Ear infection and Surgery – This course is designed to understand the concept of community health nursing: nurses’ roles and interventions in family health, school health, occupational health, environmental health, elderly health care, gender issues, disaster management and principles and terminology of epidemiology. The aim of the course is to acquire knowledge and skills in community health nursing.
Ear infection and Surgery
Definition of Ear Infection:
An ear infection (acute otitis media) is most often a bacterial or viral infection that affects the middle ear, the air-filled space behind the eardrum that contains the tiny vibrating bones of the ear.
Signs & Symptoms of Ear Infection:
The onset of signs and symptoms of ear infection is usually rapid.
Children
Signs and symptoms common in children include:
- Ear pain, especially when lying down
- Tugging or pulling at an ear
- Difficulty sleeping
- Crying more than usual
- Acting more irritable than usual
- Difficulty hearing or responding to sounds
- Loss of balance
- Fever of 100° F (38° C) or higher
- Drainage of fluid from the ear
- Headache
- Loss of appetite
Adults
Common signs and symptoms in adults include:
- Ear pain
- Drainage of fluid from the ear
- Diminished hearing
Risk Factors
Risk factors for ear infections include:
1. Age. Children between the ages of 6 months and 2 years are more susceptible to ear infections because of the size and shape of their Eustachian tubes and because of their poorly developed immune systems.
2. Group child care. Children cared for in group settings are more likely to get colds and ear infections than are children who stay home because they’re exposed to more infections, such as the common cold.
3. Infant feeding. Babies who drink from a bottle, especially while lying down, tend to have more ear infections than do babies who are breast-fed.
4. Seasonal factors. Ear infections are most common during the fall and winter when colds and flu are prevalent. People with seasonal allergies may have a greater risk of ear infections during seasonal high pollen counts.
5. Poor air quality. Exposure to tobacco smoke or high levels of air pollution can increase the risk of ear infection.
Disease Of External Ear:
Preauricular sinus
Congenital swellings (Pinna)
Collaural fistula
Congenital anamolies (Pinna)
Atresia external canal
Congenital tumors of external canal drtbalus
Erysipelas
Perichondritis
Aural seroma drtbalus
Cerumen
Keratosis obturans
Disease of Middle Ear:
- Bezold’s abscess
- Cholesteatoma
- Gradenigo’s syndrome
- Otitis mediatas.
- Perforated eardrum
- Tympanic membrane retraction
- Tympanosclerosis
- Tympanostomy tube
Disease of Inner ear:
- Acoustic Neuroma
- Benign Paroxysmal Positional Vertigo
- Drug-Induced Ototoxicity
- Herpes Zoster Oticus
- Meniere Disease
- Purulent Labyrinthitis
- Vestibular Neuronitis
Treatment of Ear Infection:
Most mild ear infections clear up without intervention. Some of the following methods are effective in relieving the symptoms of a mild ear infection:
- Applying a warm cloth to the affected ear.
- Taking over-the-counter pain medication such as ibuprofen or acetaminophen.
- Using over-the-counter or prescription ear drops to relieve pain.
- Taking over-the-counter decongestants such as pseudoephedrine.
Complications of Ear Infections
◆ Trouble hearing.
◆ Rupture of the eardrum.
The following complications may also develop if there are repeat ear infections:
◆ Tissue growth behind the eardrum (cholesteatoma). If the tissue grows large enough, it can block the middle ear and affect hearing. Surgery is necessary to remove the growth.
◆ Damage to the tiny bones in the middle ear
Rare complications include infection in the:
◆ Bone that is located behind the ear (mastoiditis).
◆ Tissues surrounding the brain and spinal cord (meningitis).
These problems are rare, and they are becoming even rarer.
Common Symptoms of Ear Surgery:
- Pain around the surgical site (improves with time but may last up to two weeks)
- Numbness around the incision and ear (gradually improves with time)
- Clicking, popping, pulsing, ringing, or other sounds
- Soreness or bruising of the lips, eyelids, and shoulders
- Jaw, neck or throat pain
- Headaches and fatigue
Post-Operative Management of Ear Surgery:
Wound Care
- For one to two days, there may be a small amount of blood oozing from the incision inside the ear canal and/or behind the ear.
- For one to two weeks, some blood (or brown, pink, yellow, black or clear fluid) may drain from ear canal; cotton in the ear can be changed as needed if it is soaked with drainage; stop using cotton if there is no drainage
- Ear packing may fall out, but do not remove it; apply ear drops directly to packing.
- In one week, skin tape covering the incision may be removed if it has not fallen off.
- Do not remove any stitches, as they dissolve on their own.
Medications
- Resume home medication, unless instructed otherwise
- Follow prescription instructions for application procedure, frequency, and quantity of ear drops
- Acetaminophen (Tylenol) or ibuprofen (Motrin) as needed for pain
- Prescription narcotics (Norco, Percocet) for breakthrough pain only (**some narcotics have acetaminophen included, so do not take acetaminophen at the same time)
- Fiber and stool softeners (docusate) may help with constipation from pain medications
- Anti-nausea medications may be prescribed for dizziness with nausea and/or vomiting
- Always keep the inside of the ear dry
Showering
- Shower or bathe 48 hours after surgery, but do not soak or scrub the wound
- Place a cotton ball coated with Vaseline or an earplug in the outside bowl of the ear (don’t tal
- use cotton without lubricant or push on packing inside the ear) If water gets in, dab with a dry towel; don’t place anything inside the ear canal
- Dry incisions immediately after showering and apply moisturizing lotion (Aquaphor, Cetaphil) or antibiotic ointment (if prescribed).
Diet
- Consume healthy food and maintain hydration by drinking plenty of water
- Food may taste different or there may be decreased taste for weeks to months
Nursing Responsibilities after Surgery in Post-Operative Ward:
- The patient should be kept on nothing by mouth according to doctor’s order.
- IV fluid should be given according to doctor’s order.
- Maintain input and output chart.
- Maintain patency of NG tube. Notify physician if tube becomes dislodged
- Note character and amount of gastric drainage.
- Provide oral hygiene on a regular, frequent basis, including petroleum jelly for lips.
- Auscultate for resumption of bowel sounds and note passage of flatus.
- Monitor tolerance to fluid and food intake, noting abdominal distension, reports of increased pain, cramping, nausea and vomiting.
- Avoid milk and high-carbohydrate foods in the diet.
- Note admission weight and compare with subsequent readings.
- Administer IV fluids, TPN, and lipids as indicated.
- Monitor laboratory studies (Hb and Het, electrolytes, and total protein, prealbumin).
- Progress diet as tolerated, advancing from clear liquid to bland diet with several small feedings.
- Administer medications as indicated:
✔ Anticholinergics: atropine, propantheline bromide (Pro-Banthine)
✔ Fat-soluble vitamin supplements, including vitamin B12, calcium
✔ Iron preparations
✔ Protein supplements
✔ Medium-chain triglycerides (MCT)
- Care of the surgical area
- Care of IV cannel
- Care of the bowel and bladder
- Patient and their family members assured and informed about patient condition.
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