EXPOSE ON ENT

THOME CHRONIC OTITIS MEDIA

- DEFINITION AND TYPES

- Pathophysiology

- SIGNS AND SYMION

- CAUSES

- FISK FACTORS

- EXAMS AND TEST (diagnosis)

- MANAGEMENT

- COMPLICATION

- PREVETION

- ALURSING MANAGEMENT

- FIRS T AID

PRESENTED BY:

Supervisor:
 DEFINITION AND TYPES

Chronic otitis media (com) or middle ear

Infection is an acute bacterial infection whish
Often blocks your ear drums is a bacteria
Or viral infection in the middle ear space.
The middle ear is an air chamber containing
The mechanism that conduct sound from the
Air in the external ear to the finds from the
Inner ear. It in dudes the eardrum (tympanic
Membrane), the asides and their ligaments
Host classifications now separate chronic otitis media into two
distinct types.

→Mucosal: it occurs due to tympanic member perforation and

subsequent inflammation of the middle ear mucosa; it is also known
as Chronic suppurate otitis media

→squamous: It occurs due to retraction of the tympanic membrane

and is associated with the formation of a cholesteatoma
PATHOPHYSIOLOGY
Chronic mucosal otitis media develops due
To chronic inflammation secondary to
Perforation in the tympanic membrane (TM).
The cause of the initial perforation may be
Infection, iatrogenic (egg grommet insertion). Or trauma
Any associated discharge from the perforation
Is termed an active mucosal chronic otitis
Media, also known as chronic supportive
Om" (CSOM). The mastoid air cell are continuous with the middle
ear. Also be affected cavity in this disease.

Chronic mucosal otitis media is a common condition. It has a

prevalence of 0.9% amongst children and 0,5% amongst adult in the
UK. Half of all cases develop a degree of hearing impair
SIGNS AND SYMPTOMS
A chronic ear infection can cause milder Symptoms than an acute ear
infection. Symptoms may affed one or both ears and may be constant
or come and go. Signs include
*A feeling of pressure in the ear
* Mild ear pain
* Fluid draining from ears.
* Low fever
* Hearing loss
* Trouble sleeping
 SIGNS AND SYMION

A chronic ear infection can cause milder Symptoms than an acute ear
infection. Symptoms may affed one or both ears and may be constant
or come and go. Signs include

*A feeling of pressure in the ear

* Mild ear pain
* Fluid draining from ears.
* Low fever
* Hearing loss
* Trouble sleeping
 CAUSES
The Eustachian tube runs from the middle of each ear to the back of
the throat. This tube drains fund made in the middle ear. If The
Eustachian tube becomes blocked fund earn build up when this
happens infection can occur
A chronic ear infection develops when fluid or an infection behinol
the eardrum does not
A chronic ear infection may be caused by:
*An acute ear infection that does not completely go away
* Repeated ear in infections san
Ear infections are more common in children because their Eustachian
tubes are shorter, narrower, and more horizontal than in adults.
Chronic ear infections are much less common than acute ear
infections.
RISK FACTORS

Risk factors for ear infections include:

• Age. Children between the ages of 6 months and 2 years are more
susceptible to ear infections because of the size and shape of their
Eustachian tubes and because their immune systems developing.

• Group child care. Children cared for in group settings are more
likely to get colds and ear infections than are children who stay
home. The children in group settings are exposed to more infections,
such as the common cold.

• Infant feeding. Babies who drink from a bottle, especially while

lying down, tend to have more ear infections than do babies who are
breast-fed.

• Seasonal factors. Ear infections are most common during the fall
and winter. People with seasonal allergies may have a greater risk of
ear infections when pollen counts are high.

• Poor air quality. Exposure to tobacco

smoke or high levels of air poll
 EXAM AND TESTE:
Your health care provider will look in the ears using
An otoscope. The exam may reveal:
• Dullness, redness in the middle ear
•Air bubbles in the middle ear
•Thick fluid in the middle ear
•Eardrum that sticks to the bones in the middle ear
• Draining fluid from the eardrum
•A hole (perforation) in the eardrum
•An eardrum that bulges out or pulls back inward (collapses)

Tests May Include:

• Cultures of the fluid that may show a bacterial infection.

•A CT scan of the head or mastoids may show that the infection has
spread beyond the middle ear.
• Hearing tests may be needed.
 Management

The mainstay of treatment in chronic mucosal otitis media is aural

toileting and topical antibiotic or steroid treatments until symptoms
reduce or resolve.

Patients with symptoms lasting >6 weeks or those with large

amounts of debris should be seen by an ENT specialist. The patient
should be counselled on the importance of keeping the ear clean and
dry.

