are some of the infections that
can trigger Meniere's disease.

32. ALLERGY :- A past infection can interact with an
existing allergy, which can cause decompensation
of the endolymphatic sac. This interaction can then
trigger endolymphatic hydrops (excess fluid in the
ear), causing an imbalance in the drainage of fluid.
An allergic reaction can result in inflammation of
the inner ear, compromising the filtering capability,
and consequently, blockages.

34. SIGN AND SYMPTOMS
• Reoccurring episodes of vertigo. You have a spinning
sensation that starts and stops spontaneously. Episodes
of vertigo occur without warning and usually last 20
minutes to several hours, but not more than 24 hours.
Severe vertigo can cause nausea.
• Hearing loss. Hearing loss in Meniere's disease may
come and go, Eventually, most people have some
permanent hearing loss.

35. • Ringing in the ear (tinnitus). Tinnitus is the perception
of a ringing, buzzing, roaring, whistling or sound in
your ear.
• Feeling of fullness in the ear. People with Meniere's
disease often feel pressure in an affected ear (aural
fullness).

36. DIAGNOSTIC EVALUATION
 Audiometry exam - This will find hearing loss in
the affected ear..
 Electrocochleography (ECoG). This test looks at
the inner ear in response to sounds. It might help
to determine if there is an abnormal buildup of
fluid in the inner ear.

37.  Rotary chair testing. This lets your doctor see how
eye movement affects your inner ear. You sit in a
turning chair that’s controlled by a computer
 Posturography. This tests your balance and how
well you can keep it. You stand barefoot on a
platform that can move in several directions. You
wear a harness that lets your doctor see how you
respond when the platform moves in certain ways.

41. MANAGEMENT
• Motion sickness medications, such as meclizine or
diazepam (Valium), may reduce the spinning sensation
and help control nausea and vomiting.
• Anti-nausea medications, such as promethazine, might
control nausea and vomiting during an episode of vertigo.
• Diuretics. To reduce fluid in your ear, your doctor
might prescribe a diuretic -- medicine that keeps your
body from retaining fluids. If you take a diuretic, your
doctor probably also will ask you to cut the amount of
salt in your diet.

42. Steroids, such as dexamethasone can give to the patient .
SURGICAL MANAGEMENT
Endolymphatic sac procedure. The endolymphatic sac
plays a role in regulating inner ear fluid levels. During the
procedure, the endolymphatic sac is decompressed, which
can alleviate excess fluid levels. In some cases, this
procedure is coupled with the placement of a shunt, a tube
that drains excess fluid from your inner ear.

44. • Labyrinthectomy. With this procedure, the surgeon removes the
balance portion of the inner ear, thereby removing both balance
and hearing function from the affected ear. This procedure is
performed only if you already have near-total or total hearing loss
in your affected ear.
• Vestibular nerve section. This procedure involves cutting the
nerve that connects balance and movement sensors in your inner
ear to the brain (vestibular nerve). This procedure usually corrects
problems with vertigo while attempting to preserve hearing in the
affected ear. It requires general anesthesia and an overnight
hospital stay.

45. NURSING DIAGNOSIS
• Risk for injury related to altered mobility because
of gait disturbed and vertigo.
• Impaired adjustment related to disability
requiring change in lifestyle because of
unpredictability of vertigo.
• Risk for fluid volume imbalance and deficit
related to increased fluid output, altered intake,
and medications.
• Anxiety related to threat of, or change in, health
status and disabling effects of vertigo.

46. COMPLICATIONS
 The disease interrupts the natural cycle of your life
and lead to anxiety, depression, fatigue, and emotional
stress. It can also lead to:
• A loss in balance
• Increases your risk of falling
• Increases your risk of getting into an accident
• Driving problems

47. LABYRINTHITIS
Labyrinthitis is an inner ear disorder. The two vestibular nerves in
your inner ear send your brain information about your balance
control. When one of these nerves becomes inflamed, it creates a
condition known as labyrinthitis
Or
Labyrinthitis is an infection of the inner ear. It
causes inflammation that can affect the structures of this part of the
ear and disrupt the flow of sensory information from the ear to the
brain. This disruption can result in a range of symptoms, including
dizziness, vertigo, and even hearing loss.

