.

RVU WC
MSN I 3rd yr. Nursing Students
Ear nose & throat disorders

04/13/2024
By: Mamo S
By:Mamo S (BSc, MSc) 1
 Objective
After the end of this session:
• Describe anatomical and physiological
overview of ENT
• Define each common ENT disorders
• Cause and pathophysiology of each
disorders
• Identify assessment , clinical identity and
diagnostic
• Nursing managements of each disorders
04/13/2024 By:Mamo S (BSc, MSc) 2
 Anatomy and physiology of the ear
The structure of ear consists of three parts:
Outer
Middle
Inner ears.
 Outer ear: collects sounds & funnels them through
auditory system.
It is composed of three parts
 Pinna (or auricle)
 External auditory canal (external auditory meatus)
 Tympanic membrane (or eardrum)

04/13/2024 By:Mamo S (BSc, MSc) 3

04/13/2024 By:Mamo S (BSc, MSc) 4
2. Middle ear
o Transmits sound from the outer ear to the inner ear.
o Consists of an oval, air-filled space .
o Eustachian tube :connects the middle ear to the
nasopharynx.
o Normally, the Eustachian tube is closed, but it opens
by action of the tensor velipalatini muscle when the
person performs yawns, or swallows

04/13/2024 By:Mamo S (BSc, MSc) 5

 Three tiny bones (Ossicles):

Hammer (malleus)

Anvil (incus) and

Stirrup

 Conducts sound waves from tympanic membrane

(outer ear) to the oval window (inner ear).

04/13/2024 By:Mamo S (BSc, MSc) 6

3. Inner ear
 Innermost part of the ear (about the size of a pea)
 Complex in shape.
 Responsible for sound detection & balance.

Three main components:

A. Vestibule
- Round open space accesses various passage ways.
- The central structure within the inner ear.

04/13/2024 By:Mamo S (BSc, MSc) 7

B. Semicircular canals
- Fluid filled tubes
- A key part of the vestibular system and
- Maintenance of balance when head or body rotates.

C. Cochlea
- Dedicated to hearing.

04/13/2024 By:Mamo S (BSc, MSc) 8

04/13/2024 By:Mamo S (BSc, MSc) 9
Balance & Equilibrium
 Body balance is maintained by the cooperation of the
muscles & joints of the body (visual system), & labyrinth
(vestibular system).
 These areas send their information about equilibrium, or
balance, to the brain (cerebellar system) for coordination &
perception in the cerebral cortex.

Blood Supply
 Posteriory auricular artery
 Anteriory auricular artery
04/13/2024 By:Mamo S (BSc, MSc) 10
Nerve supply
 Greater auricular(CN2-3)
 Lesser occipital (C2)
 Auricular branch of facial (Concha)

Lymphatic drainage
 Mastoid tip
 Pre-auricular
 Deep cervical

04/13/2024 By:Mamo S (BSc, MSc) 11

 Assessment
Inspection of the External ear for:
 Deformities

 Lesions

 Discharge

 Size
 Symmetry and
 Angle of attachment to the head

04/13/2024 By:Mamo S (BSc, MSc) 12

 Diagnostic evaluation
 Audiometry
 Otoscopic examination
 Whisper test
 Weber test:
 Rinne test

04/13/2024 By:Mamo S (BSc, MSc) 13

 Rinne Test
- Assesses both air and bone conduction of sound.
- Normal hearing reports – AC > BC .
- For conductive hearing loss BC=AC, BC >AC.
- For sensorineural hearing loss AC >BC.

