nursing management of client with otitis externa

1. PARUL INSTITUTE OF NURSING

2. OTITIS EXTERNA
• It is an infection of the outer opening of the
ear and ear canal.
• Also referred to as swimmer’s ear or External
otitis. It results from the exposure of moisture.
• It occurs most commonly among children
between the ages of seven and twelve and
among the elderly.

4. CLASSIFICATION
Acute: Lasts less
than 6 weeks.
• Typically due to
bacterial infection
Chronic: Lasts more
than 3 months.
• Due to Allergies or
autoimmune
diseases.

5. ETIOLOGY
• Swimming in the contaminated water.
• Objects in ear( cotton swabs or other small
objects to clear the ear canal, hearing aid, ear
plugs).
• Infections: Staphylococcus aerus, P.
Auruginosa, Candida albicans.
• Other trauma

6. RISK FACTORS
Diabetes Psoriasis.
Atopic
dermatitis
Eczema Asthma HIV

7. PATHOPHYSIOLOGY
•

8. CLINICAL MENIFESTATIONS
• Red, swollen ear canal
• Four discharge from ear.
• Itchiness.
• Fever
• Ear pain( Pain worsened when external ear is
touched).
• Temporary conductive loss.
• Severe cases : Ear canal narrowed through
exudates.

9. DIAGNOSTIC EVALUATION
• History collection
• Physical examination: Redness in the ear,
fullness of ear.
• Lab test: Gram staining and culture of
discharge.
• Imaging test: CT scan, MRI of head,
radionuclide scan.

10. MANGEMENT
• The goal of treatment is to stop the infection and allow
your ear canal to heal.
• Avoid getting affected ear wet.
• Remove any discharge/debris by gently swabbing outer ear
with cotton wool.
• Remove anything from affected ear which may cause an
allergic reaction such as hearing aids,earplugs,earrings.
• Debridement: the infected debris should be gently and
thoroughly removed from the canal with suction or dry
cotton swabs under adequate lighting
• Painkillers such as ibuprofen, Paracetamol.
• Burow’s solution: Mixture of aluminum sulphate and
acetic acid. It is used against the bacterial infection.

11. • Antibiotic +Corticosteroid eardrops is used.
Such as ciprofloxacin And hydrocortisone.
• Antifungal eardrops: Nystatin.
• Dry ear precautions (e.g. wearing shower cap,
avoiding swimming) are strongly advised for
both external otitis and fungal external otitis..

12. • Prevention: External otitis can be prevented
by applying a few drops of 1:1 mixture of
rubbing alcohol and vinegar just after the
swimming.

13. COMPLICATIONS
• Abscesses.
• Narrowing of ear canal
• Inflamed or perforated eardrum
• Cellulitis.
• Malignant otitis externa: Mostly occur with
person with diabetes mellitus.

14. MALIGNANT OTITIS EXTERNA
• Malignant otitis externa (MOE) also known as
necrotizing otitis externa , is an invasive
bacterial infection that involves the external
auditory canal and skull base.
• It is a complication of otitis externa that
occurs in immunocompromised patients.
• It is typically seen in elderly diabetic patients.

15. • Pseudomonas Auruginosa is causative in 95%
of cases.
• Other causative organisms such as S.aureus,
Proteus mirabilis, Klebsiella etc.
• It is treated with antipseudomonal antibiotics
• Fluoroquinolones are also given.

18. PREVENTION
• Keep ears dry
• Swim wisely
• Avoid putting foreign objects in ear
• Use caution after an ear surgery or
infection.

19. NURSING MANAGEMENT