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Chronic otitis media
Definition
is a recurrent infection of the middle ear and/or mastoid air cells in the presence of a tympanic membrane perforation.
Pathophysiology
Chronic mucosal otitis media develops due to chronic inflammation secondary to a perforation in the tympanic membrane
The cause of the initial perforation may be infection, iatrogenic (e.g. grommet insertion), or trauma.
Any associated discharge from the perforation is termed an active mucosal COM, also known as “Chronic Suppurative OM” (CSOM). The mastoid air cells are continuous with the middle ear cavity and may also be affected in this disease
Signs symptoms
Fussiness in infants
Pus-like drainage from the ear
Fever, usually low-grade
Hearing loss
Ear pain or discomfort that is usually mild and feels like pressure in the ear
Causes
A flare-up may occur after a cold, an ear infection, or after water enters the middle ear.
People usually have hearing loss and persistent drainage from the ear.
Acute otitis media and blockage of a eustachian tube are among the causes of chronic suppurative otitis media.
There are multiple causes for recurring (chronic) ear infections, or recurring otitis media, ranging from allergies, sinusitis, ear injuries, and bacterial infections from colds or flu.
Nursing interventions
Monitoring signs and symptoms. Since otitis media is expected to settle after a few days, treatment normally begins with monitoring. Symptoms are monitored and are expected to settle within two days, although the infection can last for a week or two.
Pain management. Pain can be managed using over-the-counter pain relief medications. However, anaesthetic otic drops can also be prescribed as long as there is no tear on the eardrum.
Promote wound healing and return of skin integrity
Improving hearing and communication
Antibiotic therapy. Antibiotic is not given first-hand in otitis media. However, health care providers can recommend the use of appropriate antibiotics in severe cases of otitis media, and if the infection does not settle on its own. It is believed that unnecessary use of antibiotics can cause resistance.
Ear drainage. In some cases, the health care provider may recommend a procedure to drain the fluid build-up in the middle ear. The procedure involves the insertion of a tiny tube through the eardrum to the middle ear to suck and drain the fluid out. It can be done in an outpatient setting.
References
Ironside JW, Smith C. Central and peripheral nervous systems. In: Cross SS, ed. Underwood's Pathology. 7th ed. Philadelphia, PA: Elsevier; 2019:chap 26.
Chole RA, Sharon JD. Chronic otitis media, mastoiditis, and petrositis. In: Flint PW, Francis HW, Haughey BH, et al, eds. Cummings Otolaryngology: Head and Neck Surgery. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 140.
