Disorder of the external and middle ear, otitis media and otosclerosis
- 1. OTITIS MEDIA AND OTOSCLEROSIS GROUP 2 1. UKULU FAITHFUL 2. AKABUIRO BLESSING 3. OMOLEYE GBEMISOLA 4. OWOLABI GRACE 5. OKOROAFOR SHIPHRAH 6. ORIOWO OLOLADE 7. ADEDAPO ADERONKE 8. IGE JOY 9. OLAYIWOLA ZAINAB 10. UNOROH PECULIAR
- 2. OTITIS MEDIA
- 3. OUTLINE 1. DEFINITION 2. TYPES OF OTITIS MEDIA 3. EPIDEMIOLOGY 4. PATHOPHYSIOLOGY 5. SYMPTOMS 6. RISK FACTORS 7. COMPLICATIONS 8. DIAGNOSTIC TEST 9. NURSING AND MEDICAL MANAGEMENT 10.PHARMACOLOGICAL MANAGEMENT 11. NURSING DIAGNOSIS 12.PREVENTION 13.CONCLUSION
- 4. DEFINITION Otitis media is an infection or inflammation of the middle ear that usually follows a buildup of fluid in the middle ear space. It is a very common condition, especially in young children, and is often caused by bacteria or viruses that travel up the Eustachian tube from the nose and throat. Otitis media can cause ear pain, fever, and hearing loss, and if left untreated, can lead to serious complications. Proper diagnosis and treatment, which may involve antibiotics or ear tubes, is important to prevent long- term issues.
- 5. TYPES OF OTITIS MEDIA There are three main types of otitis media: Acute Otitis Media (AOM) Occurs abruptly, causing swelling and redness of the middle ear. Fluid and mucus become trapped inside the ear, leading to ear pain, fever, and hearing loss. Often follows a cold, sore throat, or respiratory infection.
- 6. Continuation Otitis Media with Effusion (OME) Also known as serous otitis media or secretory otitis media. Fluid and mucus continue to accumulate in the middle ear after an initial infection subsides. Can cause a feeling of fullness in the ear and hearing loss, but is often asymptomatic.
- 7. Continuation Chronic Suppurative Otitis Media (CSOM) Middle ear inflammation that results in a perforated eardrum with discharge from the ear for more than six weeks. May be a complication of acute otitis media. Pain is rarely present. All three types can lead to hearing loss if untreated. Proper diagnosis by an otolaryngologist is important to determine the appropriate treatment, which may include antibiotics, pain medication, or surgery in some cases.
- 8. EPIDEMIOLOGY Incidence and Prevalence Global Prevalence: Otitis media is a very common childhood disease, with varying incidence and prevalence estimates worldwide. Developing Countries: In developing countries, the prevalence of acute otitis media (AOM) in children under 12 years old was 1.05%, with a higher rate in children under 4 years old (1.95%). Age Distribution Peak Incidence: The peak incidence of otitis media occurs during the second 6-month period of life, with significant increases in the first year and continuing through the third year of life. Age Groups: By 1 year of age, 62% of children had at least one episode of AOM, and by 3 years of age, 83% had at least one episode.
- 9. PATHOPHYSIOLOGY Eustachian Tube Dysfunction The Eustachian tube connects the middle ear to the nasopharynx, allowing drainage and ventilation of the middle ear. In children, the Eustachian tube is shorter, more horizontal, and narrower compared to adults, predisposing dysfunction. Eustachian tube obstruction leads to negative pressure in the middle ear and fluid accumulation..
- 10. Continuation Infection - Nasopharyngeal organisms, such as bacteria and viruses, can migrate up the Eustachian tube to the middle ear. - Common bacterial pathogens include Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. - Viruses like respiratory syncytial virus, influenza virus, and rhinovirus can cause inflammation in the nasal passages and impair defense mechanisms, predisposing to bacterial infection.
- 11. Continuation Inflammation - Infection leads to inflammation of the middle ear mucosa. - Inflammation causes fluid accumulation in the middle ear space. - Persistent inflammation can lead to chronic otitis media with effusion or chronic suppurative otitis media.