04/13/2024 By:Mamo S (BSc, MSc) 14

 Inflammatory Ear Disorders
Otitis externa (external otitis, swimmer's ear)
Definition:- inflammation of the skin of the external ear
canal & auricle.
Causes
Water in the ear canal (swimmer’s ear)
 Trauma to ear canal
Permitting entrance of organisms
 Systemic conditions (vitamin deficiency &
endocrine disorders.)
04/13/2024 15
By:Mamo S (BSc, MSc)
 Bacteria like :
 Protus vulgaris
 Streptococcus
 Staphylococcus aureus
 Fungi:
 Aspergillus niger
 Candida albicans

04/13/2024 By:Mamo S (BSc, MSc) 16

Predisposing factors
 Swimming in contaminated water

 Cleaning the ear canal with pin, finger or other

foreign objects
 Exposure to dust, hair care products, or other irritants,

 Regular use of earphones, earplugs, which trap

moisture in the ear canal,

 Chronic drainage from a perforated tympanic

membrane
04/13/2024 By:Mamo S (BSc, MSc) 17
 Clinical Manifestations EO
 Pain

 Discharge from the external auditory canal

 Aural tenderness (usually not present in middle ear

infections)

 Occasionally fever,

 Cellulitis

 Lymphadenopathy.

04/13/2024 By:Mamo S (BSc, MSc) 18

Other symptoms may include:

 Pruritus

 Hearing loss or a feeling of fullness.

 On otoscopic examination,

ear canal is erythematous and edematous.

 Discharge may be yellow or green & foul-smelling.

 In fungal infections, hair like black spores may even

be visible.
04/13/2024 By:Mamo S (BSc, MSc) 19
Diagnosis
Hx & P/E
Otoscopy examination
Culture & sensitivity
Medical Management
To relieve pain:
o Heat therapy to the periauricular region (heat lamp;
hot; wet compresses; heating pad)
o Analgesics like aspirin, acetaminophen, codein
04/13/2024 By:Mamo S (BSc, MSc) 20
Antibiotics
o If fever or regional cellulites develops
o Instillation of antibiotic ear drops
o Application of keratolytic or 2% salicylic acid in
cream containing nystatin to treat candidal organisms
– In chronic otitis external, primary treatment consists of
cleansing the ear & removing debris.

04/13/2024 By:Mamo S (BSc, MSc) 21

Prevention of otitis external

- Advice the patient to use wool ear plugs coated with

petrolatum, to keep water out of the ears when showering

or shampooing.

- Tell the patient to wear earplugs or to keep his head

above water when swimming.

- Avoid cleaning the ears with pins or foreign objects

04/13/2024 By:Mamo S (BSc, MSc) 22
 Tympanic Membrane Perforation

Definition
- Is a hole or rupture in the eardrum, a thin membrane
that separates the ear canal and the middle ear.
- Often accompanied by decreased hearing & occasional
discharge.
- Pain is usually not persistent.

04/13/2024 By:Mamo S (BSc, MSc) 23

 Causes
- Usually caused by infection or trauma.

- Skull fracture

- Explosive injury

- Sever blow to the ear

- Excessive nose blowing

- Foreign objects (Cotton tipped applicator, Pins, Keys)

- Infection (otitis media)

- Rapid change of pressure that occur with non pressurized

air flight(baro trauma).
04/13/2024 By:Mamo S (BSc, MSc) 24
Clinical manifestation
A hole or a tear in the tympanic membrane during otoscope exam

Anterior perforation Posterior perforation

04/13/2024 By:Mamo S (BSc, MSc) 25

Medical Mgmt.

 Although most tympanic membrane perforations heal

spontaneously within weeks after rupture, some may take several

months to heal.

 Some perforations persist because scar tissue grows over the

edges of the perforation, preventing extension of the epithelial

cells across the margins and final healing.

04/13/2024 By:Mamo S (BSc, MSc) 26

 In the case of a head injury or temporal bone fracture,

a patient is observed for evidence of CSF fluid

otorrhea or rhinorrhea

 Surgical management

Tympanoplasty (surgical repair of the tympanic

membrane) is used.

04/13/2024 By:Mamo S (BSc, MSc) 27

Nursing intervention

 Inspects for any CSF, otorrhea or rhinorhea.

