OTITIS MEDIA AND

TUMOUR
OTITIS MEDIA AND TUMOR
 It is the inflamation of the middle ear & is
characterised by the accumulation of fluid in
the middle ear, bulging of the cardrum &
pain in the ear.
 Types of Otitis Media :-

 Otitis media is mainly of three types :-

1. Acute otitis media

2. Chronic atitis media

3. Serous otitis media
ACUTE OTITIS MEDIA
It is an acute infection of the middle ear, which appears
suddenly and usually last for 6 weeks.
ETIOLOGY:-
1. The primary cause of acute otitis media is
usually streptococcus pneumonie, Haemophilus
influenza & Moraxella catarrhalis, pneumococci,
beta hemolytic streptococci.
2. Viral pathogens such as:
 a. Respiratory syncytial virus
 b. Influenza virus
 c. Parainfluenza virus
 d. Rhinovirus
 e. Adenovirus
3. Allergies
4. Position changes like holding the infant in
supine position during breast feeding.
RISK FACTORS
1. It is more commonly seen in children.
2. It is more prevalent in male than females.
3. Lack of breastfeeding and use of pacifiers in children.
4. It is more common during winter months.
5. Patient with cleft palate or Down's syndrome.
6. Decreased immunity due to: a. Human
Immunodeficiency Virus (HIV)b. Diabetes. Other
immunodeficiencies
7. Ciliary dysfunction
8. Cochlear implants
9. Vitamin A deficiency
10. Passive smoke exposure
11. Genetic predisposition
12. Family history of recurrent acute otitis media in parents
or siblings.
Otitis media begins as an
inflammatory process following
Immature immune system

the edema caused by the

inflammatory process obstructs the
narrowest part of the Eustachian
tube

Increased dysfunction of Eustachian

Tube (ET) ear)

Decreased ventilation
• An increased negative pressure in the middle ear
• Increasing exudate from the inflamed mucosa
• Buildup of mucosal secretions

Allows Growth and multiplication of bacterial and viral

pathogens in the middle ear.

Pus formation in the middle ear space

Reflux of nasopharyngeal flora into ear through

Eustachian tube resulting to Colonization in middle ear

Middle ear inflammation (otitis media)

 CLINICAL MANIFESTATION:-
 Pain in the ear
 Sensation of fullness
 Fever
 Tinnitus may occur
 Drainage/ discharge from the ear
 Hearing loss
 May cause eardrum to rupture

Diagnostic evaluation:-
• History taking
• Tympanosentesis
• Computed tomography
• MRI
MANAGEMENT
 Medical management:-
1. Administer analgesics

2. Provide bed rest

3. Antibiotics

4. Administer nasal vasoconstrictors and apply

dry heat,etc.
 Surgical management:-
1. Myringotomy or Tympanoplasty
NURSING MANAGMENT
1. Explain procedure to patient and family
members
2. Aspirate the fluid and send for culture
following tympanotomy
3. Place cotton loosely in the outer ear to
collect drainage.
4. Change the cotton when it becomes moist
to lessen the danger of secondary infection.
5. Wash hands after changing cotton plugs or
cleaning the ear
6. Monitor vital signs.
COMPLICATIONS:-
 Hearing loss (conductive and sensorineural).
 Tympanic membrane perforation (acute anc chronic).
 Chronic suppurative otitis media (with or withou
cholesteatoma).
 Cholesteatoma (cyst like mass in middle ear).
 Tympanosclerosis (decreased or absent tympani
membrane mobility).
 Mastoiditis
 Petrositis (infection and inflammation of the apic
portion of the petrous temporal bone).
 Labyrinthitis
 Facial paralysis
 Cholesterol granuloma.
 Infectious eczematoid dermatitis.
CHRONIC OSTITIS MEDIA
 Chronic otitis media is a chronic inflammation of
the middle ear with tissue damage.
1. It is characterized by chronic purulent discharge
from the middle ear. It is the result of repeated
episodes of acute otitis media causing
irreversible tissue pathology, and a persistent
perforation of the tympanic membrane.
2. This disease is a chronic inflammation of the
middle ear and mastoid cavity.
ETIOLOGY:-
 It occurs as a result of inadequate treatment of
acute otitis media.
 It is caused by:
1. Streptococcus-Group A beta hemolytic
streptococci
2. Staphylococcus
3. Proteus
4. Pseudomonas organisms are the most common.
5. It may be caused by antibiotic resistant organism
or a particularly virulent strain of organism.
6. Chronic suppurative otitis media can occur as a
complication of tympanostomy tubes inserted for
the treatment of otitis media with effusion.
RISK FACTORS:-
1. Bacteria more often affect children with
chronic suppurative otitis media.
2. Immunocompromised persons are at high
risk.
3. Chronic systemic disease is also a risk
factor.
4. Poor management of acute suppurative
otitis media.
5. It is a more common cause in areas that
have a high incidence of tuberculosis.
CLINICAL MANIFESTATIONS:-
 It usually starts in children and persists into
adulthood
1. Deafness

