OTITIS MEDIA

DEFINITION:-

It is an inflammation of middle ear or infection of middle ear caused by entrance of pathogenic organisms

TYPES:-

It is mainly of three types:

  1. Acute O.M. (Suppurative otitis media)
  2. Serous O.M.
  3. Chronic O.M.


  1. Acute O.M.: It is an acute infection of middle ear, usually lasting less than 6 weeks.

  2. Serous O.M.: It means accumulation of serous fluid in middle ear without evidence of active infection, but fluids results from a negative pressure in the middle ear caused by Eustachian tube obstruction.

  3. Chronic O.M.: It is the result of repeated episodes of acute O.M. causing irreversible tissue pathology and persistent perforation of tympanic membrane.
    It also leads to mastoid bone infection.


CAUSES:-

  1. Pathogenic infections:
    • Bacteria (streptococcus pneumonia)
    • Virus
    • Upper respiratory infection, e.g., sinusitis.
    • Allergic reaction
    • Entrance of foreign body in ear.
  2. Inadequate treatment of acute otitis media.


SIGN/SYMPTOMS:-

  1. ACUTE OTITIS MEDIA:
    • Pain
    • Hearing loss
    • Purulent drainage (otorrhoea)
    • Fever may be rise to 104F-105F
    • Irritability
    • Headache
    • Anorexia
    • Nausea/Vomiting.

  2. CHRONIC OTITIS MEDIA:
    • Otalgia (ear pain)
    • Redness and swelling
    • Perforation of tympanic membrane
    • Tinnitus (Ringing sound hears in ears)
    • Dizziness
    • Building of tympanic membrane
    • Obstruction of Eustachian tube.


PATHOPHYSIOLOGY:-

    Acute Otitis Media
    ↓
    Due to infection
    ↓
    Inflammation occurs and exudate edema in Eustachian tube in middle ear
    ↓
    Serous exudation in middle ear
    ↓
    Thickened, purulent and pus formation
    ↓
    Leads to tympanic membrane perforations
    ↓

    Chronic Otitis Media
    ↓
    Accumulation pf pus inflammatory exudate under pressure in middle ear cavity
    ↓
    May leads to necrosis of tissue
    ↓
    Damage of tympanic membrane
    ↓
    Conductive hearing loss
    ↓
    Extension of infection may occur into the mastoid cells (mastoiditis)


DIAGNOSTIC FINDING:-

  • Physical Examination
  • Otoscopic Examination
  • Audiometry
  • Tympanometry
  • Culture and sensitivity test
  • Microscopic views
  • MRI.


COMPLICATIONS:-

  • Complete hearing loss
  • Facial nerves paralysis
  • Meningitis
  • Mastoiditis.


MEDICAL MANAGEMENT:-

  1. Broad spectrum antibiotics therapy, e.g.,
    • Complete hearing loss
    • Facial nerves paralysis
    • Meningitis
    • Mastoiditis.

  2. Antihistamines, e.g., Phinamine maleate, Chlorphenamine.
  3. NSAIDs drugs (for inflammation and pain) e.g., Nimuslide
  4. Antiseptic ear wash with antibiotic therapy in case of chronic otitis media.


SURGICAL MANAGEMENT:-

  1. Myringotomy: Incision through eardrum to create an artificial opening, either to allow infected fluid to drain from the middle ear in acute otitis media.

  2. Tympanotomy: (In Chronic Otitis Media): A surgical operation to expose the middle ear and allow access to the ossicles. It is usually performed by using around the eardrum and turning it forwards.

  3. Tympanoplasty: Surgical repair of tympanic membrane (eardrum) or surgical repair of a perforated eardrum by grafting.

NURSING MANAGEMENT:-

  1. Risk for infection related to Eustachian tube dysfunction.
  2. Altered auditory sensation perception related to fluid accumulation in middle ear.
  3. Otalgia (pain) related to disease condition.
  4. Impaired communication related to otalgia and hearing loss.
  5. Knowledge deficit related to disease process.

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