Advertisement Upgrade to remove ads

Overview

Inflammation of the middle ear associated with fluid accumulation, most commonly due to poor functioning of the eustachian tube
Acute, chronic, suppurative, or secretory
Otitis media with effusion involving persistent inflammation with asymptomatic middle ear fluid, possibly leading to otitis media if fluid becomes infected
Recurrent when 3 episodes occur within 6 months or 4 or more episodes occur within 1 year
There are several categories of otitis media, including:
Acute otitis media: disruption of eustachian tube patency, usually of short duration (less than 3 weeks)

Chronic otitis media: disruption of eustachian tube patency, usually longer than 12 weeks

Secretory otitis media: viral infection, allergy, or barotrauma

Suppurative otitis media: bacterial infection with pneumococci, group A beta-hemolytic streptococci, staphylococci, and gram-negative bacteria

Chronic secretory otitis media: adenoidal tissue overgrowth, edema, chronic sinus infection, or inadequate treatment of acute suppurative otitis media

Chronic suppurative otitis media: inadequate treatment of acute otitis episodes or infection by resistant strains of bacteria
Acute otitis media: disruption of eustachian tube patency, usually of short duration (less than 3 weeks)
Chronic otitis media: disruption of eustachian tube patency, usually longer than 12 weeks
Secretory otitis media: viral infection, allergy, or barotrauma
Suppurative otitis media: bacterial infection with pneumococci, group A beta-hemolytic streptococci, staphylococci, and gram-negative bacteria
Chronic secretory otitis media: adenoidal tissue overgrowth, edema, chronic sinus infection, or inadequate treatment of acute suppurative otitis media
Chronic suppurative otitis media: inadequate treatment of acute otitis episodes or infection by resistant strains of bacteria

Overview-Pathophysiology

Dysfunction of the Eustachian tube leads to relative negative pressure in the middle ear space.
This results in a lack of aeration and accumulation of fluid, providing an environment conducive to the growth of microorganisms.
The disease process differs according to type of otitis media.

Overview-Suppurative form

Nasopharyngeal flora reflux through the eustachian tube and colonize the middle ear.
Respiratory tract infections, allergic reactions, and position changes allow reflux of nasopharyngeal flora through the eustachian tube and colonization in the middle ear.

Overview-Secretory form

Obstruction of the eustachian tube promotes transudation of sterile serous fluid from blood vessels in the middle ear membrane.

Overview-Causes

Bacteria, commonly Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, and group A streptococcus
Viruses, most commonly rhinovirus and respiratory syncytial virus

Overview-Risk Factors

Smoking in the household
Family history of middle ear disease
Male gender
Native Americans and Eskimos
Craniofacial abnormalities
Gastroesophageal reflux

Overview-Incidence

Information about the incidence of otitis media in adults is uncertain.

Overview-Complications

Spontaneous rupture of the tympanic membrane
Persistent perforation
Chronic otitis media
Mastoiditis
Meningitis
Cholesteatomas
Abscesses, septicemia
Lymphadenopathy, leukocytosis
Permanent hearing loss and tympanosclerosis
Vertigo

Assessment-History

Upper respiratory tract infection
Allergies
Severe, deep, throbbing ear pain
Dizziness
Nausea, vomiting

Assessment-Acute secretory otitis media

Sensation of fullness in the ear
Popping, crackling, or clicking sounds on swallowing or moving the jaw
Hearing an echo when speaking

Assessment-Tympanic membrane rupture

Pain that suddenly stops
Recent air travel or scuba diving

Assessment-Physical Findings

Sneezing and coughing with upper respiratory tract infection
Mild to high fever
Painless, purulent discharge in chronic suppurative otitis media
Obscured or distorted bony landmarks of the tympanic membrane in acute suppurative otitis media
Tympanic membrane retraction in acute secretory otitis media
Clear or amber fluid behind the tympanic membrane
Blue-black tympanic membrane with hemorrhage into the middle ear
Pulsating discharge with tympanic perforation
Conductive hearing loss (varies with the size and type of tympanic membrane perforation and ossicular destruction)
Decreased eardrum motility (otitis media with effusion)

Assessment-Chronic otitis media

Thickening and scarring of tympanic membrane
Decreased or absent tympanic membrane mobility
Cholesteatoma

Diagnostic Test Results-Laboratory

Culture and sensitivity tests of exudate show the causative organism.
Complete blood count shows leukocytosis (if acute otitis media is due to bacteria).

Diagnostic Test Results-Imaging

Radiographic studies demonstrate mastoid involvement.

