External Otitis, Otitis Media
What is external otitis and what causes it?
inflammation or infection of the external ear canal
caused by bacteria or fungi (hearing aid use, mechanical trauma, local hypersensitivity reaction)
Serous otitis media is associated with prolonged obstruction of the auditory tube caused by allergies, exposure to smoke and other things. How does serous otitis media manifest and how long does it take to go away?
Fluid moves from capillaries to space, gets stuck and thickens. This fluid causes hearing loss and/or popping in ear, retraction or bulging of tympanic membrane (can rupture), changes in pressure can cause pain and vertigo
Usually resolve in 2-4 weeks, if not, anti-inflammatories can be taken
What surgical interventions might be performed for a diagnosis of acute otitis media?
Myringotomy (incision) - tympanocentesis (aspirate fluids) - tympanostomy tubes (ventilation)
After the perforation of the tympanic membrane, what forms inside the middle ear chamber from layers of dead skin cells? If left untreated, what structures are affected?
cholesteatoma
the ossicles (3 small bones) and other middle ear organs
What is meniere's disease and what are its possible causes?
chronic disorder that affects hearing and balance (excess endolymphatic fluid)
may be caused by trauma, infections, autoimmune disorders, extreme stress, medications, or toxins
How does external otitis manifest itself?
feelings of fullness in the ear, ear pain (otalgia) especially when moving the auricle, watery or purulent drainage, ear canal may appear inflamed and edematous
Acute otitis media is the most common middle ear problem, it is inflammation or infection of the middle ear. Whats the most common cause? Acute otitis often follows what?
Often due to bacteria colonizing the middle ear
often follows upper respiratory infection or allergies
What are 2 possible complications with acute otitis media?
labyrinthitis (otitis interna - infection of inner ear)
mastoiditis (infection of mastoid process)
Treatment of chronic otitis media
systemic antibiotics
tympanocentesis
tympanoplasty
What are some clinical manifestations of meniere's disease?
onset may be gradual or sudden, complain of feeling of fullness (pressure), recurrent attacks of vertigo, tinnitus, and unilateral sensorineural hearing loss, N/V/D nystagmus, hypotension, sweating, headaches, abdominal pain
How would you diagnose, treat, and prevent external otitis?
Diagnose: H&P, culture and sensitivity
Treat: analgesics and warm dry heat, antibiotic or antifungal ear drops (cellulitis may need systemic antibiotics), topical corticosteroids
Prevention: preventative measures (no cotton swabs or objects in the ear canal, swimming protection during and drying after)
How would acute otitis media manifest on a patient?
pain - fever - diminished hearing - fluid draining from ear - dizziness - vertigo - tinnitus
What are the manifestations of labyrinthitis and how is it treated?
vertigo, sensorineural hearing loss, and nystagmus (rapid involuntary movement of the eye)
treat with IV antibiotics
What are the nursing assessments and interventions to perform pre operatively for patients having ear surgery?
informed consent - assessment of knowledge - assessment of hearing - agreement on means of communication - pre-operative teaching (no nose blowing, coughing, sneezing, etc.) - surgical prep (administer medications, positioning)
What tests can you do to diagnose meniere's disease?
h&p, ear exam & hearing test, x-ray, ct, mri, etc
What can cause a blockage in the ear canal and and how might is present itself?
causes: impacted cerumen or foreign body or insects can cause blackages
manifestations: conductive hearing loss, sensation of fullness, tinnitus, coughing
How would you diagnose acute otitis media?
history - tympanic membrane examination (red, inflamed/dull, bulging) - culture if ruptured
What are the manifestations of mastoiditis and how is it treated? what can mastoiditis progress to?
earache, hearing loss, redness, swelling over mastoid, fever, tinnitus, headache, drainage from the ear
treat with IV antibiotics
can progress to meningitis
What are some post-op nursing assessments for patients having ear surgery?
bleeding/drainage - N/V (antiemetics - zofran) - vertigo/dizziness (meclizine - antivert) - post-op hearing exam
What drugs are used to treat meniere's disease?
diuretics - antihistamine - antivertigo - tranquilizers - antiemetics - scopolamine - possible gentamicin
What is otitis medias and the different kinds?
inflammation or infection of the middle ear
serous otitis media (otitis media with effusion)
acute otitis media
chronic otitis media
What meds would be prescribed for the patient with acute otitis media?
antibiotics - analgesics - antipyretics
What is chronic otitis media? Chronic otitis media can be the result of recurrent _____ _____ _____ or ______
permanent perforation of the tympanic membrane.
acute otitis media
trauma
What are some post-op nursing interventions for patients having ear surgery?
Elevate head of bed and position on unaffected side, patient teaching (avoid blowing nose, coughing, and sneezing - possibly antihistamines to reduce allergies), avoid water in ear (swimming, showering, and shampooing), no swimming, diving, or air travel without physician approval, s/sx of complications
What treatments are used for Meniere's disease?
bed rest in dark room, position for limited movement, safety to decrease fall risk, diet changes (low sodium, limit alcohol, caffeine, tobacco), surgery (endolymphatic decompression and shunt, vestibular neurectomy, labyrinthectomy