 Instruct the patient to protect his/her ear from

water when tympanic membrane perforation

occurs

 Observe for any sign of potential infection.

04/13/2024 By:Mamo S (BSc, MSc) 28

 Teach patient

To avoid trauma

To avoid incrementing objects into the

external canal.

Use ear protectors when blunt trauma

experienced (boxing sporting)

04/13/2024 By:Mamo S (BSc, MSc) 29

 Otitis media

Definition: an inflammation of the middle ear.

Path physiology
 When fluid or pus collects in the middle ear
it increases pressure
 Which in turn, causes bulging of the
eardrum
 Spontaneous rupture of the eardrum.
 Slowly and scaring can cause diminished hearing
04/13/2024 By:Mamo S (BSc, MSc) 30
 Pts with perforated ear drums are prone to
repeated infections through out their life.
Clasification of otites media
1. Acute otitis media
2. Chronic otitis media

04/13/2024 By:Mamo S (BSc, MSc) 31

 Acute otitis media (AOM)
 AOM:- an acute infection of the middle ear, < 2 weeks.
 Acute otitis media is common in children.

The pathogens that cause acute otitis media are usually

 Streptococcus pneumoniae,
 Haemophilus influenzae
 Moraxella catarrhalis, which enter the middle ear after
eustachian tube dysfunction caused by obstruction related

04/13/2024 By:Mamo S (BSc, MSc) 32

 AOM cont’d

 Upper respiratory infections (URTI),

 Inflammation of surrounding structures (e.g.

rhinosinusitis, adenoid hypertrophy), or

 Allergic reactions (e.g. allergic rhinitis).

04/13/2024 By:Mamo S (BSc, MSc) 33

 AOM cont’d
o Bacteria can enter the eustachian tube from

contaminated secretions in the nasopharynx and the

middle ear from a tympanic membrane perforation.

o A purulent exudate is usually present in the middle

ear, resulting in a conductive hearing loss.

04/13/2024 By:Mamo S (BSc, MSc) 34

 Acute otitis media cont`d

AOM (Purulent)

04/13/2024 By:Mamo S (BSc, MSc) 35

 Acute otitis media cont`d

Clinical manifestations
o Drainage from the ear (otorrhea),
o Fever
o Hearing loss
o Tinnitus
o Otalgia(pain)
o Redish tympanic membrane
o Bulged or perforated tympanic membrane
o Leukocytes may be present
04/13/2024 By:Mamo S (BSc, MSc) 36
 AOM cont`d

Diagnostic evaluation

 Clinical manifestation

 Otoscopic examination

 Fluid culture(tympanocentesis)

 WBC analysis

04/13/2024 By:Mamo S (BSc, MSc) 37

 AOM cont`d
Medical Management
– Broad spectrum antibiotic, Anti pain, Anti pyretic

The drainage to be analyzed (by culture and sensitivity

testing) so that the infecting organism can be identified
and appropriate antibiotic therapy prescribed.
Surgical Management
– Incision in the tympanic membrane is known as
myringotomy (Tympanotomy).

04/13/2024 By:Mamo S (BSc, MSc) 38

 AOM cont`d

Complication of acute otitis media

- Chronic otitis median
- Mastoditis
- Permanent hearing loss
- Sever systemic toxicity(H. influenza type B)
Indications for the onset of serious complications are
- Persistent elevation of temperature
- Pain and deep tenderness in the region of the mastoid
- Head ache
- Drowsiness/lethargy
- Disorientation/confusion
04/13/2024 By:Mamo S (BSc, MSc) 39
 Comparison of AOE & AOM
Features AOE AOM
Ottorrhea May or may not be Presents if tympanic mb
present perforate, discharge is
profuse
Otalgia Present, may awaken a Relief if tympanic mb
pt. at night rupture
Aural tenderness Present on palpation Usually absent
Systemic Absent Fever, URTI, Rhinitis
symptoms

