Acute Otitis Media
Definition
Otitis media (OM) is an infection or inflammation of part or all of the mucosa of the middle ear, eustachian tube, mastoid antrum and mastoid cells. This inflammation usually occurs when an infection in the throat and respiratory system spread to the middle ear. The infection can be caused by viruses or bacteria, and can be in the form of acute or chronic (Perlstein, 2005). Inflammation of the middle ear (otitis media / OM) is common in children and the second most common problem in pediatric practice (Paparella et al, 1997).
Acute otitis media is an acute infection of the middle ear are generally caused by bacteria. Preceded by infection of the nose and / or throat. This type of infection is common in children - children than adults.
Etiology of Acute Otitis Media
The main cause of acute otitis media is the inclusion of pathogenetic bacteria into the middle ear is normally sterile. Most often occurs when there is dysfunction such eusthacius tube obstruction caused by respiratory infections, inflammation of the surrounding tissue. For example sinusitis, adenoid hypertrophy, or an allergic reaction, such as allergic rhinitis. Bacteria commonly found as a causative organism was streptococcus pneumonia, hemopilus influenza, and Moraxella catarrhalis. How to enter the bacteria in most patients possibly through the eustachian tubes due to concentrations in nasopharyngeal secretions. Bacteria can also enter the middle ear when there is perforation of the tympanic membrane. There is usually a purulent exudate in the middle ear and cause conductive hearing loss.
Clinical Manifestations of Acute Otitis Media
The symptoms of otitis media may vary according to the severity of the infection and can be mild and transient or severe. This condition is usually unilateral in adults, and there may be otalgia. The pain will disappear spontaneously in case of spontaneous perforation of the tympanic membrane or after myringotomy (incision of the tympanic membrane). Other symptoms may include discharge from the ears, fever, hearing loss, and tinnitus. On otoscopy examination, external auditory meatus often appear normal, and there is no pain when the auricle is moved. Tympanic membrane often appears red and bulging.
Chronic Otitis Media
Chronic otitis media is a condition that is associated with irreversible tissue pathology. Chronic otitis media is a permanent perforation of the tympanic membrane, with or without a permanent change in the middle ear (merck, 2004). Most of Chronic Otitis Media is a continuation of Acute Otitis Media and a small part caused by perforation of the tympanic membrane ear trauma. Germs usually aerobic gram-positive bacteria, the long-standing infection often also contained gram-negative and anaerobic bacteria (Djaafar, 2002).
Etiology of Chronic Otitis Media
Usually caused by recurrent episodes of acute otitis media. Often associated with tympanic membrane perforation settled. Chronic middle ear infections not only cause damage to the tympanic membrane, but also can destroy osikulus and almost always involve the mastoid.
Factors infection usually comes from the nasopharynx (adenoiditis, tonsillitis, rhinitis, sinusitis), reaches the middle ear through the Eustachian tube. Abnormal Eustachian tube function is a predisposing factor that is found in children with cleft palate and Down's syndrome. The presence of patulous tube, causing reflux of nasopharyngeal contents of which are factors of Chronic Otitis Media incidence high in the United States. Humoral abnormalities (such as hypogammaglobulinemia) and cell-mediated (such as HIV infection, leukocytes laziness syndrome) can manifest as chronic ear secretions.
Other causes of Chronic Otitis Media include:
- Environment.
- Genetic.
- Otitis media earlier.
- Infection.
- Upper respiratory tract infection.
- Autoimmune.
- Allergy.
- Impaired function of the eustachian tube.
Clinical Manifestations of Chronic Otitis Media
Symptoms can be minimal, with various degrees of hearing loss and there is a persistent otorrhoea interminet or foul-smelling. Cholesteatoma usually cause pain. Evaluation showed otoscopic tympanic membrane perforation, and cholesteatoma can be seen as a future behind the tympanic membrane or white out into the external canal through the perforations. Audiometric results in cholesteatoma cases often exhibit conductive or mixed hearing loss.
Symptoms of Chronic otitis media by type are :
1) Chronic otitis media type of benign
Symptoms include mucoid discharge that is not too smelly, when first discovered a foul odor may be present but with cleaning and local antibiotic use is usually quickly disappear, mucoid discharge can be constant or intermittent.
Conductive hearing loss is always obtained in patients with varying degrees of hearing loss depends on the severity of damage to the bones and cochlear hearing during acute necrotic infection early in the disease.
Central tympanic membrane perforation is often shaped like a kidney but always leave the rest on the edges. Inflammatory process in the region is limited to the mucosa so that the tympanic membrane becomes shaped line mucosa and mucous membranes depending on the degree of infection can be thin and pale or red and thick, sometimes a polyp but mucoperiosteum come thick and lead to the meatus blocking the view of the tympanic membrane and middle ear until the polyp is lifted. Discharge seen coming from the tympanic cavity and eustachian tube orifice were mucoid and after one or two treatments reduced local stench.
2) Chronic Otitis Media malignant type, with cholesteatoma
Secretions to infection with typical cholesteatoma flavorful, very smelly secretions, yellow and gray, dirty purulent can also be seen small pieces, shiny white.
Types of conductive hearing loss arising from the formation of cholesteatoma with conductor also due to the loss of air tools, on acute necrotizing otitis media. In addition to conductive type can also be mixed type because of damage to the cochlea is due to erosion of the bones due to osteolytic semicircular canal cholesteatoma.
Nursing Diagnosis for Acute Otitis Media and Chronic Otitis Media
1. Acute Pain / Chronic Pain related to the inflammatory process.
2. Impaired verbal communication related to the effects of hearing loss.
3. Disturbed Sensory perception: hearing related to obstruction, infection of the middle ear or auditory nerve damage.
4. Risk for injury related to hearing loss, decreased visual acuity.
5. Anxiety related to surgical procedure, diagnosis, prognosis, anesthesia, pain, loss of function, the possibility of a greater hearing loss after surgery.
6. Social isolation related to pain, foul-smelling otorrhoea.
7. Knowledge Deficit regarding treatment, and prevention of relapse of the disease process.