Lippincott Certification Review Medical-Surgical Nursing



●● Tympanometry may be performed. ●● An age-appropriate hearing test may be performed for persistent OME.

●● Treatment aims to eradicate the underlying cause, for instance, eliminating eustachian tube obstruction. ●● Medications for AOM include antibiotics; amoxicillin is generally first line unless the patient is allergic. Acetaminophen or ibuprofen is given as needed for pain. ●● Surgical procedures (for select cases of OME with documented hearing loss or recurrent AOM) include myringotomy and aspiration of middle-ear fluid, followed by insertion of a polyethylene tube into the tympanic membrane. ●● Educate the parents or caregivers on the expected duration of tube function (months to years), recommended follow-up schedule, and detection of complications. ●● Tympanostomy tube otorrhea may occur and is treated with topical antibiotics. ●● There are no routine water precautions needed for children with tympanostomy tubes, unless tympanostomy tube otorrhea is present. ●● Nursing interventions ●● Teach the patient and his family about the disorder, including treatment and follow-up care. ●● Many cases of mild to moderate childhood AOM will resolve without antibiotics. The provider may take a “watch and wait” approach with appropriate follow-up (within 48 hours of onset for persistence of symptoms, or sooner for worsening) for: ●● Age 6 months to 23 months: nonsevere unilateral AOM ●● Age 24 months or older: nonsevere unilateral or bilateral AOM ●● Administer analgesics, antipyretics, and antibiotics as ordered. ●● Watchful waiting with follow-up office testing and evaluation 3 months from diagnosis is appropriate for most OME not at high risk for complications. ●● Chronic OME is reevaluated at 3- to 6-month intervals. ●● Allow the patient and family to verbalize their feelings and concerns; answer all questions and provide emotional support. ●● Provide clear, concise explanations. ●● Discourage OTC antihistamines, intranasal steroids, or decongestants as these are not proven to help and can cause side effects. ●● Teach the patient or parent/caregivers when to call for an evaluation of ear problems. ●● Swallowing during take-off and landing of airplane flights can help even out pressure. ●● If temporary mild to moderate hearing loss occurs, teach the patient/family ways to manage impaired

communication. Teach them to report worsening or persistence of hearing loss as appropriate. ●● Prepare the patient and family for possible surgery; provide appropriate postoperative care. Otosclerosis ●● Description ●● Otosclerosis (or hardening of the ear) is an overgrowth of bone that impedes normal ossicular motion and can fix the stapes to the oval window. ●● Otosclerosis is the most common cause of progressive conductive hearing loss in adults with normal tympanic membranes. ●● The disease has a familial tendency and usually occurs between ages 15 and 50; twice as many women are affected as men. ●● Pregnancy may trigger the onset. ●● Signs and symptoms ●● Progressive hearing loss, which may be unilateral at first and may become bilateral, typically begins at an early age. ●● Vertigo and tinnitus also can occur. ●● The patient may report hearing their own voice better than the voices of others. ●● Diagnosis and treatment ●● Diagnostic tests may include audiometry; electronystagmography; caloric testing; magnetic resonance imaging or computed tomography; Weber, Rinne, and Romberg tests; and facial nerve testing. ●● Hearing aids are recommended to improve hearing. ●● Bisphosphonates may be prescribed to slow progression of otosclerosis. Copyright © 2025 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited.

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