Lippincott Certification Review Medical-Surgical Nursing

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Chapter 18

●● Topical antimicrobial ear drops are first-line treatment. They commonly include acetic acid or an antibiotic, with or without a corticosteroid. Suspected or known nonintact tympanic membrane (TM) should not receive ototoxic ear drops. An antifungal will be prescribed for otomycosis. Only severe bacterial infections require oral antibiotics. ●● Nursing interventions ●● Clean and dry the patient’s ear gently and thoroughly. ●● Give prescribed drugs. If the ear canal is severely swollen, a wick may be inserted to deliver medication throughout the canal. Tell the patient to not remove the wick until instructed to do so; however, it may fall out on its own as the edema subsides. ●● To prevent recurrence, tell the patient to avoid potential irritants and to dry ears thoroughly. A few drops of a 50/50 mixture of 5% acetic acid solution (white household vinegar) in 70% rubbing alcohol after swimming can help dry the ear and adjust the pH to prevent AOE. Mild AOE can often be self-treated with a 50/50 solution of 5% acetic acid solution (white household vinegar) and distilled water. ●● Warn against cleaning the ears with cotton-tipped applicators or other objects. Otitis Media ●● Description ●● Otitis media (OM) commonly results from poorly functioning eustachian tubes. ●● There are various presentations of the disorder with different treatments. ●● Acute otitis media (AOM) is a common childhood condition. It is characterized by a rapid onset of signs and symptoms of inflammation in the middle ear, commonly viral or bacterial in origin. ●● Otitis media with effusion (OME) is the presence of middle-ear effusion (MEE) without signs or symptoms of an acute infection. ●● OME may precede or predispose to AOM, occur after AOM, or occur as a result of eustachian tube dysfunction related to an upper respiratory tract infection. It is important to distinguish between the two because antibiotics are not indicated for OME, and many cases of AOM do not need antibiotics as well. ●● MEE/OME may persist for several weeks or months. ●● Chronic OME is the persistence of OME for 3 months or more. Persistent OME may lead to hearing loss, balance problems, behavior problems, recurrent AOM, and reduced school performance. ●● The pathogens that most commonly cause AOM include Streptococcus pneumoniae , Haemophilus influenzae , and Moraxella catarrhalis . ●● Complications of OM include rupture of the tympanic membrane, hearing loss, vertigo, meningitis, and septicemia. ●● Signs and symptoms

●● Preverbal children may display holding or tugging at the ear, excessive crying, fever, or altered sleep patterns. Older children and adults may report a rapid onset of otalgia, fever, and fullness of the ear. ●● The patient may also experience a sensation of fullness in the ear as well as popping or crackling sounds when swallowing or chewing. ●● Other signs and symptoms may include purulent discharge from the ear (otorrhea), evidence of hearing loss, and, if tympanic membrane ruptures, pain that abruptly ceases. ●● Diagnosis and treatment ●● The patient’s history may include upper respiratory infection or allergies. ●● Otoscopic examination shows fluid MEE behind the tympanic membrane; in chronic OM, it reveals thickening or scarring of the tissue. ●● The normal TM is translucent and pearly gray with the ability to visualize landmarks. ●● OME will have MEE but typically no other signs. ●● AOM typically shows MEE with a bulging erythematous TM. If the TM has perforated, there may be a hole seen and fluid in the external ear canal. ●● Pneumatic otoscopy is the standard tool for diagnosis of the presence of MEE by reduced movement of the TM in AOM and OME. ●● Culture and sensitivity testing of the exudate, if ordered. ●● Labs not supported other than culture and sensitivity radiographic studies, if performed, may demonstrate mastoid involvement. Copyright © 2025 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited.