DISORDERS OF EARS

Presented by:
Sivasakthi. K
M.sc nursing
CON-PIMS
INTRODUCTIO
N
Ear, nose and throat disorders
particularly infection are extremely
common among children.
Ear infections occur almost as
often as the common cold.
The infection can develop in the
otitis media, otitis externa or
external otitis
ANATOMY OF THE EAR
 PHYSIOLOGY OF THE EAR
EXTERNAL EAR:
• Receives sound and transmit them to the middle ear via the eardrum.

MIDDLE EAR:
• middle ear bones from the bridge between eardrum and the inner ear. Eustachian tube,
ensures that the pressure on either side of the eardrum is balanced and the sound can
be heard correctly.
INNER EAR
• organ of corti transforms the mechanical energy of the sound waves into nerve energy
by creating electric impulses that are sent to the brain through the vestibulocochlear
nerve
TERMINOLOGIE
S
Tinnitus
Otalgia
Barotraumas
Myringotomy
Otorrhea
Myringoplasty
Tympanoplasty
otosclerosis
DISORDER
OF
EXTERNA
L EAR
 Inflammation of external auditory canal
Causes:
Infection by staphylococcus aureus causing boils
in auditory canal
Swimmers ear

OTITIS Prolonged exposure to moisture or by allergic

reaction to dandruffs, soap, hair spray and hair
EXTERNA dyes
Clinical manifestation:
Pain and discharge from auditory canal
Fever
Pruritis , hearing loss or feeling of fullness.
CONT’D
Medical management:
Antibiotic
Antifungal
Corticosteroid
Analgesic
Prevention:
Avoid swimming and not allow water to enter the ear
when shampooing or showering.
A cotton ball can be covered in a water insoluble gel
such as petroleum jelly and placed in the ear as a barrier
to contamination
This Photo by Unknown Author is licensed under CC BY-ND
IMPACTED
CERUMEN
Definition
It is a condition in which earwax
accumulates in ear canal leading to blockage
and pressure on ear canal.
Cause:
Use of eardrum or ear plugs
Putting object in the ear
CONT’D

Clinical manifestation:
Tinnitus
Itching
Difficulty in hearing
Ear discharge
Odor from ear
Management
Irrigate ear canal
Instill antibiotic ear drops
Manual removal of wax
 Furunculosis
Definition:
It is infectious disorder characterized formation of boils in the
hair follicles.
Causes
Poor hygiene
Malnutrition
Weak immune system
Prescence of abrasions and cuts
CONT’D
Signs and symptoms
Tenderness
Hearing loss
Management
Nimesluide 100mg bd
Apply antibiotic steroid
cream
Warm compress
Abscess drainage by incision
ROLE OF
NURSE
Nurse need to teach
Not to clean the external auditory
canal with cotton tipped applicator
Avoid swimming
Not to allow water in ear
Use of petroleum jelly as a barrier
Octic preparation after swimming
 FOREIGN BODIES IN THE EAR
Foreign bodies refers to any object in the ear
which can cause harm in absence of medical
attention. Some of the items that are
commonly found in the ear canal includes
Food
Insects
Toys
Buttons
Small batteries
CLINICAL FEATURES:
Pain in the ear
Rednesss
Drainage from ear
MANAGEMENT:
Prompt removal of objects by
physician.
Instruments may be inserted in the
ear.
Magnets are used if object is metallic
A machine with suction helps to pull
the objects out.
DISEASE OF
THE MIDDLE
EAR
OTITIS MEDIA
Definition:
Otitis media is one of the most
common infection of early
childhood.
Types of
otitis
media
 ACUTE OTITIS MEDIA
Childhood acute otitis media tend to occur
in a bimodal age distribution with children
between ages 12 and 24 months and
between ages 5 and 6 years at greater risk.
ETIOLOGY
 streptococcus pneumonia
 Hemophilus influenza
 Moraxella catarrhalis
 Streptococcus pyrogens
 Staphylococcus aureus
 SIGNS AND
SYMPTOMS
Presence of middle ear effusion
Often history of recent upper
respiratory tract infection
Ear pain
Ear tugging and rubbing
Fever
Excessive crying
Poor appetite
Impaired hearing in affected ear
 DIAGNOSIS

Otoscopic examination generally

reveals a red and bulging tympanic
membrane.
Suppration may have already
occurred in which case reddish
brown fluid may be seen filling the
ear canal.
TREATMENT AND CARE FOR
CHILD
Antimicrobial therapy
Amoxicillin and cotrimoxazole- first line
therapy
Secondary line therapy is indicated for
unresponsive infections eg., cefuroxime
TREATMENT FOR COMPLICATED AOM

Tymphanocentosis ( aspiration of
middle ear fluid) may be performed
with an 18 gauge spinal needle.
Prolonged antibiotic prophylaxis
(eg) amoxicillin for 3 -6 months for
child with recurrent episodes of
AOM.
OTITIS MEDIA WITH EFFUSION
Following episode of AOM, serous
or mucoid middle ear effusion may
be seen in number of children.
Effusion has been found to persist
in upto 40% of children
SIGNS AND
SYMPTOMS
Mild to moderate hearing loss
Sense of earblockage
Sometimes asymptomatic
No ear pain
DIAGNOSI
S
Otoscopy – dull tympanic membrane
with or without fluid
Reduce mobility of the tympanic
membrane
 TREATMENT

