MIDDLE EAR INFECTION, MEDICAL SURGICAL NURSING

1. OTITIS
MEDIA
SUDESHNA BANERJEE DUTTA
LECTURER
S.R.S.V.M B.SC NURSING COLLEGE

2. OTITIS MEDIA
Definition:-
 “It is an infection & inflammation of middle
ear that most often occur in infant & young
children but can occur at any age”
 Most common in children under 15 yr of age
 It may be acute, chronic & serous otitis
media.

4. ACUTE SUPPURATIVE OTITIS MEDIA (ASOM)
DEFINITION-
“It is an acute infection of the middle ear which causes
inflammation & purulent fluid accumulation; usually lasting
less than 6 weeks”
ETIOLOGY:
✓ Bacteria eg. Streptococcus pneumoniae, H. Influenza
✓ Upper respiratory tract infection
✓ Infection of nasopharynx (tonsilitis, common cold)
**These infections may reach to middle ear through
traumatic perforation in tympanic membrane

5. PATHOPHYSIOLOGY
Due to etiological factor(URTI, Bacteria)
Serous exudates & edema in middle ear
Pus formation
Tympanic membrane rupture
OTITIS MEDIA

6. CLINICAL MANIFESTATIONS
➢ Otorrhea (Ear discharge )
➢ Otalgia (ear ache)
➢ Fever
➢ Rhinitis (inflammation of the mucous membrane of the
nose)
➢ Tympanic membrane erythema, may be
perforated
➢ Hearing loss
➢ Irritability

7. DIAGNOSTIC EVALUATION
➢ History
➢ Physical examination
➢ Otoscopic examination (a procedure that examines the
auditory canal and tympanic membrane for infection or
blockage )
➢ Audiometry (tests the ability to hear sounds)
➢ Tympanometry ( an examination used to test the condition
of the middle ear and mobility of the eardrum; tympanic
membrane)

8. OTOSOPIC EXAMINATION

9. AUDIOMETRY

10. TYMPANOMETRY

11. MANAGEMENT
Medical Management-
✓ Antibiotic
✓ Analgesic
✓ Antihistamine
Surgical management-
Myringotomy or Tympanotomy (incision in the tympanic
membrane to relieve pressure caused by excessive
buildup of fluid, or to drain pus from the middle ear.)

12. CHRONIC SUPPURATIVE OTITIS MEDIA (CSOM)
Definition:-
“It results from repeated infection in middle ear causing
permanent perforation of tympanic membrane. The
infection involves middle ear with mastoid cells”

13. ETIOLOGY
➢ Inappropriate treatment of acute otitis media.
➢ URTI, Allergic rhinitis.
➢ Eustachian tube deformity
➢ Sinusitis

15. SUPPURATIVE+PERFORATION
a. Atico-antral chronic otitis media –
Inflammation involves bones (e.g. mastoid,
tympanic ring, ossicles ).
b. Tubo-tympanic otitis media
Acute otitis media Permanent
perforation Muco-purulent discharge.

16. NON-SUPPURATIVE (SEROUS OTITIS MEDIA)
Stages
URTI or acute otitis media Fluid collection in middle ear
and obstruction of eustachian tube Tympanic
membrane retraction
Fluid become pus like creates pressure Tympanic
membrane perforation
Could end up with mastoiditis (a serious infection in the
mastoid process, which is the hard, prominent bone just
behind and under the ear) ( if not stopped )

17. TYMPANIC MEMBRANE RETRACTION

18. CLINICAL MANIFESTATIONS
✓ Hearing loss
✓ Otorrhea
✓ Low pitched tinnitus

19. MANAGEMENT
Medical management-
➢ Careful suctioning of the ear under microscopic
guidance.
➢ Instillation of antibiotic drops
Surgical management
➢ Tympanoplasty (reconstruction of the eardrum)
➢ Ossiculoplasty (surgical reconstruction of the middle ear
bones to restore hearing)
➢ Mastoidectomy (removes diseased mastoid cells)