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DISORDERS OF THE MIDDLE EAR (ACUTE OTITIS MEDIA (Pathophysiology (In…
DISORDERS OF THE MIDDLE EAR
ACUTE OTITIS MEDIA
Definition
It is an infection and inflammation of the middle ear.
Causes
Bacteria.
Haemophilus influenza.
Allergic reactions
Clinical manifestations
Coldness.
Tonsillitis.
Adenoiditis.
Allergic swelling of the throat.
Dysphagia.
Pus.
Perforated eardrum.
Purulent discharge.
Risk factors
Prematurity and low birth weight.
Young age.
Early onset.
Family history.
Altered immunity.
Neuromuscular disease.
Pathophysiology
In respiratory tract infection.
The infective organisms ascend along the Eustachian tube.
It enters the middle ear.
Inflammation occurs.
The Eustachian tube become swollen and blocked.
There would be a negative pressure in the middle ear.
Movable joints of the ossicles become immovable.
Impossible transmission of sound waves.
Hearing decreases.
Nursing management
Teach the patient how to wick the ear.
Encourage the patient to complete the coarse of antibiotics.
Surgical management
Myringotomy
Performed by inserting tubes through the tympanic membrane to equalize the pressure inside.
Medical management
Administration of analgesics.
Administration of antibiotics.
Nursing care plan
Monitor and record vital signs closely.
Monitor the child for relief of pain.
Encourage and offer liquid to soft foods.
Avoid re-infection.
CHRONIC OTITIS MEDIA
Definition
Untreated acute otitis media becomes chronic if the infection has not cleared and continues for more than two weeks.
Causes
HIV infection.
Tuberculosis.
Pharyngeal congestion.
Lowered immune status.
Inadequate drainage through the Eustachian tube.
Recurrent otitis media with increased virulence of infecting organisms.
Clinical manifestations
Tonsillitis.
Coldness.
Adenoiditis.
Allergic swelling of the throat.
Dysphagia.
Purulent discharge.
Pus.
Perforated eardrum.
Pathophysiology
In the respiratory tract infection.
The infective organisms ascend along the Eustachian tube.
It enters the middle ear.
There would be an inflammation.
The Eustachian tube become swollen and blocked.
There would be a negative pressure in the middle ear.
Movable joints of the ossicle become immovable.
Impossible transmission of sound waves.
Fever increases.
Hearing decreases.
Risk factors
The presence of allergy or atopy.
Upper respiratory tract infection.
History of acute otitis media.
Passive smoke.
Low social status.
Genetic factors.
Nursing management
The nurse should carefully dry the ear by wicking.
Prepare broad spectrum antibiotic ear drops.
Medical management
Administration of oral antibiotics for child.
Administration of analgesics.
Surgical management
Tympanoplasty
Performed to repair defects for the purpose of reconstructing sound conduction pathways.
There are five types.
Nursing care plan
Don't use commercially available cotton ear buds.
Don't insert or instill anything in the ear except that which is prescribed.
Keep dry the inside of the ear.
Patient musk keep follow-up appointments.
Tell the patient to report any painful swelling behind the ear.
OTOSCLEROSIS
Definition
This is the condition where the moveable joints between the ossicles in the middle ear are fixed.
Causes
Degenerative process of ageing.
Genetic, from parent to offspring.
Abnormal growth of bone in the ear.
Clinical manifestations
Hearing loss.
Nerve deafness.
Paracusis.
Dizziness.
Balance problems.
Tinnitus.
Pathophysiology
There is progressive loss of stapes movement
Due to the formation of sclerotic bone.
It fixes the stapes foot plate onto the oval window.
The stapes become immobile.
There would be a conductive hearing loss.
Risk factors
Family history.
Gender.
Pregnancy.
Race.
Measles virus.
Non-fluoridated water.
Nursing management
Hearing aids.
Surgical management
Stapedotomy
Removal of abnormal bone growth and insert a tiny implant.
Stapedoctomy
Entire stapes is replaced by a small prosthesis.
Medical management
Taking of calcium
Vitamin D supplements.
Nursing care plan
Tell the patient to avoid blowing the nose.
Advice to avoid cold temperatures.
Advice to avoid loud noises.
Tell the patient to see doctor if ever experiencing g pains.
MASTOIDITIS
Definition
It is the infection and inflammation of the mastoid air cells as a result of recurrent chronic otitis media.
Causes
Recurrent of chronic otitis media.
Pathophysiology
Mastoid air cells have a rich supply of blood.
In otitis media, infection drains into the mastoid cavity.
Where infecting organisms thrive and multiply.
Result in increased exudate.
Excessive drainage from the mastoid cavity traverses through the middle ear.
Also out of the perforated tympanic membrane through into the external auditory canal.
Inflammation process in the mastoid air cells result in oedema and more exudate.
There would be an increase pressure of the bony cavity.
Clinical manifestations
Mastoid process swelling.
Mastoid process tenderness.
Severe pains in the ear.
Profuse purulent ear discharge.
Risk factors
A recent middle ear infection.
A weak immune system.
Cholesteatoma.
Smoking during pregnancy.
Snoring.
Nursing management
Alley anxiety pre operative.
Obtain audiogram results.
Monitor vital signs after the procedure.
Promote comfort.
Tell the patient to report bleeding.
Medical management
Administration of antibiotics.
Administration of analgesics.
Surgical management
Mastoidectomy
Surgical opening and removal of the infected mastoid process.
Types
Simple mastoidectomy- incision behind the ear to remove infected mastoid process.
Modified radical mastoidectomy- removal of the posterior wall of the ear canal.
Radical mastoidectomy- removal of the ossicles and tympanic membrane.
Tympanoplasty- repair of the tympanic membrane to preserve hearing.
Nursing care plan
Prevent bleeding.
Give plenty of fluid as prescribed.
Promote rest.
Inform the patient about disease process.