Edema of external Present Absent

auditory canal

Tympanic May appear normal erythematic, bulging &

membrane may be perforated

Hearing loss Conductive type conductive type

04/13/2024 By:Mamo S (BSc, MSc) 40

 Chronic otitis media (COM)
 Chronic infections of the middle ear.
 Results in damage the tympanic membrane, destroy
the ossicles, and involve the mastoid.
Cause
 Repeated episode of acute otitis media
 The perforation may also be the result of
mechanical trauma or blast injury
 Bacterial infection

04/13/2024 By:Mamo S (BSc, MSc) 41

 COM cont`d

04/13/2024 By:Mamo S (BSc, MSc) 42

 COM cont`d
Clinical Manifestations

 Intermittent, foul-smelling otorrhea.

 Pain is not usually experienced, except in cases of acute

mastoiditis

 Postauricular area is tender, erythematous and edematous.

 Otoscopic examination may show a perforation,

 Cholesteatoma

04/13/2024 By:Mamo S (BSc, MSc) 43

 COM cont`d

Diagnostic evaluation
 Otoscopic evaluation- may reveal
o Perforation
o Cholesteatoma (white mass behind the tympanic

membrane or coming through to the external canal

from perforation)

 Audiometric test
o Show conductive or mixed hearing loss in

case of cholesteatoma
04/13/2024 By:Mamo S (BSc, MSc) 44
 COM cont`d

Medical Management

Careful cleansing of the ear using the

microscope and suction instruments

Instillation of antibiotics drops or

Application of antibiotic powder

Systemic anti-biotic in case of acute infection

04/13/2024 By:Mamo S (BSc, MSc) 45

 COM cont`d
Surgical Management
If medical treatments are ineffective.

Tympanoplasty

Ossiculoplasty:- is the surgical reconstruction of

the middle ear bones to restore hearing.

Mastoid surgery:- are to remove the

cholesteatoma, gain access to diseased structures.

04/13/2024 By:Mamo S (BSc, MSc) 46

 COM cont`d

Nursing Interventions

 Reducing anxiety

 Relieving pain

 Preventing infection

 Improving hearing and communication

 Preventing injury

 Preventing altered sensory perception

 Promoting home and community-based care

04/13/2024 By:Mamo S (BSc, MSc) 47
 Mastoiditis
It is Bacterial infection & inflammation of the air cells of
the mastoid antrum.
Usually a complication of:
Chronic otitis media
Acute otitis media (less frequently )
Chronic systemic disease
Immune suppression

04/13/2024 By:Mamo S (BSc, MSc) 48

 cont`d
 Cause
 Bacteria that cause mastoditis include

– Pneumococci / in children/
– Haemophilus influenza
– Beta hemolytic streptococci
– Staphylococci
– Gram negative organisms

04/13/2024 By:Mamo S (BSc, MSc) 49

 cont`d
Clinical manifestation
– Thick, purulent discharge gradually becomes more profuse, possibly leading
to otitis external.
– Low grade fever.

– Dull ache & tenderness in the area of the mastoid process

Diagnostic evaluation

– X- ray shows

– Culture sensitivity test

– Audiometric testing:Sounds vary, based on their loudness (intensity) and

the speed of sound wave vibrations (tone).

– Hearing occurs when sound waves stimulate the nerves of the inner ear
04/13/2024 By:Mamo S (BSc, MSc) 50
 cont`d
Management

– Parenteral antibiotic therapy

– Myringotomy - to draying purulent fluid

– Simple mastoidectomy

– Radical mastoidectomy (chronically in flamed

mastaid)

04/13/2024 By:Mamo S (BSc, MSc) 51

 cont`d
 Nursing intervention
– Give pain medications as needed
– Check wound drainage
– Check patients hearing, watch for sign of complications
(infection, facial nerve paralysis with unilateral facial
drooping bleeding, and vertigo)
– Position pt. on affected side after surgery to facilitate
drainage.

