Otitis media involves the inflammation or infection 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.
Otitis Media Causes
- Age. Children are more commonly affected
- Haemophilus influenzae is the most common cause
- Poor immune system.
- Children attending care groups.
- Secondary smoking.
- Family history of ear infections
- Bottle feeding.
- Heredity. Commonly seen in people with Alaskan heritage.
- Other conditions. Cleft palate causes problems with drainage of the Eustachian tubes.
Signs and Symptoms of Otitis Media
The following can be noted in a child that is suspected to have otitis media:
- Severe ear pain 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.
Expected Outcomes
- The patient will regain hearing as normal.
- 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.
- Relief of pain
- Avoidance of re-infection
Nursing Assessment for Otitis Media
Health history: Asking the patient or caregiver about current symptoms, previous ear infections, allergies, and any recent illnesses or treatments.
Physical examination: Examining the ear for signs of inflammation or infection, including redness, swelling, and discharge. Checking for fever and other signs of illness.
Otoscopic examination: Using an otoscope to look inside the ear and check for signs of infection or fluid buildup.
Audiometry testing: Conducting hearing tests to assess any hearing loss that may be associated with the condition.
Tympanometry: A test that measures the movement of the eardrum in response to changes in air pressure, which can help diagnose the type of otitis media.
Assessment of pain: Assessing the patient’s level of pain and discomfort, including the location, severity, and duration of pain.
Assessment of communication: Assessing the patient’s ability to communicate, including any difficulties with speech or hearing.
Nursing Interventions for Otitis Media
Assess the hearing ability of the patient. Older children can be asked questions if there is muffling or absence of sounds in one ear. Rationale: 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. Rationale: To reduce anxiety of the patient and caregiver.
Encourage the caregiver to promote reduction of noises at home. Rationale: The child may get scared or anxious about sounds that he/she cannot hear properly.
Administer antibiotics and medications as prescribed. Rationale: 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. Rationale: 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. Rationale: To monitor if the otitis media is worsening and if there is a need for further investigation and treatment. Severe untreated otitis media can result in hearing loss.
Assess the caregiver’s readiness to learn, misconceptions, and blocks to learning (e.g. decreased cognitive ability). Rationale: To address cognition and mental status towards the new diagnosis of otitis media and to help overcome blocks to learning.
Re-assure the parent that otitis media is quite common especially in children but close monitoring of symptoms is recommended. Rationale: 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.
Nursing Care Plan for Otitis Media
Disturbed Sensory Perception
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
Deficient Knowledge
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.”
More Otitis Media Nursing Diagnoses
Sample Nursing Test Questions for Otitis Media
- Which of the following is the most common cause of otitis media?
a) Streptococcus pneumoniae
b) Staphylococcus aureus
c) Haemophilus influenzae
d) Escherichia coli
Answer: c) Haemophilus influenzae
Rationale: Haemophilus influenzae is the most common bacterial cause of otitis media, accounting for approximately 30-40% of cases. Streptococcus pneumoniae and Moraxella catarrhalis are other common bacterial pathogens associated with otitis media.
2. Which of the following symptoms is commonly seen in a child with otitis media?
a) Clear discharge from the ear
b) Severe ear pain
c) Normal hearing
d) Absence of fever
Answer: b) Severe ear pain
Rationale: Severe ear pain is a common symptom of otitis media in children. Other symptoms may include fever, irritability, difficulty hearing, and a purulent discharge from the affected ear.
3. Which of the following interventions is a priority when caring for a child with acute otitis media?
a) Administering oral antibiotics as prescribed
b) Applying warm compresses to the affected ear
c) Placing the child in an upright position
d) Administering over-the-counter analgesics
Answer: a) Administering oral antibiotics as prescribed
Rationale: Administering oral antibiotics as prescribed is a priority intervention for a child with acute otitis media caused by bacterial infection. Antibiotics help to eradicate the infection and reduce symptoms. Warm compresses, an upright position, and over-the-counter analgesics may also provide comfort, but they are not the primary treatment for otitis media.
4. Which of the following complications can occur if otitis media is left untreated?
a) Hearing loss
b) Sinusitis
c) Bronchitis
d) Conjunctivitis
Answer: a) Hearing loss
Rationale: Untreated or recurrent otitis media can lead to temporary or permanent hearing loss, especially in young children. Sinusitis, bronchitis, and conjunctivitis are not direct complications of otitis media.
5. The nurse is educating parents about preventive measures for otitis media. Which instruction should be included?
a) Avoiding breastfeeding
b) Keeping the child in a highly humidified environment
c) Encouraging the child to bottle-feed while lying down
d) Ensuring the child receives recommended immunizations
Answer: d) Ensuring the child receives recommended immunizations
Rationale: Ensuring the child receives recommended immunizations, such as the pneumococcal conjugate vaccine and the Haemophilus influenzae type b vaccine, can help prevent otitis media. Breastfeeding, maintaining a moderate humidity level, and ensuring the child is in an upright position during bottle-feeding are other preventive measures.
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.
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier.
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.
Best Nursing Books and Resources
These are the nursing books and resources that we recommend.
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The Nursing Diagnosis Handbook E-Book: An Evidence-Based Guide to Planning Care
This is an excellent reference for nurses and nursing students. While it is a great resource for writing nursing care plans and nursing diagnoses, it also helps guide the nurse to match the nursing diagnosis to the patient assessment and diagnosis.
This handbook has been updated with NANDA-I approved Nursing Diagnoses that incorporates NOC and NIC taxonomies and evidenced based nursing interventions and much more.
NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023
All introductory chapters in this updated version of a ground-breaking text have been completely rewritten to give nurses the knowledge they require to appreciate assessment, its relationship to diagnosis and clinical reasoning, and the goal and use of taxonomic organization at the bedside.
Nursing Care Plans: Nursing Diagnosis and Intervention
It contains more than 200 care plans that adhere to the newest evidence-based recommendations.
Additionally, it distinguishes between nursing and collaborative approaches and highlights QSEN competencies.
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