2. Pain less or dull ache: Pain occurs occasionally.

3. Dizziness

4. Odorless or foul smelling ear discharge

5. Tenderness of mastoid

6. Fever, post-auricular erythema and edema

7. Cholesteatoma

8. Decreased or absent tympanic membrane

mobility
9. Conductive hearing loss.
DIAGNOSTIC EVALUATION
1. Present history: History of several episodes
of acute otitis media and possible rupture
of eardrum.
2. Ear examination, audiometric test to check
for hearing loss, otoscopy to check
tympanic membrane.
3. Culture and sensitivity test of ear
discharge.
4. X-ray.
5. Computed tomography
6. Magnetic Resonance Imaging (MRI)
MANAGEMENT:-
 Medical Management
1. Local treatment consists of careful
suctioning of the ear under microscopic
guidance.
2. Instillation of antibiotic and steroid drops or
applica- tion of antibiotic powder
3. IV antibiotics like ampicillin, sulbactam and
cefuroxime.
NURSING MANAGEMENT:-
1. Explain procedure to patient and family members.
2. Aspirate the fluid and send for culture following
tympanotomy.
3. Place cotton loosely in the outer ear to collect
drainage.
4. Change the cotton when it becomes moist to lessen
the danger of secondary infection.
5. Discharge may be infectious, so wash hands after
changing cotton plugs or cleaning the ear.
6. Monitor vital signs.
7. Antibiotics should be continued for several days
even though symptoms have subsided.8. Assess
pain level, administer prescribed analgesics and
divert the patient.
COMPLICATIONS
1. Hearing loss
2. Tympanic membrane rupture
3. Labyrinthitis
4. Mastoiditis
5. Temporal abscess
6. Cholesteatoma
7. CNS infection: Meningitis, intracranial
abscess
SEROUS OTITIS MEDIA
 Serous otitis media is also called otitis media with
effusion or non-suppurative otitis media or glue
ear. In this type of otitis media, no infected fluid
accumulates in the middle ear. This condition is
found primarily in children.
ETIOLOGY:-
1. Viral upper respiratory infection.
2. Residual otitis media, inadequate
treatment of acute supportive otitis media.
3. Allergy
4. Enlarged lymphoid tissue: Adenoidal tissue
growth.
5. Pressure injury caused by an inability to
equalize presume between environment
and middle ear.
CLINICAL MANIFESTATIONS:-
1. Many patients are asymptomatic.
2. Sensation of fullness in affected ear.
3. Popping, cracking, bubbling or clicking
sounds with swallowing and jaw movement.
4. Hearing an echo while speaking.
5. Having a vague feeling of top heaviness
and tympanic membrane retraction.
6. Slight conductive hearing loss ranging from
15 to 35 dB.
7. Bulging tympanic membrane without any
redness on otoscopic examination.
DIAGNOSTIC EVALUATION:-
1. History and physical examination.
2. Audiometric studies, Rinne test, Weber test,
Whisper voice test to check hearing.
3. Imaging tests may be done.
MANAGEMENT:-
1. Inflation of Eustachian tube several times per
day using valsalva maneuver may be the only
treatment required.
2. Nasopharyngeal decongestant therapy may be
helpful.
3. If medical management fails, then
myringotomy and aspiration of middle ear fluid
may be needed.
4. Treat the underlying cause:
a. Treatment of allergies.
b. Adenoidectomy for hypertrophied adenoids.
c. Adequate treatment of upper respiratory
infections and otitis media.
NURSING MANAGEMENT
1. Instruct the patient to perform valsalva's maneuver
several times daily to maintain Eustachian tube patency.
2. Instruct patient to get prompt treatment of otitis media to
prevent further complications.
3. Instruct patient about medication, their correct
administration, dose, etc.
4. If a nasopharyngeal decongestant is prescribed, teach
correct instillation.
5. Instruct parents not to feed their infant in a supine
position or put him/her to bed with a feeding bottle. Teach
them correct feeding practices in order to prevent reflux of
nasopharyngeal flora.
6. Teach patient or parents about otitis media, its causes,
clinical manifestations and treatment. Teach them to seek
medical treatment at the earliest sign of an earache.
COMPLICATIONS
 If serous otitis media left untreated,
complications may develop including:
1. Hearing loss