04/13/2024 By:Mamo S (BSc, MSc) 52

 Nose & sinus D/o
Anatomy of the Nose and Sinuses
External nose: Projects from the
face.
• Vary in size and shape because of
differences in nasal cartilage.
Parts:
o Root
o Apex
o Nares
o Alae – lateral boundaries
o Nasal septum – middle structure

04/13/2024 By:Mamo S (BSc, MSc) 53

 Assessments of Nose & Sinuses

Examination of
Nasal endoscopy
the nose
 Nasal speculum
 Nasal endoscopy
 Rhinometry
 Sinus endoscopy
(antroscopy).

04/13/2024 By:Mamo S (BSc, MSc) 54

 cont`d

Sinus:
 Air-filled extensions of the
respiratory part of the
nasal cavity into the ff
cranial bones:
– Frontal
– Ethmoid
– Sphenoid
– Maxillary
04/13/2024 By:Mamo S (BSc, MSc) 55
 Rhinitis
Definition:- inflammation of the nasal mucosa.
Classification
1.Acute rhinitis: - also known as the common
cold, or coryza.
 may be bacterial or viral in origin & it
usually lasts 5-7 days, with or without
treatment.
2. Allergic rhinitis:- most often as a seasonal
disorder
04/13/2024 By:Mamo S (BSc, MSc) 56
 cont`d

Causes
o Tree pollen
o Grass pollen
o House dust
o Feather pillows
o Mold/decay
o Cigarette smoke
o Animal dander’s
04/13/2024 By:Mamo S (BSc, MSc) 57
 cont`d

3. Vasomotor rhinitis: -
 Cause the same c/m as those of acute & allergic rhinitis

but has no known cause.

4. Rhinitis medicamentosa: -
 Is caused by abuse or over use of topical and

decongestant sprays or intranasal cocaine.

 Substances initially cause vasoconstriction when used

frequently, however the initial decongestion is followed

by sever mucosal edema.

04/13/2024 By:Mamo S (BSc, MSc) 58
 cont`d
Clinical manifestation
 Rhinorrhea(excessive nasal drainage, runny nose);

 Nasal congestion (obstruction)

 Paroxysmal sneezing

 Pruritus of the nose & eyes

 Fever

 Pale, irritated, edematous nasal mucosa, red and

edematous eye lids & conjunctiva.

 Excessive lacrimation

 Head ache
04/13/2024 By:Mamo S (BSc, MSc) 59
 cont`d
Complications:
 Untreated allergic rhinitis may led to asthma
 Recurrent otitis media with hearing loss
 Sinusitis
 Nasal or Sinusal polyps
 Alveolar hypoventilation
 Epistaxis

Diagnosis
 Personal & family history of allergies
 Physical finding
04/13/2024 By:Mamo S (BSc, MSc) 60
 cont`d
Nursing intervention for acute rhinitis:
 Humidification
 Decongestants to reduce the edema of nasal mucosa
 Increased fluids to prevent dehydration
 Analgesics
 Antibiotic to prevent secondary bacterial infection

For allergic rhinitis

- Avoid allergens
- Antihistamines
- Steroids
04/13/2024 By:Mamo S (BSc, MSc) 61
 Viral rhinitis (common cold)

 Infectious, acute inflammation of the mucous

membranes of the nasal cavity.

 Characterized by:

Nasal congestion,

Rhinorrhea, Sneezing,

Sore throat, and general malaise.

04/13/2024 By:Mamo S (BSc, MSc) 62
 cont`d

 Most frequent viral infection in the general

population.
 highly contagious because virus is shed for
about 2 days before the symptoms appear &
during the first part of the symptomatic phase.
Clinical manifestation
 Low-grade fever,
 Nasal congestion,

04/13/2024 By:Mamo S (BSc, MSc) 63

 cont`d

 Rhinorrhea / nasal discharge,

 Halitosis,
 Sneezing,
 Tearing watery eyes,
 “scratchy” or sore throat,
 General malaise,
 Chills, & often headache and muscle aches.

