Otitis Media

Annotations:

• Medical-Surgical Nursing (Lewis) pg. 404

1. Diagnostic
   1. Pearly Gray (Pink when inflammed)
   2. swab the ear
   3. WBC's Increased
   4. Otoscopy
      1. less than 3 down
      2. Up & Out for adults
      3. Reveal: Preforations & Changes in color
   5. C&S of Ear Drainage
      1. Positive Bacterial Culutres
   6. CBC w/ differential
   7. Serous OM
      1. Impedence Auditometry
      2. Special Gradient Acoustic Reflectometry
      3. Audiologic Testing
   8. Audiogram
      1. Chronic: if ossicles damaged could have hearing loss as great as 50 to 60 dB
   9. Detect Damage
      1. sinus X-ray
      2. CT/MRI (Bone destruction or Presence of mass)
2. Complications
   1. Prevent Spontaneous Preforation of The TM
   2. Chronic Risk
      1. Chronic: Destruction of Ossicles
      2. accumulation in fluid in middle ear
      3. Cholestatoma can destroy adjacent bones
3. Symptoms
   1. Adults
      1. Ear Pain
      2. Sense of Fullness or Pressure of affected ear
      3. Snapping or Popping sensations
   2. Children
      1. Pulling of Ear(S)
      2. Fussiness
      3. Fever
      4. Anorexia, Vomiting or Diarrhea
   3. Pressure from inflammation pushes on TM (Causing it to become red, bulging & Painful)
   4. Fever, malaise, reduced hearing
   5. Referred pain: Temporomandibular joint, teeth, gums, sinuses, or throat may also cause ear pain
4. Interventions
   1. Teach
      1. Hold your baby upright while feeding
   2. NOT aspirin
   3. Antibiotics
   4. Oral Analgesics: Acetaminophen or Ibuprofen
   5. Warm Compress on the Ear
   6. Antipyretics
   7. Antihistamine
   8. Anasthetic Ear Drops
   9. Surgical
      1. Myringotomy
         1. Incision of TM to release pressure & Exudate of middle ear
      2. tympanostomy
         1. Long or Short Term
      3. Tympanoplasty/Mastoidectomy
         1. Risk for Facial Nerve paralysis
         2. Sudden Pressure Changes & Post-op infection disrupt healing
         3. Impaired hearing Post-op is expected if there is packing
         4. Teach pt. to change cotton packing as needed
   10. Ear irrigations
   11. Antiemetics
5. inflammation of the middle ear (Tympanum, ossicles & space of the middle ear) with or without infection
6. Cause/Types
   1. Supprative OM
   2. Serous/Effusion OM

      Annotations:

      • Follow  URI, chronic sinus infection, barotrauma, or OM (Thin, mucoid or purulent)
      1. Complaints of Fullness of Ear
      2. No pain/dishcharge from ear/fever, just popping/decreased hearing
      3. Auditory tube does not open & Allow equalization of atmospheric pressure. middle ear pulls fluid from surrounding tisuse
   3. Risk
      1. Defensive Barriers of middle ear intact?
      2. Functional Eustuchian tube?
      3. Tympanic Membrane Intact?
   4. Cold/Allergies
      1. Trap bacteria in middle ear causing inflammation
   5. Bacteria & Viruses
   6. Acute OM (Children)
      1. Tube that normally drains fluid & Mucus in middle ear: IS shorter & flatter than adults.
   7. Chronic
      1. (Often painless) Hearing loss, Naseua & Episodes of Dizziness. Purulent Exudate. Casued by recurrent inflammation of the ear.