Otitis Media
Middle ear infection. Common in children (short Eustachian tubes). Causes: S. pneumoniae, H. influenzae, M. catarrhalis. Symptoms: ear pain, fever, irritability (children), hearing loss, ear tugging. Otoscopy: bulging, erythematous TM. Treatment: analgesics, antibiotics if <2 years or severe (amoxicillin first-line). Watchful waiting for mild cases >2 years.
Otitis Externa
Outer ear canal infection (swimmer ear). Causes: Pseudomonas, S. aureus, fungal. Risk: moisture, trauma, swimming. Symptoms: ear pain, itching, discharge, fullness, hearing loss. Treatment: ear drops (antibiotic +/- steroid — ofloxacin), keep dry, analgesics. Malignant otitis externa (diabetic/immunocompromised): Pseudomonas, osteomyelitis — IV antibiotics.
Nursing Management
Otitis media: pain management, antibiotic adherence, follow-up. Complications: TM perforation, recurrent infections (tympanostomy tubes), mastoiditis, hearing loss. Otitis externa: keep ear dry, instill drops properly (lie on side, pull pinna up/back for adults, down/back for children), do not use cotton swabs. Prevent: avoid cotton swabs, dry ears after swimming.
Important Notes
- Malignant otitis externa in diabetic or immunocompromised patients is a serious infection (Pseudomonas osteomyelitis) — requires IV antibiotics.
- Do not insert cotton swabs into ear canal — pushes wax deeper and causes trauma leading to otitis externa.
Clinical Tips
- Amoxicillin is first-line for otitis media — watchful waiting is appropriate for mild cases in children >2 years.
- Instill ear drops correctly: lie on side, pull pinna up and back for adults, down and back for children, massage tragus.
Summary
Otitis media and externa management requires pain control, appropriate antibiotics/ear drops, keeping ears dry, and preventing complications.
