Otitis Media

Otitis Media

Otitis media is inflammation of the middle ear, or middle ear infection. “otitis “ means inflammation of the ear, and “media” means middle. It is the inflammation of the mucous membrane of the middle ear, Eustachian tube, and mastoid. It may be acute or chronic.

Classification of Otitis Media

Acute Otitis Media

The middle ear infection occurs abruptly causing swelling and redness. Fluid and mucus become trapped inside the ear, causing the child to have a fever, ear pain, and hearing loss.

Clinical Manifestation

• The severity of the illness affects the otitis media symptoms.
• Usually unilateral in adults, the disease might come with otalgia. After spontaneous perforation or therapeutic incision of the tympanic membrane, the pain is reduced.
• Hearing loss, ear discharge, and fever are possible additional symptoms.
• The tympanic membrane is often swollen and erythematous.

Medical Management

The outcome of acute otitis media depends on the efficiency of therapy, the virulence of the bacteria and the physical status of the patient.

• With early and appropriate broad spectrum antibiotic therapy, otitis media may resolve with no serious sequelae.
• If drainage occurs, an antibiotic preparation is usually prescribed.

Surgical Management

• Myringotomy or tympanostomy: These terms refer to incisions made in the tympanic membrane.
• After an infant's illness has subsided, fluid (effusion) and mucus continue to build up in the middle ear. Hearing loss and a sense of fullness in the ear are potential symptoms for the child. Otitis media with effusion is also referred to as serous or secretory otitis media.

Clinical Manifestation

• When the Eustachian tube is trying to open, a patient may experience hearing loss, fullness or a feeling of congestion in the ear, and even popping and crackling sounds.
• On otoscopy, the tympanic membrane appears dull, and air bubbles may be seen in the middle ear. Typically, a conductive hearing loss is evident on the audiogram.

Management

• Unless an infection develops, serous otitis media does not require medical attention. A myringotomy can be done and a tube may be inserted to keep the middle ear ventilated if the patient's hearing loss due to middle ear effusion is a concern.
• In situations of barotraumas, corticosteroids in modest dosages can occasionally reduce the edema of the Eustachian tube.
• Decongestants have not been found to work.
• A cautious Valsalva maneuver can be used to forcefully open the Eustachian tube by raising nasopharyngeal pressure.

Chronic Suppurative Otitis Media

 This condition involves a hole or perforation in our eardrum along with active bacterial infection inside the middle ear for weeks and months. The pus accumulated inside the ear is often in excess and tends to drain out of the ear as well. This condition is called otorrhea.

Chronic otitis media is the result of repeated episode of acute otitis media causing irreversible tissue pathology and persistent perforation of the tympanic membrane.

Clinical Manifestation

• There may be few symptoms, including varied degrees of hearing loss and an ongoing or sporadic otorrhea with a bad odor.
• Except in situations of acute mastoiditis, where the post-auricular region is painful to the touch and may be erythematous and edematous, pain is not often felt.
• Tympanic membrane perforation may be visible during otoscopy, and cholesteatoma can be recognized as a white mass behind the membrane or protruding into the external canal from a perforation.

Medical Management

• The ear is carefully suctioned while being monitored under a microscope as part of the local therapy for chronic otitis media.
• A purulent discharge is treated by administering antibiotic drops or applying antibiotic powder.
• In most cases, systemic antibiotics are only prescribed in the event of an acute infection.

Surgical Management

When medical treatment is found to be ineffective, surgical procedures like mastoidectomy and ossiculoplasty are performed.

Nursing Intervention for Otitis Media Child

• provide analgesics as directed to relieve discomfort
• For some kids, using a heat pack to their ears may help them feel better.
• Place the kid on the affected side to encourage drainage.
• Parent giving advice about preventive care.
• When feeding babies, keep them as upright as you can to prevent formula reflux into the Eustachian tube.
• Avoid smoking near young children and newborns.
• assist in clearing drainage when you can
• Wicks may be inserted loosely in the ear as postoperative support to encourage drainage but stop infection from spreading to the middle ear.
• Purulent drainage is prevented by regular cleaning of the outer ear and the application of a moisture barrier to the ear.