Antibiotics
Tympanostomy ( tube insertion)
PREVENTION

Surface swimming is
encouraged
Avoid swimming
altogether

This Photo by Unknown Author is licensed under CC BY-SA

CHRONIC SUPPURATIVE OTITIS
MEDIA

Persistent or recurrent ear

discharge is generally due to chronic
inflammation of the middle ear
space or mastoid air cells
CAUSE
S
Often results from neglected
acute middle ear infection.
Eustachian tube dysfunction
Causative organism
- pseudomonas arginosa
- staphylococcus aureus
- aspergillus and candidiasis
DIAGNOSIS

Chronic ear discharge is the

hallmark sign for CSOM
TREATMENT
Topical antibiotics ( quinolones)
Aural toilet
Ciprofloxacin ear drops
Surgical therapy
Tympanoplasty
Mastoidectomy
COMPLICATIO
N
Intracranial

• Meningitis
• Brain abscess
• Otitis hydrocephalus

Extracranial

• Labrynthis fistula
• Facial nerve paralysis
• mastoditis
ROLE OF NURSE
Positioning: Sit up, raise head, lie
on unaffected ear side
Heat application: Apply heating pad
or hot water bottle
Diet: Encourage breastfeeding for
infant
Hygiene: Cover mouth and nose
while sneezing, handwashing
Monitor for hearing loss
DISORDERS
OF INNER
EAR
MENIERE’S DISEASE

It is a disorder that affects the inner ear. It

causes vertigo, hearing problem and a
ringing sound in the ear, it usually affects
only one ear.
CAUSES

Excessive endolymph
Viral infection
Allergies
Stress
aspirin
 Vertigo and dizziness
Tinnitus
Deafness
CLINICAL Fullness in both ear
MANIFESTA Photophobia
TIONSigns and Nausea and vomiting

symptoms
 Antihistamines used to relieve
pressure
Sedative ( benzodiazepines) – balance
Hearing aids
Low salt
diet
Restrict
caffeine
Surger
y
TREATME Endolymphatic sac
decompression
NT Vestibular
neurectomy
LABYRINTHI
TIS
It is an inner ear disorder
it occurs when a
vestibular nerve becomes
inflamed.
CAUSES
AOM
Meningitis
Viral infection
Head injury
Allergy
Upper respiratory
tract infection
CLINICAL
MANIFESTATION
Vertigo and dizziness
Sensorineural hearing loss
Tinnitus
Otorrhea
Otalgia
Neck pain and stiffness
Cognitive impairment
Manageme
nt
HEARING
LOSS

Definition
Hearing impairment is a
general term indicating disability
that may range in severity from
slight to profound hearing loss.
TYPES
 CAUSES
Conductive
Impaired ear wax
Foreign body
AOM, CSOM
Injury to tympanic membrane
Sensorineural
Congenital
Meniere’s disease
Infections eg., mumps
CLINICAL Lack ofindifference
startle and to
blinking
MANIFESTATION General
Failure reflex
Fail to localize
to awakened
sound
soundinatloud
6
FOR INFANTS month
environment
of age
CONT’D

Children
• Use of gesture rather than verbalization
• Failure to develop speech by the age of 24 months
• Vocal play, head banging or foot stamping for
vibratory sensation
• Avoidance of social interaction
• Shy, timid and withdrawn behaviour
 Conductive
hearing loss
• Antibiotic therapy
• Hearing aid
TREATMEN
T Sensorineural

• Hearing aids
• Cochlear implants
ROLE OF Cued speech for communication
NURSE
Sign language

Speech language therapy

Socialization extremely important for

child development

Support child and family

 Childs understanding of explanation need to
be constantly reassessed
Check for working condition of hearing aid
If the verbal response is poor ask the child to
draw, write and use of sign language
Always stand at the site where the child can
able to see the nurse
Care during Make bond with child by drawing or writing
hospitalization Be an advocate for the childs special need to
other health care team members
Develop social relationship by giving play
activities
 Prevention of hearing loss
Prenatal and perinatal prevention

PREVENTION Genetic counselling, avoidance of

smoke exposure, management of
OF HEARING maternal dm, rule out syphilis
IMPAIRMENT Avoid exposure to excessive noise
Wear ear protection
 Ear is the organ of hearing and
balance. Proper management is
necessary for the prevention of
CONCLUSIO hearing impairment. Child with
hearing loss requires a special
N attention and care. Provide social and
moral support to the child.
ANY DOUBT?
Question
time
 Assignment
Write an assignment on the care of child with hearing aids
and care of hearing aids
 Wong’s “ essential of paediatric nursing”, 2nd edition,
elsiver publishers, pp904- 908, 806
Op ghai, Vinoth k paul, Aravind bagge, “ essential of
paediatrics”, 7th edition, cbc publisher, newdelhi, pp
329-334
Parul dutta, “ paediatric nursing”, 4th editiom, elsiver
REFEREN publisher, newdelhi, pp 352- 356

CE dorthy,. R . Marlow, “textbook of paediatric

nursing”, south Asian edition, pp 428- 436
Dr. renu, charhan, “anatomy for nursing”, pp 129-
135
Rimple sahrma, “ essential of paediatric nursing”, 2nd
edition, elsiever publisher, pp 236-240
 Net reference
www. Slideshare. “ disorder of the ear”. Net
www. Slideshare. “ care of child with ear
disorder”. net
www. Slideshare. “ anatomy and physiology of
REFEREN ear”. Net
CE Journal reference
E. alpert, i. spivate, abg- ilan, “ composition and
method for treatment of ear disorder”.
Kaithri batamilizia mukara, peter waiswa, “
knowledge and care seeking practices for ear
infections among parents of under five children”.