Comprehensive Nursing Case Study: Otitis Media and Otitis Externa

This nursing case study focuses on otitis media (OM) and otitis externa (OE), common ear infections. The introduction defines OM, including its subtypes (acute, with effusion, chronic suppurative, and adhesive), and OE, encompassing acute diffuse, localized, chronic, eczematous, necrotizing, and otomycosis. The study details the symptoms of both conditions, such as pain, fever, hearing problems, and discharge. It explores the structure and function of the tympanic membrane, including its layers and components. The case study covers treatments, including antibiotics for OM (Erythromycin, Amoxicillin, Ciprodex, Augmentin, Bactrim) and systemic analgesics and topical therapies for OE (acetic acid, Ciprodex, Ciprofloxacin, and Benzotic Otic Drops). The conclusion emphasizes preventive measures like handwashing and smoke avoidance, and highlights the importance of prompt treatment with antibiotics, ear drops, and pain relievers. The case study references multiple medical sources for accuracy.

Running head: OTITIS MEDIA and OTITIS EXTERNA
OTITIS MEDIA and OTITIS EXTERNA
-Nursing case study
Name of the Student
Name of the University
Author Note

1OTITIS MEDIA and OTITIS EXTERNA
Introduction-
Otitis Media (OM) is a swelling occurring in middle ear, and is frequent among
children. There can be different sub-categories of OM, namely: Acute OM, OM with
Effusion (OME), chronic suppurative OM and Adhesive OM (Emedicine.medscape.com,
2018).
Figure 1: Acute OM with purulent effusion behind a bulging tympanic membrane;
source: (Emedicine.medscape.com, 2018)

2OTITIS MEDIA and OTITIS EXTERNA
Figure 2: Chronic OM with retraction pocket of the pars flaccid; source:
(Emedicine.medscape.com, 2018)
Otitis Externa (OE): this is a conditi0on caused due to swelling or infection of
external auditory canal (EAC), auricle or both. The condition is prevalent among all age
groups. OE can be of different types, namely: Acute diffuse OE, Acute localized OE, Chronic
OE, Eczematous OE, Necrotizing OE and Otomycosis (Emedicine.medscape.com, 2018).
Figure 3: Acute OE: Ear canal is red and edematous with the presence of discharge; source:
(Emedicine.medscape.com, 2018)
Symptoms-
Otitis Media:
In Acute OM (AOM) and OM with effusion (OME), persistence of fluid in the ear can
occur, even after the cure of the infection. Symptoms of AOM include pain, fever, and
problems in hearing. In very young children it can cause crying, irritability, sleeping
problems, and pulling the ear. Additional symptoms can include pharyngitis (or sore throat),
pain in neck, rhinitis (blockage or discharge from nose), and headache, tinnitus (ringing,

3OTITIS MEDIA and OTITIS EXTERNA
buzzing or other noise in the ear) (umm.edu, 2018). Diarrhea, loss of appetite, Otorrhea,
Otalgia and Vertigo can also occur in OME and AOM (emedicine.medscape.com, 2018).
Otitis Externa:
Common symptoms of OE include discharge from the ear, itching, temporary
lowering or dullness in hearing and pain. The ear might also feel blocked. OE can affect both
ears, but is more common in a single ear. Glands around the neck can also swell and become
sore (Patient.info, 2018). The characteristic physical symptom of OE is a pain during
palpation of anterior ear canal or tragus, or during exertion of traction on the pinna or
external ear. Other symptoms can also include: Otalgia, hearing loss, fullness or pressure fest
on ears, Tinnitus, narrowing of ear canal, fever, cellulitis of face or neck
(emedicine.medscape.com, 2018).
Tympanic Membrane Structure-
Tympanic membrane or ear drum is a vital structural/functional component of the ear,
also called the ear drum. It is a round and thin layer of tissue between external ear and middle
ear. It is 0.1mm in thickness and 8-10 mm in diameter, weighing at 14mg. This tissue is very
tough, flexible and resilient. It is made up of three layers, namely, outer cutaneous layer, the
middle fibrous layer, and inner mucosal layer. The membrane is kept in position by a
cartilaginous ring that is tough and flexible (healthline.com, 2018).
The membrane is positioned at an angle of 55o to the horizontal plane of the floor,
directed laterally forward and downwards. It is oval in shape, and laterally concave, slightly
drawn inwards at the center at the point where the handle of malleus is connected. The
components of the tympanic membrane includes: anterior and posterior malleolar fold, pars
flaccid/ sharpnell membrane/ rivinous membrane, pars tensa, annulus tympanicus, umbo,