- 12. SIGNS AND SYMPTOMS Acute Otitis Media (AOM) - Otalgia (ear pain) - Otorrhea (ear discharge) - Headache - Fever - Irritability - Loss of appetite - Vomiting - Diarrhea
- 13. Otitis Media with Effusion (OME) - Hearing loss - Tinnitus (ringing in the ear) - Vertigo (dizziness) - Otalgia (ear pain) Chronic Suppurative Otitis Media - Persistent ear infection resulting in a perforated eardrum and discharge from the ear
- 14. RISK FACTORS The key risk factors for otitis media include: Modifiable Risk Factors - Using pacifiers or bottle feeding - Having a working mother - Seasonal rhinitis - Allergic rhinitis - Adenoid hypertrophy - Attending daycare centers - Exposure to secondhand smoke - Having 3 or more siblings - Living in a household with 4 or more people Non-Modifiable Risk Factors - Male gender - Family history of otitis media - Younger age (peak incidence in first 3 years of life) - Ethnicity
- 15. COMPLICATIONS Intracranial Complications Meningitis Brain abscess Epidural abscess Lateral sinus thrombosis Otitic hydrocephalus Gradenigo's syndrome (involving the 5th, 6th, and 7th cranial nerves)
- 16. Extracranial/Intratemporal Complications Mastoiditis Petrositis Facial nerve palsy Tympanic membrane perforation Chronic suppurative otitis media Cholesteatoma Ossicular erosion Hearing loss
- 17. DIAGNOSTICTEST 1. Otoscopy Examination of the eardrum (tympanic membrane) using an otoscope. Key findings include redness, bulging, decreased mobility, and the presence of fluid. 2. Pneumatic Otoscopy Uses an otoscope that can puff air against the eardrum. Decreased or absent mobility of the eardrum indicates the presence of middle ear effusion. 3. Tympanometry Measures the movement of the eardrum in response to changes in air pressure. A flat or abnormal tympanogram indicates the presence of middle ear fluid.
- 18. 4. Acoustic Reflectometry Measures the amount of sound reflected off the eardrum. Increased sound reflection indicates the presence of middle ear fluid. 5. Tympanocentesis Aspiration of fluid from the middle ear for culture and analysis. Considered the gold standard for diagnosis, but not routinely recommended. Other tests like hearing evaluations and imaging (CT/MRI) may be used if complications are suspected.
- 19. NURSING, MEDICAL AND PHARMACOLOGICAL MANAGEMENT Nursing Management 1. Pain Management and Comfort - Administer analgesics like acetaminophen or ibuprofen to relieve ear pain and fever - Apply warm compresses to the affected ear to provide comfort - Position the patient upright or on the unaffected side to ease pressure 2. Infection Control - Encourage frequent handwashing to prevent spread of infection - Educate the patient/caregiver on proper hygiene and cough/sneeze etiquette 3. Monitoring and Assessment - Closely monitor vital signs, including temperature - Assess the patient's hearing and speech development, especially in children - Observe the ear for signs of drainage or changes in the tympanic membrane 4. Patient Education - Teach the patient/caregiver about the importance of completing the full course of antibiotic therapy, if prescribed - Advise against using cotton swabs or other objects to clean the ear - Recommend avoiding bottle feeding and pacifier use to prevent recurrence
- 20. Medical and Pharmacological Management Antibiotics - Amoxicillin is the first-line antibiotic for bacterial otitis media - A 10-day course is usually recommended, though shorter durations may be effective Pain Relief - Acetaminophen or ibuprofen can be used to manage ear pain and fever Decongestants and Antihistamines - May be used to help relieve Eustachian tube dysfunction and fluid buildup Tympanostomy Tubes - Surgical placement of tubes in the tympanic membrane to allow drainage and ventilation - Considered for recurrent or persistent otitis media with effusion Watchful Waiting - For mild cases of acute otitis media, a period of observation without antibiotics may be appropriate
- 21. NURSING DIAGNOSIS Acute pain related to inflammation and increased pressure from fluid accumulation in the middle ear Impaired verbal communication due to the pain or hearing impairment Disturbed sleep pattern related to pain and discomfort Anxiety related to the illness, especially if there are repeated episode Acute pain related to inflammation and increased pressure from fluid accumulation in the middle ear Impaired verbal communication due to the pain or hearing impairment Disturbed sleep pattern related to pain and discomfort Anxiety related to the illness, especially if there are repeated episodes
- 22. PREVENTION 1. Vaccination 2. Encourage exclusive brestfeeding 3. Avoiding secondhand smoke 4. Good hygiene practices 5. Environmental modifications 6. Proper postioning 7. Managing allergies and sinus infections 8. Regular health checkup 9. Encouraging healthy lifestyle 10. Avoiding bottle propping
- 23. OTOSCLEROSIS
- 24. OUTLINE INTRODUCTION PATHOPHYSIOLOGY CLINICAL MANIFESTATIONS DIAGNOSIS COMPLICATIONS TREATMENT NURSING MANAGEMENT EDUCATION
- 25. INTRODUCTION Otosclerosis is A condition that affects the bones in the middle ear, particularly the stapes bones.This abnormal bone growth can interfere with the transmission of sound vibrations to the inner ear, leading to hearing loss. Ostoscleosis primarily affects young adults and is more common in women than men. The condition is typically diagnosed between the ages of 15 and 45, with many cases identified in individuals in their twenties ad thirties.
