OTITIS MEDIA

CHISO MOLLAH MKANDAWIRE

NURSING DEPARTMENT
BROAD OBJECTIVE
By the end of this presentation, students’ should be
able to acquire knowledge, skills and attitude to enable
them manage clients with otitis media.
SPECIFIC OBJECTIVES
Define otitis media
Etiology
Clinical manifestation
Management
Complications
Health education
DEFINITION
Otitis media is the inflammation of the middle ear
which is usually secondary upper respiratory tract
infections.
Its incidence is highest in children aged 6months to 2
years and it may increase at the age of 5 to 6 and boys
are more affected than girls. The disease is more
prevalent during winter season and early spring.
MIDDLE EAR
AETIOLOGY
The causes of otitis media can be grouped as primary
and secondary causes.
1. PRIMARY CAUSES
Virus: hemophilia's influenza
Bacteria: streptococci
2. SECONDARY CAUSES/PREDISPONSING
FACTORS
 Cold
 Bottle feeding
Cont.
Passive smoking
Early entry into group child care.
Structure of the infant’s Eustachian tube
Presence of indwelling tubes
Family history of otitis media
Immunosuppression
Low social economic class( overcrowiding)
Cleft plate and sex (male)
CLASSIFICATION
1. ACUTE OTITIS MEDIA
This is an inflammation of the middle ear space with a
rapid onset of the signs and symptoms of acute
injection namely fever and oltagia.
If the middle ear becomes contaminate d with bacteria,
pus and pressure in the middle ear can result and it is
called acute bacterial otitis media.
Cont.
2. OTITIS MEDIA WITH EFFUSION( SEROUS OTITIS
MEDIA)
This is fluid in the middle ear space without symptoms
of acute infection. This occurs as a result of the
negative pressure produced by altered Eustachian tube
function.
The child has no pain or fever but may complain of
feeling full and permanent hearing loss may result.
3. CHRONIC SUPPURATIVE
OTITIS/PURULATIVE
It involves perforation in the eardrum and at the active
bacterial within the middle ear space for several weeks
or more. It is common in persons with poor
Eustachian tube function.
Hearing impairment often accompanies this disease.
CLINICAL MANIFESTATIONS
Pain(oltagia)-caused by Irritability, crying
pressure from surroundingLethargy
structures of the middle Hearing loss
ear as the exudates Tinnitus
Fever Feeling of ear fullness
Enlargement of post Vomiting and diarrhea
auricular and cervical Dizziness
lymph nodes Sensation of movement if air
Otorrhoea is present above the fluid level
Pulling and rubbing of ears
Anorexia
MEDICAL MANAGEMENT
It is specific for each type of otitis media as classified
1. ACUTE OTITIS MEDIA
 Cotrimoxale 18mg/kg stat orally then 6mg/kg
12hourly for 10 days.
 Paracetamol 10-15mg/kg orally 4-6hourly for 3 days
and amoxicillin 15mg/kg 8hourly orally for 7-10days
orally.
2. OTITIS MEDIA WITH EFFUSION
Treatment will depend on culture of the purulent
discharge.

3. CHRONIC SUPPURATIVE OTITIS MEDIA

Clean/mop the ear with cotton wool until the cotton
wool comes dry four times a day.
Give antibiotics when the guardian has been taught to
clean the ear.
Cont.
After culture and sensitivity give medications based on
the micro organisms found. But the common micro
organisms found are pseudomonas, streptococcus,
klebisiela and Escherichia coli.
Other measures include analgesics or antipyretics
such as paracetamol.
SURGICAL MANAGEMENT
1. MYRINGOTOMY
 Surgical small incision of the ear drum to relive pain,
by allowing drainage of the purulent fluid which may
also be used for culture.
2. TYMPANOSTOMY TUBE PLACEMENT AND
ADENOIDECTOMY.
 Done to treat recurrent otitis media
 Tympanostomy tubes are pressure equalizer tubes
that facilitates continued drainage of fluid and allow
ventilation of the middle ear.
NURSING MANAGEMENT
DIAGNOSES
1. Altered comfort, pain(otalgia) related to increased
pressure in the middle ear secondary to fluid
accumulation a evidenced by verbalization.
INTERVENTIONS
 Position the child according to comfort preferance
usually lying on the affected side.
Cont.
Apply external heat, with heating pad or hot water
bottle on low setting. This helps the muscles to relax
hence reducing the pain.
Avoid chewing by offering liquid or soft foods because
chewing stimulates pain.
Provide diversion therapy by playing with the child
Massage the child to provide pain relief.
Administer antipyretics as needed.
Cont.
2. Altered thermoregulation, hyperthermia related to
microbial invasion in the middle ear as evidenced by
high temperature.
INTERVENTIONS
Do tepid sponging which will help in reducing body
temperature by 1 degree Celsius. Through conduction.
Encourage fluid intake to help maintain hydration and
cooling of the body.
Administer pcm 10mg/kg orally 8hourly for three days.
Cont.
3. Risk for altered nutrition less than body requirement
related to decreased food intake secondary to anorexia.
Interventions
Provide food in small frequent amounts and it should
be the child’s favourite food.
Provide food in a pleasant place
Provide oral care to stimulate the taste buds.
Provide food appetizers like lemons and oranges
Administer multivitamin which helps in boosting
immunity.
GENERAL INTERVENTIONS
Administer antibiotics as prescribed.
Promote compliance to medications regime
Emphasize to parents the importance of regular
administration and completion of the course of
therapy
Position with affected ear in dependent position with
the child lying on the affected side
Impress on the caregiver the importance of following
directions for administering medications.
Feed in upright.
Cont.
Encourage gentle nose blowing
Eliminate tobacco smoke and known allergen from
environment
Teach collect administration of medications
Stress importance of regular hearing tests to assess
early signs of impairment.
Teach to recognize signs of hearing impairment in the
infant of child.
Avoid excessive water in the ear if myringotomy tubes
were part of the therapy.
COMPLICATIONS
INTRACRANIAL Chronic suppurative otitis
Meningitis media
Brain abscess Cholesteastoma
Epidural abscess Ossicular fixation
Otic hydrocephalus Facial nerve paralysis
Lateral venous sinus Tympanic membrane
thrombosis perforation
INTRATEMPORAL Osteomaritis.
Permanent hearing loss
HEALTH EDUCATION
Teach them about drug compliance and anatomy of
the Eustachian tubes, this helps the client to
appreciate the importance of compliance and also
prevent recurrence of otitis media.
Teach to recognize on the signs of impaired hearing in
the child e.g tinnitus, not responding after speech.
Advise parents on proper feeding position of infant e.g
not to use feeding while baby is lying down.
Cont.
Counsel parents to expect perforation, they may find
mucupus and blood on the child’s pillow.
The guardian or parents should understand home care
infection prevention including control of allergies and
environment control
Teach the guardian or parents about the
accompanying signs and symptoms that indicate
complications.
thanks