4OTITIS MEDIA and OTITIS EXTERNA
tympanic notch of rivinus, and cone of light/light reflex. Blood is supplied by the divergences
from External Carotid Artery, and neuronal supply is through the ninth cranial nerve via
Jacobsen’s branch (epomedicine.com, 2018).
Figure 4: Components of tympanic membrane; source: (epomedicine.com, 2018).
The tympanic membrane or ear drum helps in the hearing process. Sound waves
entering the ear, hits the membrane, producing vibrations. These vibrations are then picked
up by bones in the middle ear (malleus, incus and stapes). Damage or absence of the
tympanic membrane can cause difficulty hearing or even hearing loss (healthline.com, 2018).
Prescription and Dosage-
Otitis Media:
Treatment for OM is possible with antibiotics, administered once or twice daily and
can include Erythromycin 200mg/5ml and sulfisoxazole 600mg/5ml, Amoxicillin 250mg (to
be taken with food or within 1 hour of a meal), Ciprodex ear drops 0.14ml (4 drops in the
affected ear, twice daily for a week), Augmentin 200mg (that is an antibiotic, prepared from a

5OTITIS MEDIA and OTITIS EXTERNA
combination of amoxicillin and cavulanate potassium), Bactrim 40mg/Kg of body weight
(Drugs.com, 2018; Emedicine.medscape.com, 2018).
Otitis Externa:
Systemic Anagesics like codeine and non steroidal anti inflammatory drugs (NSAID)
can be used. Tropical treatment can include cleansing the auditory canal using tropical
antibacterial therapy (like 2% acetic acid) with hydrocortisone or aluminium acetate (Sander,
2018). Other medications can include: Ciprodex ear drops 0.14 ml (4 drops in each affected
ear, twice daily for a week), Ciprofloxacin and dexamethasone- 0.3% - 0.1% (4 drops in each
affected ear, twice a day for a week), Benzotic Otic Drops in 20% aqueous solution
(Drugs.com, 2018).
Conclusion-
Infections of the ear can lead to several complications apart from the common
problems and effects on hearing capability. The propensity of infections of the middle ear can
be greatly reduced by frequently washing hands, avoiding environment with lots of smoke.
The infections can be treated with antibiotics, ear drops and ibuprofen or acetaminophen
(umm.edu, 2018).

6OTITIS MEDIA and OTITIS EXTERNA
References:
Drugs.com. (2018). List of Otitis Media Medications (105 Compared) -
Drugs.com. Drugs.com. Retrieved 2 February 2018, from
https://www.drugs.com/condition/otitis-media.html
Drugs.com. (2018). RE Benzotic Otic Drops - FDA prescribing information, side effects and
uses. Drugs.com. Retrieved 2 February 2018, from https://www.drugs.com/pro/re-
benzotic-otic-drops.html
Emedicine.medscape.com. (2018). Acute Otitis Media Medication:
Antibiotics. Emedicine.medscape.com. Retrieved 2 February 2018, from
https://emedicine.medscape.com/article/859316-medication#2
emedicine.medscape.com. (2018). Otitis Externa: Practice Essentials, Background,
Anatomy. Emedicine.medscape.com. Retrieved 2 February 2018, from
https://emedicine.medscape.com/article/994550-overview
Emedicine.medscape.com. (2018). Otitis Media: Practice Essentials, Background,
Pathophysiology. Emedicine.medscape.com. Retrieved 2 February 2018, from
https://emedicine.medscape.com/article/994656-overview
epomedicine.com. (2018). Applied Anatomy of Tympanic Membrane |
Epomedicine. Epomedicine. Retrieved 2 February 2018, from
http://epomedicine.com/medical-students/applied-anatomy-of-tympanic-membrane/
healthline.com. (2018). Tympanic Membrane Pictures, Function & Anatomy | Body
Maps. Healthline. Retrieved 2 February 2018, from
https://www.healthline.com/human-body-maps/tympanic-membrane#1

7OTITIS MEDIA and OTITIS EXTERNA
Patient.info. (2018). Ear Infection (Otitis Externa) | Causes, Symptoms and
Treatment. Patient.info. Retrieved 2 February 2018, from
https://patient.info/health/earache-ear-pain/ear-infection-otitis-externa#nav-2
Sander, R. (2018). Otitis Externa: A Practical Guide to Treatment and Prevention. Aafp.org.
Retrieved 2 February 2018, from https://www.aafp.org/afp/2001/0301/p927.html
umm.edu. (2018). Otitis media. University of Maryland Medical Center. Retrieved 2
February 2018, from https://www.umm.edu/health/medical/altmed/condition/otitis-
media