Most tympanic membrane perforations will heal spontaneously

however large perforations can persist and referral for surgical
management may be required.
Possible Complications

A chronic ear infection may cause permanent changes to the ear and
nearby bones, including:
• Infection of the mastoid bone behind the ear (mastoiditis)

• Ongoing drainage from a hole in the eardrum that does not heal, or
after ear tubes are inserted
• Cyst in the middle ear (cholesteatoma)

• Hardening of the tissue in the middle ear (tympanosclerosis)

• Damage to, or wearing away of the bones of the middle ear, which
help with hearing
• Paralysis of the face

• Inflammation around the brain (epidural abscess) or in the brain

• Damage to the part of the ear that helps with balance

Hearing loss from damage to the middle ear may slow language and
speech development. This is more likely if both ears are affected.
Prevention

The following tips may reduce the risk of developing ear infections:

• Prevent common colds and other

illnesses. Teach your children to wash their hands frequently and
thoroughly and to not share eating and drinking utensils. Teach your
children to cough or sneeze into their elbow. If possible, limit the
time your child spends in group child care. A child care setting with
fewer children may help. Try to keep your child home from child care
or school when ill.

• Avoid secondhand smoke. Make sure that no one smokes in your

home. Away from home, stay in smoke-free environments.

• Breast-feed your baby. If possible, breast feed your baby for at

least six months. Breast milk contains antibodies that may offer
protection from ear infections.

• If you bottle-feed, hold your baby in an

upright position. Avoid propping a bottle in your baby's mouth while
he or she is lying down. Don't put bottles in the crib with your baby.
 Surgical Management

The aim of surgical management is to close the perforation in the

tympanic membrane, thereby relieving the symptoms of persistent
discharge and preventing recurrent infection.

Surgery can also potentially improve hearing, although this will

largely depend on the pre operative state of the auditory apparatus.

Surgical options include:

•Myringoplasty - closure of perforation in pars tensa

•The closure is achieved by patching on an autologous graft, usually

harvested from the tragal cartilage or temporalis fascia

•Tympanoplasty - a myringoplasty combined with reconstruction of

the ossicular chain
 Nursing Interventions Rationale

Assess client's Pain scale measures the

description and changes in the level of
frequency of pain; Use a pain by different
pain rating scale. Observe providers.
if the infant is tugging or
rubbing an ear. Preverbal infants
vigorously pull or rub the
affected ear, roll the
head and appear
irritable.

Monitor and A normal response to

record vital signs closely. pain is an increase in
respiratory rate, heart
rate, and blood pressure;
fever may cause
discomfort.
Encourage and assist the Promotes physical
parent to hold and comfort and distraction
comfort the client. for a child experiencing
illness.

Encourage the mother to Movement of the

provide and offer liquid eustachian tube, such as
to soft foods. with chewing, may
further aggravate the
pain.

Administer pain Analgesic such as

medication such as acetaminophen and
acetaminophen or ibuprofen alter response
ibuprofen as prescribed. to pain.
Monitor child for relief of Provides information
pain and any side effects about the effectiveness
of medication. of the medication and
prevents untoward
effects.

Have the child sit up, put Elevation promotes

pillows behind the head, drainage and reduces
or lie on the unaffected pressure from fluid.
ear.

Reassure parents that the Parents may be

discomfort usually concerned about their
subsides within a day on child's pain but may not
antibiotics but reinstruct know to continue the
the importance of antibiotic after symptoms
compliance with the subside
whole prescription.
At-Home Remedies to
Treat Ear Infections
A warm compress Hold a
washcloth under warm water and
squeeze it to release the extra
water. Then, lay it over the ear
that's infected for 20 minutes or so
to lessen the pain. A warm water
bottle held over the infected ear should also do the trick. (3,4)
"People do the warm compresses simply to try to
soothe, to try to draw out the inflammation,"
Chandrasekhar says, adding that
she does believe it can make

people feel a little bit better .

Warm olive oil in the ear

Chandrasekhar says there's no

proof this works but says it's okay
to try as long as the olive oil isn't
piping hot and there's no hole in
the eardrum. "It may soothe or it
1. may not soothe," she says. "If
there's no swollen eardrum, [olive
oil] may not cause any harm
whatsoever."
Blow-drying the ear This method
can also help people who routinely
suffer from swimmer's ear (who
aren't always swimmers — simply
being out on a windy and rainy day
could cause the infection). Pointing
a blow-dryer on low heat near the
ear can help dry up any leftover
moisture in the ear after being out
in the elements, pool, or shower.
A solution of equal parts rubbing
alcohol and vinegar Applying a
couple of drops of this solution in
the infected ear could help people
suffering from repeat infections of
swimmer's ear (medically called
otitis externa), which occurs when
water gets stuck in the ear canal
and bacteria grow. The rubbing
alcohol helps the water in the ear
evaporate, and the vinegar
prevents bacteria from spreading.