Diagnostic Test Results-Diagnostic Procedures

Tympanometry detects hearing loss and evaluates the condition of the middle ear.
Audiometry shows degree of hearing loss.
Pneumatic otoscopy may show decreased tympanic membrane mobility.

Treatment-General

In acute secretory otitis media, autoinsufflation (pinching nose while gently exhaling) several times per day (possibly the only treatment required)
Concomitant treatment of the underlying cause
Elimination of eustachian tube obstruction

Treatment-Medications

Antibiotic therapy, such as amoxicillin or azithromycin (if allergic to penicillin) as first-line agents; cefdinir, cefpodoxime, cefuroxime axetil, amoxicillin-clavulanate potassium, ceftriazone sodium, clarithromycin, erythromycin, or trimethoprim-sulfamethoxazole as second-line agents
Analgesics and antipyretics such as acetaminophen or analgesic eardrops such as antipyrine/benzocaine

Treatment-Surgery

Myringotomy and aspiration of middle ear fluid
Myringoplasty
Tympanoplasty
Mastoidectomy
Cholesteatoma excision
Stapedectomy for otosclerosis

Nursing Considerations-Nursing Diagnoses

Acute pain
Disturbed sleep pattern
Impaired verbal communication
Risk for infection
Risk for injury

Nursing Considerations-Expected Outcomes

express feelings of increased comfort
regain hearing or develop compensatory mechanisms
resume normal sleep patterns
communicate feelings and needs
remain free from signs and symptoms of infection
avoid injury.

Nursing Considerations-Nursing Interventions

Administer analgesics, antipyretics, and antibiotics as ordered; institute measures to reduce fever.
Allow the patient and his family to verbalize feelings and concerns; answer all questions and provide emotional support.
Prepare the patient and his family for possible surgery.

Nursing Considerations-With hearing loss

Offer reassurance, when appropriate, that hearing loss caused by serious otitis media is temporary.
Provide clear, concise explanations.
Admininster prescribed medications, such as analgesic drops for pain or antibiotics
Face the patient when speaking and enunciate clearly and slowly.
Allow time for the patient to grasp what was said.
Provide a pencil and paper.
Alert the staff to the patient's communication problem.

Nursing Considerations-After myringotomy

Wash hands before and after ear care.
Position the child to maintain drainage flow.
Place sterile cotton loosely in the external ear to absorb drainage and prevent infection. Change the cotton when damp. Avoid placing cotton or plugs deep in the ear canal.
Give prescribed analgesics.
Reinforce dressings after tympanoplasty.

Nursing Considerations-Monitoring

Pain level
Excessive bleeding or discharge
Auditory acuity
Ability to communicate needs
Postoperative status, including drainage and dressings
Signs and symptoms of infection

Nursing Considerations-Associated Nursing Procedures

Assessment techniques
Eardrop instillation
Health history interview and physical assessment
Heat application
Oral drug administration
Pain management
Temperature assessment

Patient Teaching-General

disease, possible underlying causes, diagnosis, and treatment
prescribed drug therapy, including the drug name, dosage, route of administration, frequency of administration, and duration of therapy
technique for administering ear drops if prescribed
possible adverse effects of drug therapy, such as gastrointestinal upset with amoxicillin and signs and symptoms of hypersensitivity
importance of completing the entire course of antibiotic therapy as ordered
need for adequate fluid intake
that symptoms of acute otitis media typically improve in 48 to 72 hours; that otitis media with effusion after an acute episode usually resolves within 3 months
use of fitted earplugs for swimming after myringotomy
importance of notifying the practitioner if the tube falls out and for ear pain, fever, or pus-filled discharge
measures to preventing recurrence (See Preventing otitis media.)
importance of adhering to follow-up care, such as an otoscopic examination 4 weeks after diagnosis for acute otitis media and monthly otoscopic or tympanometric examinations monthly until the condition resolves.

Please allow access to your computer’s microphone to use Voice Recording.

Having trouble? Click here for help.

We can’t access your microphone!

Click the icon above to update your browser permissions above and try again

Example:

Reload the page to try again!

Reload

Press Cmd-0 to reset your zoom

Press Ctrl-0 to reset your zoom

It looks like your browser might be zoomed in or out. Your browser needs to be zoomed to a normal size to record audio.

Please upgrade Flash or install Chrome
to use Voice Recording.

For more help, see our troubleshooting page.

Your microphone is muted

For help fixing this issue, see this FAQ.

Star this term

You can study starred terms together

NEW! Voice Recording

Create Set