04/13/2024 By:Mamo S (BSc, MSc) 64

 cont`d

Medical management

 An adequate fluid intake, rest, prevention of chilling,

and use of expectorants as needed.

 Warm salt-water gargles soothe the sore throat, and

(NSAIDs), such as aspirin or ibuprofen, relieve aches

and pains.

 Antihistamines are used to relieve sneezing,

rhinorrhea, and nasal congestion.

04/13/2024 By:Mamo S (BSc, MSc) 65
 cont`d

 Guaifenesin (Mucinex), an expectorant, is available

without a prescription and is used to promote

removal of secretions.

 Several antiviral medications are available by

prescription, including amantadine (Symmetrel)

and rimantadine (Flumadine).

04/13/2024 By:Mamo S (BSc, MSc) 66

 cont`d

 Antimicrobial agents (antibiotics) should not

be used, because they do not affect the virus.
 Topical nasal decongestants (e.g.,
phenylephrine nasal(Neo-Synephrine),
oxymetazoline nasal [Afrin]) should be used
with caution.

04/13/2024 By:Mamo S (BSc, MSc) 67

 cont`d

 Topical therapy delivers medication directly to the

nasal mucosa, and its overuse can produce rhinitis
medicamentosa, or rebound rhinitis.

 The inhalation of steam or heated, humidified air

has been a mainstay of home remedies for common
cold sufferers, but the value of this therapy has not

been demonstrated.

04/13/2024 By:Mamo S (BSc, MSc) 68

 cont`d

Nursing management
Teaching Patients Self-Care
 Most viruses can be transmitted in several ways:
o Direct contact with infected secretions;
o Inhalation of large particles from others’ coughing or
sneezing
o Inhalation of small particles (aerosol) that may be
suspended in the air for up to an hour.
 Hand washing (or use of alcohol-based antibacterial
cleaning agents)
04/13/2024 By:Mamo S (BSc, MSc) 69
 Rhinosinusitis (sinusitis)

Definition:- formerly called sinusitis, is an inflammation

of the paranasal sinuses & nasal cavity.

 Classified by duration of symptom as

1. Acute (less than 4 weeks),

a. Acute bacterial rhinosinusitis (ABRS)

b. Viral rhinosinusitis (AVRS).

c. Recurrent acute rhinosinusitis is characterized by

four or more acute episodes of ABRS per year

04/13/2024 By:Mamo S (BSc, MSc) 70

 cont`d
2. Sub acute (4 to 12 weeks),

3. Chronic (more than 12 weeks).

4. Allergic sinusitis - accompanies allergic rhinitis
5. Hyperplastic sinusitis - is a combination of
purulent acute
Causes
 Bacteria(pneumococci; hemophilus influenza,
anaerobes)

04/13/2024 By:Mamo S (BSc, MSc) 71

 cont`d
 Viral less frequently.
o Bacterial invasion generally occurs when a cold
spreads to the sinuses
 Excessive nose blowing during an acute infection forces
infected material in to the sinuses.

04/13/2024 By:Mamo S (BSc, MSc) 72

 cont`d
Sign and Symptoms
- Nasal congestion, followed by a gradual buildup of
pressure in the affected sinus
- Blood tinged nasal discharge, later becoming
purulent
- Malaise, sore throat, headache
- Low grade fever (37.20C - 37.50C)

04/13/2024 By:Mamo S (BSc, MSc) 73

 cont`d

 Pain depends on the affected sinus:

o Maxillary sinusitis:- cheeks and upper teeth

o Ethmoid sinusitis:- eyes

o Frontal sinusitis :- eye brows

o Sphenoid sinusitis (rare):- behind the eye

04/13/2024 By:Mamo S (BSc, MSc) 74

 cont`d

 Sub-acute sinusitis:- suggest purulent nasal discharge

that continues longer than 3 weeks after an acute
infection subsides with a clinical manifestation of:
 Stuffy nose
 Vague facial discomfort
 Fatigue
 None productive cough
 Chronic sinusitis:- causes continuous mucopurulent
discharge