49. CAUSES AND RISK FACTORS
The exact cause of labyrinthitis (inner ear infections) is
unknown. It may be caused by swelling or problems with
the nerve inside the brain responsible for balance and
hearing.
Labyrinthitis also may occur during or after a viral
infection. Viruses associated with labyrinthitis include:-
• influenza, herpes viruses, measles, mumps, rubella, h
epatitis, Epstein-Barr virus, and polio

50. • Bacterial infections-(OTITIS MEDIA ) can lead the
labyrinthitis
 Rarely, other ear problems like barotrauma (injury due
to abnormal pressure inside the ear) or otosclerosis
(abnormal growth of bone impeding the middle ear)
can cause labyrinthitis.

51. PATHOPHYSIOLOGY
Due to etiological factor
Inflammatory mediators invade the membranous
labyrinth
It causes Inflammation of labyrinth
It damage the vestibular and auditory end organs

52. It causes vertigo, hearing loss

53. SIGN AND SYMPTOMS
• dizziness
• vertigo
• loss of balance
• nausea and vomiting
• tinnitus, which is characterized by a ringing or
buzzing in your ear
• difficulty focusing your eyes

54. TYPES
 VIRAL LABYRINTHITIS:- Also known
as vestibular neuronitis, this condition is often the
result of a viral infection. The symptoms are typically
vertigo, nausea and vomiting. The symptoms are
usually acute in the first 24 hours, after which they
tend to gradually subside over the next few days.

55. BACTERIAL LABYRINTHITIS
 This can happen in one of two ways: First, bacteria
from a middle ear infection make toxins that get into
the inner ear and cause inflammation and swelling.
Or second, an infection in the bones surrounding the
inner ear makes toxins that cause the same symptoms.
 A chronic, or ongoing, middle ear infection can cause it.

56. DIAGNOSTIC TEST
• History taking
• Physical examination
• Pneumatic otoscope
• A CT or MRI scan of your head to record images of your
cranial structures
• Electroencephalogram (EEG), which is a brain wave test,
during this test small sensors are attached to the scalp to pick
up the electrical signals produced by the brain

57. MANAGEMENT
• Medications that can reduce dizziness and nausea,
such as meclizine
• corticosteroids, such as prednisone
• antihistamines, such as fexofenadine (Allegra),
diphenhydramine (Benadryl), or loratadine (Claritin)
• ANTIBIOTIC
• ANTIVIRAL

58.  VESTIBULAR REHABLITATION THERAPY:-
 Vestibular rehabilitation (VR), also known
as vestibular rehabilitation therapy (VRT), is a
specialized form of physical therapy used to treat
vestibular disorders or symptoms, characterized by
dizziness, vertigo, and trouble with balance, posture,
and vision.

59.  Habituation Exercises
 Habituation exercises are
used to treat symptoms of
dizziness that are
produced because of
head motion or visual
stimuli. These patients
typically report increased
dizziness when they turn
their heads quickly or with
position changes like
bending forwards to tie
their shoes or looking
upwards.

60. Gaze Stabilization
Exercises
Gaze stabilization
exercises are used
to improve visual
acuity and
steadiness during
head movements.

61.  Balance Training
Exercises
 Balance training exercises
are a staple of vestibular
rehabilitation and used to
improve steadiness so
patients can more
successfully participate in
activities of daily living,
work and leisure or
physical activities.

62.  SURGICAL MANAGEMENT :-
 In case of labyrinthitis resulting from otitis media
,perform myringotomy.
 A ventilating tube also may indicated
 Labyrinthectomy
COMPLICATIONS
 Meningitis
 Permanent balance disability
 Permanent hearing loss

63. NURSING DIAGNOSIS
1. Disturbed sensory perception related
labyrinthitis
2. Impaired verbal communications related to
hearing loss
3. Self esteem disturbance related to changes in
body function
4. Pain (acute or chronic ) related to labyrinthitis

64. DEAFNESS
Deafness is defined as a degree of hearing loss such
that a person is unable to understand speech, even in
the presence of amplification.
OR
A general deafness definition is a condition of
extreme hearing loss. Deaf people have very little
hearing or no hearing at all

65. CAUSES AND RISK FACTOR
 Conductive causes include:
• Tumors or foreign objects in the ear canal and
even impacted earwax
• Fluid in the ear
• Infections, including those that cause very high
fevers or that can be passed from mother to
baby during pregnancy or birth

66. • Malformation of the outer or middle ear
• Perforated eardrum, which is a hole or tear in the
eardrum
 Sensorineural causes include:
• Diseases and illnesses, including viral infections,
Meniere’s disease, and autoimmune diseases,
• Drugs that damage hearing, or ototoxic drugs, such
as
some antibiotics and cancer chemotherapy agents

67.  Exposure to loud noise

68. LEVELS OF DEAFNESS
• Mild deafness or mild hearing impairment: The
person can only detect sounds between 25 and 29
decibels (dB). They may find it hard to understand the
words other people are saying, especially if there is a lot
of background noise.
• Moderate deafness or moderate hearing
impairment: The person can only detect sounds between
40 and 69 dB. Following a conversation using hearing
alone is very difficult without using a hearing aid.

