OTITIS MEDIA IN ENGLISH

                                                       

                                         OTITIS MEDIA IN ENGLISH

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            OTITIS MEDIA

            Otitis media is defined as infection of middle ear, which is a cavity behind the tympanic membrane or ear drum. Mainly otitis media is of two types

            Acute otitis media

            Chronic otitis media

            ACUTE OTITIS  MEDIA-

            Acute ottits media is defined as an acute infection of the middle ear, usually lasting less than 6 weeks. Acute otitis media (AOM) is a painful type of ear infection. It is the most common infection of ear necessitating medical therapy, and main cause of pain in ear for children younger than 5 years

            CAUSES OF AOM

            Acute otitis media (AOM) results from infection by viruses or bacteria, often as a complication of the common cold or of allergies. The pathogens that cause acute otitis media are usually Streptococcus pneumoniae, Haemophilusinfluenzae, and Moraxella catarrhalis, which enter the middle ear after eustachian tube dysfunction caused by obstruction related to upper respiratory infections, inflammation of surrounding structures.

            In children acute otitis media (AOM) occurs when  child’seustachian tube becomes swollen or blocked and traps fluid in the middle ear. The trapped fluid can become infected. In young children, the eustachian tube is shorter and more horizontal than it is in older children and adults. This makes it more likely to become infected.

            CLINICAL MENIFESTATIONS OF AOM-

            The symptoms of otitis media vary with the severity of the infection, mainly it is acute earache. The condition is usually unilateral in adults and  may be unilateral or bilateral in children.

            The pain is relieved after spontaneous perforation or therapeutic incision of the tympanic membrane.

            Other symptoms may include drainage from the ear, fever, and hearing loss.

            On otoscopic examination, the external auditory canal appears normal but The tympanic membrane is erythematous and often bulging.

            There is no pain with movement of the auricle of the ear, because problem is inside the ear.

            DIAGNOSTIC INVESTIGATIONS OF AOM-

            Otoscopy-   it is done by use an instrument called an otoscope to look into   ear and detect: Redness, swelling, blood, pus , fluid in the middle ear or perforation of the eardrum

            Tympanometry- During a tympanometry test a small instrument is used to measure the air pressure in  the ear and determine if the eardrum is ruptured.

            TREATMENT-

            Medical management of AOM includes early and appropriate broad spectrum antibiotic therapy.

            If drainage occurs, an antibiotic otic preparation (ear drops)  is usually prescribed.

            Symptomatic treatment may include use of antipyretics and pain killers

            Surgical management of AOM includes an incision in the tympanic membrane is known as myringotomy or tympanotomy. The tympanic membrane is numbed with a local anesthetic before procedure. The procedure is painless and takes less than 15 minutes. Under microscopic guidance, an incision is made through the tympanic membrane to relieve pressure and to drain serous or purulent fluid from the middle ear. The incision heals within 24 to 72 hours.

            CHRONIC OTITIS MEDIA-

            Chronic otitis media (COM) is an inflammatory disorder of the middle ear. It is defined as some long-term problems (more than 6 weeks ) with the middle ear, such as AOM not responding to treatment, reoccurring AOM or  a hole (perforation) in the eardrum that does not heal.

            CAUSES OF COM-

            All causes leading to acute otitis media (AOM) may also lead to  Chronic otitis media if left untreated.  It occurs when  child’seustachian tube becomes swollen or blocked and traps fluid in the middle ear. The trapped fluid can become infected. Chronic infections of the middle ear damage the tympanic membrane, destroy the  ossicles, and involve the mastoid.

            CLINICAL MENIFESTATIONS  OF COM-

            Symptoms of chronic otitis  media are minimal, with varying degrees of hearing loss and a persistent or intermittent, foul-smelling otorrhea. Pain is usually not experienced, except in cases of complications such as acute mastoiditis, when the postauricular area is tender and may be erythematous and edematous.

            On otoscopic examination we may find a perforation in the tympanic membrane , and cholesteatoma can be identified as a white mass behind the tympanic membrane or coming through to the external canal from a perforation.

            DIAGNOSTIC  INVESTIGATIONS OF COM-

            Otoscopy-   it is done by use an instrument called an otoscope to look into   ear and detect: presence of cholesteatoma and/or perforation of the eardrum

            CT SCAN AND MRI- To detect level of damage to middle  ear and associated bones is assessed by ct scan or MRI.

            TREATMENT OF  COM-

            Medical management of Chronic Otitis Media includes-

            careful suctioning of the ear under otoscopic guidance.

            Instillation of antibiotic drops or application of antibiotic powder is used to treat purulent discharge.

            Surgical management of COM, including tympanoplasty (Reconstruction of tympanic membrane), ossiculoplasty (Reconstruction of middle year bones),andmastoidectomy (removal of cholesteatoma by incising into mastoid) , are used if medical treatments are ineffective.

            NURSING MANAGEMENT-

            Medical management of otitis media is done on OPD basis so Nursing management is needed if surgery is scheduled.

            On admission in the ward a carefull assessment is made and based on assessment nursing care plan is prepared.

            Pre operative care may include relieving  of anxiety by proper information about disease and treatment process.

            The patient also is encouraged to discuss any anxieties and concerns about the surgery.

            Informed consent is taken after proper information about the surgery

            external auditory canal packing is used if a tympanoplasty was performed so care should be provided to prevent injury or bleeding from ear.

            Measures are initiated to prevent infection in the operated ear.

             The external auditory canal wick, or packing, may be impregnated with an antibiotic solution before instillation  so prepare dressing trayaccordingly. 

             Antibiotics and other medications are administered on time as prescribed .

            Reassure the patient as hearing in the operated ear may be reduced for several weeks because of edema, accumulation of blood and tissue fluid in the middle ear, and dressings or packing.

            Vertigo may occur after mastoid surgery if the semicircular canals or other areas of the inner ear are traumatized. Safety measures such as assisted ambulation are implemented to prevent falls and injury

            Post operative and discharge teaching includes information about the expected effects and potential side effects of the medication and how to take medications at home.

            Patients also need instruction about any activity restrictions, Possible complications such as infection, facial nerve weakness, or taste disturbances, including the signs and symptoms to report immediately.