Otitis Media

Otitis Media Nursing Diagnosis Interventions and Care Plans

Otitis Media NCLEX Review Care Plans

Nursing Study Guide on Otitis Media

Otitis media involves the inflammation of the middle part of the ear, which is the space located behind the eardrum.

It is commonly diagnosed in children but can affect adults as well.

Ear infections usually clear up on their own, hence antibiotic treatment is not usually started unless deemed necessary by a health care provider.

Treatment is usually focused on regular monitoring and pain management. Frequent ear infections can cause hearing problems and other serious complications if left untreated.

Signs and Symptoms of Otitis Media

As in many conditions, the signs and symptoms of an ear infection are not often communicated well in children.

However, the following can be noted in a child that is suspected to have otitis media:

  • Earache which is worse when lying down
  • Tugging or pulling of the affected ear
  • Trouble or difficulty with sleeping
  • Children may cry more than usual
  • Restlessness
  • Trouble hearing or responding to sounds
  • Loss of balance
  • Fever of 38 degrees C or above
  • Ear discharge
  • Headache
  • Loss of appetite

In adults, ear pain, fluid discharge from ear, and trouble hearing are the most common signs and symptoms.

Causes and Risk Factors of Otitis Media

Infection in the middle ear or otitis media often happens as a secondary infection.

Illnesses like common colds can cause mucus build up in the middle ear. This build-up of mucus is usually drained out by the Eustachian tube.

However, the mucus build-up can also cause swelling or blockage of the Eustachian tube, resulting to the spread of infection in the middle ear.

The anatomy of the Eustachian tube, being more horizontal in children, can contribute to the risk of it being obstructed easily.

Also, the adenoids can cause obstruction to the Eustachian tube when they get swollen.

Adenoids are small organs next to the opening of the Eustachian tube. It is normal for children to have larger adenoids, and these are deemed as the common cause of otitis media in their age group.

The risk factors that can increase the likelihood of developing otitis media include:

  • Age. Children are more commonly affected. It can be attributed to their immune system not being fully developed. Also, the children’s anatomy predisposes them to develop otitis media.
  • Poor immune system. Although otitis media is common to children because of their weak and not fully developed immune system, adults with immunosuppression such as those receiving chemotherapy have an increased risk for ear infections.
  • Children attending care groups. It is easier for children in groups to catch and transfer microbes and infection to one another.
  • Secondary smoking. Air pollution can increase the risk of respiratory infections which therefore increases the chance of ear infections.
  • Family history of ear infections
  • Bottle feeding. It is noted that bottle-fed children are more at risk of having otitis media.
  • Heredity. Otitis media is commonly seen in people with Alaskan heritage.
  • Other conditions. Cleft palate causes problems with drainage of the Eustachian tubes.

Complications of Otitis Media

Otitis media does not normally cause long term complications. However, repeated, or prolonged infections can cause serious problems, such as:

  • Hearing impairment. Otitis media can cause issues with hearing, but usually returns to normal when the infection is completely treated. However, if the infection is recurring, it may cause permanent damage to the eardrums and other ear structures, resulting to a permanent hearing loss.
  • Developmental delays. Hearing loss, whether temporary or permanent, can delay milestones in the child’s development.
  • Spread of infection. Infection can spread around the surrounding organs if otitis media is left untreated, or if it will not respond to treatment. Mastoiditis which is the infection of the bony protrusion behind the ear or mastoid can occur. Serious secondary infections can also root out from otitis media such us meningitis. The chances are rare, but it can happen.
  • Tearing of the eardrum. Tears in the eardrum usually heal within a week after commencing treatment. If not, a surgical repair is needed.

Diagnosis of Otitis Media

  • History taking – to check for risk factors and possible cause of the infection
  • Physical examination – using a pneumatic otoscope, the physician can determine the presence of fluid in the middle ear; the doctor will gently push air in the eardrum and then the doctor will observe movements or vibration
  • Tympanometry – also checks for vibration of the eardrum which will suggest presence of fluid in the middle ear
  • Acoustic reflectometry – uses sound to measure the presence of fluid in the middle ear. The more fluid present, the more sound the eardrum will reflect

Treatment of Otitis Media

  1. 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.
  2. 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.
  3. 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.
  4. 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. 

Prevention of Otitis Media

Otitis media is quite common especially in children. It normally goes away on its own. However, it is an unpleasant and uncomfortable experience. Preventing the occurrence of otitis media is centred on avoiding the causes and risk factors. It is also important to talk to a doctor about immunizations for common infections like influenza.

Nursing Care Plans for Otitis Media

Nursing Care Plan 1

Nursing Diagnosis: Disturbed Sensory Perception (Auditory) related to the inflammation of the middle ear as evidenced by verbal complaint of hearing problems, inability to respond when spoken to, ear pain , and redness and swelling of the middle ear as visualized through otoscopy

Desired Outcome: The patient will regain hearing as normal.

InterventionRationale
Assess the hearing ability of the patient. Older children can be asked questions if there is muffling or absence of sounds in one ear.To establish a baseline assessment of otitis media in terms of hearing capacity.
Re-assure the patient and the parents or guardian that the hearing loss is usually temporary and normal hearing can be regained as early as a few days after starting treatment.To reduce anxiety of the patient and caregiver.
Encourage the caregiver to promote reduction of noises at home.The child may get scared or anxious about sounds that he/she cannot hear properly.
Administer antibiotics as prescribed.Otitis media that is caused by a bacterial infection may need a full course of antibiotics.
Inform the parents or guardian to speak slowly and clearer to the child. Encourage them to face the child while speaking.To promote good communication between the child and the caregiver.
Encourage the child to inform his/her parents or guardian if there is any worsening of symptoms, such as ear pain, discharge, or worsening of hearing ability.To monitor if the otitis media is worsening and if there is a need for further investigation and treatment.

Nursing Care Plan 2

Nursing Diagnosis: Deficient Knowledge related to new diagnosis of otitis media as evidenced by the parent of the child’s verbalization of “I want to know more about how to treat the ear infection of my child.”

Desired Outcome: At the end of the health teaching session, the patient’s caregiver will be able to demonstrate sufficient knowledge of otitis media and its management.

InterventionRationale
Assess the caregiver’s readiness to learn, misconceptions, and blocks to learning (e.g. decreased cognitive ability).To address cognition and mental status towards the new diagnosis of otitis media and to help overcome blocks to learning.
Explain what otitis media is, its cause, and related signs and symptoms. Avoid using medical jargons and explain in layman’s terms.To provide information on otitis media and its pathophysiology in the simplest way possible.
Inform the patient the details about the prescribed medications for otitis media such as ear pain relievers and antibiotics (e.g. drug class, use, benefits, side effects, and risks) to manage otitis media. Ask the caregiver to repeat or demonstrate the administration details to you, especially on how to give otic drops to the patient.To inform the patient of each prescribed drug and to ensure that the patient fully understands the purpose, possible side effects, adverse events, and administration details.
Re-assure the parent that otitis media is quite common especially in children but close monitoring of symptoms is recommended.Most cases of otitis media resolve on their own without the need for antibiotic therapy. However, it is still important to monitor any worsening of symptoms to determine the need for a pharmacologic treatment.

Other nursing diagnoses:

  • Acute Pain
  • Risk for Infection

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines and policies and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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