04/13/2024 By:Mamo S (BSc, MSc) 75

 cont`d
 Allergic sinusitis:- are the same as those of allergic
rhinitis, symptoms are:
o Sneezing
o Frontal headache
o Watery nasal discharge
o Stuffy, burning, itchy nose,
 Hyperplastic sinusitis:- bacterial growth on diseased
tissue cause tissue edema; thickening of the mucosal
lining and the development of mucosal polyps produce
stuffiness of the nose, and headaches

04/13/2024 By:Mamo S (BSc, MSc) 76

 cont`d
Diagnosis

 Sinus x-ray

 Antral puncture:- provide a specimen for culture and

sensitivity test

 Transillumination: allows inspection of the sinus cavities

by passing a light through them, purulent drainage

prevents passage of light

 Nasal examination reveals: inflammation and pus

04/13/2024 By:Mamo S (BSc, MSc) 77
 cont`d

Treatment

- Analgesic ( meperidine, codein) for acute sinusitis

- Vasoconstrictors (epinephrine or phenylpherine) to

decrease nasal secretions

- Steam inhalation promote drainage

- Antibiotics to combat infection

- Local application of heat to relive pain and congestion

04/13/2024 By:Mamo S (BSc, MSc) 78

 cont`d
 In sub-acute sinusitis:
o Antibiotics
 In acute sinusitis:
o Vasoconstrictors may lesson nasal congestion
o After acute infection subsides, sinus irrigations (needle
puncture followed by saline wash) occasionally followed by
corticosteroids to decrease inflammation
 In allergic sinusitis:
o Antihistamines
o Identifications of allergens
o Corticosteroid, epinephrine

04/13/2024 By:Mamo S (BSc, MSc) 79

 cont`d

 In chronic & hyperplastic sinusitis:

o Nasal irrigation to relieve pain & congestion
o If irrigation fails to relieve symptoms, one or
more sinuses require surgery.

 For maxillary sinusitis

o Nasal window procedure: creates an opening in the sinus,
allowing secretion & pus to drain through the nose

04/13/2024 By:Mamo S (BSc, MSc) 80

 cont`d
 For chronic ethmoid sinusitis
 Ethmoidectomy removes all infected tissue
through an external or intranasal incision in to
the ethmoid sinus.

 For sphenoid sinusitis:

 External ethmoidectomy removes infected
ethmoidal sinus tissue through a crescent shaped
incision, beginning under the inner eye brow &
extending along the side of the nose.
04/13/2024 By:Mamo S (BSc, MSc) 81
 cont`d
 For chronic frontal sinusitis:
 Fronto-thmoidectomy removes infected frontal sinus
tissue through an extended external ethmoidectomy.
Nursing Intervention
 Enforce bed rest
 Encourage the patient to drink plenty of fluids to
promote drainage
 Apply warm compress 4x a day to relieve pain &
promote drainage
 Provide analgesics & antihistamines as needed

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 Watch for & report complications such as:-
o Vomiting
o Chills, fever
o Blurred or double vision
o Personality changes
 If surgery is necessary, tell the patient what to expect
postoperatively a nasal packing will be in place for 12-24
hrs following surgery.
 The patient must breathe through his mouth and will not
be able to blow his nose

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 To prevent edema & promote drainage, place the
patient in semi-fowler's position.
 Ice compress to relieve edema, pain & minimizing
bleeding after surgery.
 Frequently change dressing and record the
consistency, amount and color or drainage (expect
scant, bright red, & clotty drainage)
 Provide mouth care because the patient is breathing
through his mouth.

04/13/2024 By:Mamo S (BSc, MSc) 84

 THANK YOU

04/13/2024 By:Mamo S (BSc, MSc) 85