CHRONIC OTITIS MEDIA- it is an infection caused when acute otitis media is not treated therefore becomes chronic if the infection has not cleared and continues for more than two weeks.
In chronic otitis media there's ottorrhoea which indicates that there is an eardrum perforation with a serious complication, such as deafness, mastoiditis, cholesteatoma, a brain abscess or meningitis.
signs and symptoms
Otalgia
Occasionally true vertigo
Otorrhea
Aural fullness
Hearing loss
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causes
Lower immune status
Pharyngeal congestion
Lack of drainage through the eustachian tube especially if upper respiratory infection is a current factor
Tuberculosis
Recurrent acute otitis media with increased virulence of the infecting organisms
HIV infection
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PATHOPHYSIOLOGY
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The inflammatory reaction caused by this results in the Eustachian tube becoming swollen and blocked, which results in a negative pressure in the middle ear.
Fluid stagnates because there is no drainage, the movable joints of the ossicles become immovable, and transmission of sound waves is not possible.
As the inflammatory process advances, fever increases and hearing decreases.
In the presence of pus, the eardrum bulges outwards with a possible risk of perforation.
Should the eardrum perforate, there will be a purulent discharge from the ear
Nursing management
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The nurse should carefully dry the patient's ear by wicking
Broad spectrum antibiotic ear drops preparations should be as prescribed by the doctor, and if it is a child, oral antibiotics may be prescribed for five days with a follow-up after two weeks , the cause prescribed should be completed
If there is no improvement at that point, then the patient should be referred for expert management.
Monitor hearing loss
Have the child sit up, raise head on pillows or lie on unaffected ear
Monitor patient's vital signs and record them
Treatment
Tympanoplasty - it is a procedure that is performed to repair defects, such as tears in the eardrum, for the purpose of reconstructing sound conduction pathways. This procedure have 5 types
Type -1 Myringoplasty is a repair of a perforation in the tympanic membrane caused by infection or trauma. The ossicles are intact.
Type -2 Repairation of a perforation in the tympanic membrane where the malleus also needs repair. The graft patch is placed against the incus
Type -3 Here replacing the tympanic membrane, the malleus, and the incus where these have been destroyed. The stapes is usually intact and mobile thus allowing the transmission of sound waves
Type- 4 The graft is placed around the mobile foot plate of the stapes. The air pocket between the graft and the round window provides protection for the round window.
Type-5 The graft seals off the middle ear to provide sound protection for the round window.
health education
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Teach the patient how to wick.
Educate the patient that use of commercially available cotton ear buds should be discouraged, because these can perforate the tympanic membrane causing more complications to the ear
The patient should not insert or instil anything into the ear except that which has been prescribed.
The completion of the course of prescribed antibiotics is very vital to prevent further development of infection and any resistance.
The inside of the ear must be kept dry, therefore the ear must be protected from getting wet when shampooing hair, showering or swimming.
Keeping follow-up appointments, check and report any painful swelling behind the ear, which indicates mastoiditis.