- 26. PATHOPHYSIOLOGY Otosclerosis is a disorder characterized by abnormal bone remodeling in the middle ear. It primarily affects the stapes bone, which is one of the ossicles involved in sound transmission.This condition often has a genetic basis, with many cases showing a hereditary pattern. Environmental factors such as hormonal changes during pregnancy and viral infections like measles may also contribute to its development.Viral infections like measles can trigger otosclerosis by causing inflammation in the inner ear.This inflammation can disrupt normal bone remodeling, leading to abnormal bone growth in the middle ear.
- 27. The pathological process begins with increased bone resorption, (the process where osteoclasts break down bone tissue, releasing minerals like calcium into the blood. This is a normal part of bone remodeling). The increased bone resorption leads to the formation of spongy, vascular bone. This early stage, known as otospongiosis, is marked by heightened activity of both osteoclasts, which break down bone, and osteoblasts, which form new bone. As the disease progresses, the spongy bone is gradually replaced by dense, sclerotic bone (sclerotic refers to the hardening or thickening of tissue. In otosclerosis, it describes the abnormal, dense bone that forms in the middle ear). This results in decreased vascularity and bone turnover, signifying the transition to the sclerotic
- 28. The most common site of otosclerotic changes is the footplate of the stapes. Abnormal bone growth in this area fixes the stapes in the oval window, preventing its normal movement. This fixation disrupts the transmission of sound vibrations to the inner ear, leading to conductive hearing loss. In some instances, the otosclerotic process extends into the cochlea, affecting the inner ear structures and leading to sensorineural hearing loss. This occurs due to the involvement of the hair cells and nerve fibers within the cochlea. Histopathologically, otosclerosis is characterized by areas of active bone resorption with numerous osteoclasts and areas of new bone formation with osteoblasts. Over time, the bone becomes dense and sclerotic, with decreased cellularity and vascularity, reflecting the chronic nature of the disorder.
- 29. In summary, otosclerosis is a disorder of abnormal bone remodeling affecting the middle ear, particularly the stapes bone, leading to conductive hearing loss and, in some cases, sensorineural hearing loss due to cochlear involvement.The condition is influenced by genetic and environmental factors, with pathological changes marked by initial bone resorption followed by dense bone formation
- 30. Clinical manifestation 1. Hearing Loss 2. Tinnitus 3. Vertigo 4. Paracusis Willisii 5. Family History 6. Schwartze Sign: In some cases, there may be a reddish-blue hue visible on the promontory of the middle ear, seen through the eardrum during an otoscopic examination.
- 31. Diagnosis 1. Medical History:A detailed history of the patient's symptoms, onset, and progression, along with any family history of hearing loss or otosclerosis. 2. Physical Examination:An otoscopic examination may be performed to look for any visible abnormalities in the ear, although otosclerosis often does not present visible signs. 3. Tuning ForkTests: Simple bedside tests, such as the Rinne and Weber tests, can help differentiate between conductive and sensorineural hearing loss. In otosclerosis, the Rinne test typically shows a negative result (bone conduction is better than air conduction), and theWeber test may lateralize to the affected ear 4. Acoustic Reflex Testing:This measures the reflexive contraction of the middle ear muscles in response to loud sounds. In otosclerosis, the stapes footplate fixation often results in absent or elevated acoustic reflexes.
- 32. Complications 1. Otosclerosis may lead to significant hearing loss. 2. Another rare complication is worsened hearing loss as a result of surgical treatment for otosclerosis. 3. Infection, dizziness, pain or a blood clot in the ear after surgery. 4. Tinnitus and facial nerve damage are also possible.
- 33. Treatment 1. Stapedectomy 2. Hearing aid 3. Cochlear implants
- 34. Nursing Management. Assess the general condition of the patient Place the patient in a side lying position. Remove sounds and noises from the patient environment. Prepare patient for surgical intervention. Assess for signs of bleeding and drainage from surgery site.
- 35. Education 1. Understanding ostosclerosis 2. Symptoms 3. Treatment options 4. Support group 5. Follow up care 6. Lifestyle modification 7. Psychological support 8. Information on progress