2. Speech impairment

3. Infection spreading to inner ear or adenoid

glands, etc.
MASTOIDITIS
Mastoiditis is an infection and inflammation of the
spaces within the mastoid bone (mastoid antrum
air cells). It is almost always associated with otitis
media (an infection of the middle ear). It is
characterized by redness, tenderness, swelling
and fluctuation over the mastoid process with
displacement of the pinna.
TYPES OF MASTOIDITIS:-
1. Acute mastoiditis has acute onset and may
spread outside the mastoid bone and
causes serious problems.
2. Chronic mastoiditis involves continuous
middle ear infection with persistent
drainage from ear.
ETIOLOGY:-
 It is caused by:
1. Streptococcus

2. Pneumococcus

3. Staphylococcus

4. Hemophilus influenza bacillus

RISK FACTORS:-
1. Middle ear infections (Streptococcus
pneumoniae and Hemophilus influenzae),
with the progression of an untreated, or
undertreated, middle ear infection.
2. Chronic systemic diseases
3. Immunosuppression
CANCER OF EAR
Ear cancer may also start from within the ear or
can spread from adjacent structure. It is a rare
condition. It can also effect the temporal bone.
Etiology:-
Several different types of cancer can affect the
ear.
 Skin Cancer:-
Cancer of ear usually starts on a skin cancer
as the external ear which then spread
throughout the various ear structures.
1. Basal cell carcinoma

2. Squamous cell carcinoma

3. Melanoma
 Adenoid Cystic Carcinoma:-
This typically affects the external auditory
canal of the ear.
 Parotid Tumors:-

Malignant growths of the parotid gland can

spread to the ear canal.
RISK FACTORS:-
1. Being fair skinned.
2. Spending time in the sun without
sunscreen.
3. Frequent ear infections.
4. Being older
CLINICAL

MANIFESTATIONS:-
The symptoms of cancer of ear vary depending on what part of ear is
affected.
 Outer Ear:-
1. Scaly patches of skin that remain, even
after moisturizing.
2. Pearly white lumps under the skin.
3. Skin ulcers that bleed.
 Ear Canal:-
1. Lump in or near the entrance to the ear
canal.
2. Hearing loss.
3. Discharge from the ear.
 Middle Ear:-
1. Discharge from the ear, which may be blood.
2. Hearing loss.
3. Ear pain.
4. Numbness on the affected side of the head.
 Inner Ear
1. Ear pain
2. Dizziness
3. Hearing loss
4. Tinnitus
5. Headache
DIAGNOSTIC EVALUATION:-
1. History and physical examination.
2. A biopsy may be done under local or
general anesthesia, depending on the
location of the affected area.
3. MRI or CT scan confirms the stage and size
of tumor.
MANAGEMENT:-
 Management generally depends on the size
and location of the cancerous growth.
 Surgical Management

1. Skin cancers on pinna are generally

removed, it may need reconstruction
surgery incase large area is affected.
2. Ear canal or temporal bone cancers require
surgery followed by radiotherapy.
Surgery includes the following:
 Sleeve Resection Surgery

 Lateral Temporal Bone Resection Surgery

 Radical Temporal Bone Resection Surgery

 Radiotherapy
NURSING MANAGEMENT:-
 Post-operative Care (In Case Surgery is Done):
1. Provide proper bed rest for at least 24 to 48 hours.
2. Check the dressing
3. The dressing may be reinforced as necessary and
changed by surgeon on alternate day.
4. Note and report the signs of facial paralysis,
headache, vomiting, stiff neck, dizziness, irritability or
disorientation, etc.
5. Administer prescribed anti- biotics to patient.
6. Check vital signs to note the signs of infection.
7. Give plenty of fluids to patient.
8. Give health education to patient and relatives about
proper maintenance of hygiene.
9. Advice for follow-up.
COMPLICATIONS:-
1. Hearing loss
2. Dizziness
3. Facial paralysis
BIBLIOGRAPHY:-
 Brunner’s and siddhars,textbook of medical
surgical nursing
 Black J.M. ,textbook of medical surgical
nursing
 Adult medical surgical nursing by lakhvinder
kaur
 Class provided notes by