69. • Severe deafness: The person only hears sounds above
70 to 89 dB. A severely deaf person must either lip-read
or use sign language in order to communicate, even if
they have a hearing aid.
• Profound deafness: Anybody who cannot hear a sound
below 90dB has profound deafness. Some people with
profound deafness cannot hear anything at all, at any
decibel level. Communication is carried out using sign
language, lip-reading, or reading and writing.

70. TYPES OF HEARING LOSS
 CONDUCTIVE HEARING LOSS
This means that the vibrations are not passing through
from the outer ear to the inner ear, specifically the
cochlea. This type can occur for many reasons,
including:
• an excessive build-up of earwax
• an ear infection with inflammation and fluid buildup
• a perforated eardrum
• malfunction of the ossicles
• a defective eardrum

71.  SENSORINEURAL HEARING LOSS
 Hearing loss is caused by dysfunction of the inner ear, the cochlea,
auditory nerve, or brain damage.
 This kind of hearing loss is normally due to damaged hair cells in
the cochlea. As humans grow older, hair cells lose some of their
function, and hearing deteriorates.
 Long-term exposure to loud noises, especially high-frequency
sounds, is another common reason for hair cell damage
 Sensorineural total deafness may occur as a result of congenital
deformities, inner ear infections, or head trauma.

72.  MIXED HEARING LOSS
This is a combination of conductive and sensorineural
hearing loss. Long-term ear infections can damage both the
eardrum and the ossicles.
 UNILATERAL AND BILATERAL DEAFNESS
Single-sided deafness (SDD), or unilateral deafness, refers
to hearing impairment in just one ear, while bilateral
deafness is hearing impairment in both

75. SIGN AND SYMPTOMS
1. Tinnitus
2. Vertigo
3. Dizziness
4. Postural imbalance
5. Difficulty understanding words
6. Poor speech discrimination
7. Withdrawal from conversations

76. DIAGNOSTIC EVALUATION
 PHYSICAL EXAMINATION :- The doctor will look
into the ear using an otoscope. This is an instrument
with a light at the end. The following may be detected
during the examination:
• a blockage caused by a foreign object
• a collapsed eardrum
• an accumulation of earwax
• an infection in the ear canal

77.  Audiometer test: The patient wears earphones, and
sounds are directed into one ear at a time. A range of
sounds is presented to the patient at various tones. The
patient has to signal each time a sound is heard.
 Tympanometry
 Weber test
 Rinne test

78. TREATMENT
HEARING AID :-Hearing aids consist of a
battery, loudspeaker, amplifier, and microphone.
Today, they are very small, discreet, and can fit
inside the ear.
Examples of hearing aids include

79. Behind-the-ear (BTE) hearing aids: Hearing aids sits in a
hard plastic case behind your ear. A plastic ear mold fits
inside the outer ear and direct sound to the ear. A different
type called a mini BTE fits entirely behind your ear with a
narrow tube that goes into your ear canal. This helps keep
earwax from building up and make sure your own voice
sounds clear
In the ear (ITE):- Hearing aids fit completely inside your
outer ear . They have a hard plastic case that holds the
electronic. They are best for people with mild to severe

81. hearing loss
Completely in the canal (CIC) hearing
aids: These are tiny, discreet devices but not
recommended for people with severe hearing loss.
An invisible in canal:- IIC aid is nearly
impossible for other to see. You may put it in every
day or it may be a device you wear for several
months at a time

84. Lip reading
Lipreading is the art of being able to see speech sounds.
It is often called speechreading because people use other
clues, such as facial expressions, gestures and
surroundings, to help them understand what is being said.
Lipreading can help people who are hearing impaired to
cope better with their hearing loss. Not every word needs
to be understood for lipreading to be useful

85. Other skills can be developed that help a person
understand better what is being said.
 Sign language
This is a language that uses signs made with the hands,
facial expressions, and body postures, but no sounds. It is
used mainly by those who are deaf.