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Acute Suppurative Otitis Media

This document discusses otitis media, or middle ear inflammation. It begins by classifying otitis media by duration as acute (less than 3 weeks), subacute (3 weeks to 3 months), or chronic (greater than 3 months). It then discusses the definition, etiology, routes of infection, microbiology, pathology and clinical features in different stages, complications, diagnosis, and treatment options including medical treatment with antibiotics and decongestants as well as surgical procedures like myringotomy.

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Dr Tipu Sultan
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55 views24 pages

Acute Suppurative Otitis Media

This document discusses otitis media, or middle ear inflammation. It begins by classifying otitis media by duration as acute (less than 3 weeks), subacute (3 weeks to 3 months), or chronic (greater than 3 months). It then discusses the definition, etiology, routes of infection, microbiology, pathology and clinical features in different stages, complications, diagnosis, and treatment options including medical treatment with antibiotics and decongestants as well as surgical procedures like myringotomy.

Uploaded by

Dr Tipu Sultan
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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DR.

ARJUN DASS
PROF. & HEAD
DEPARTMENT OF ENT
OTITIS MEDIA

Otitis Media
Inflammation of middle ear cleft

Classification:
(on duration; Senturia,1980)
 Acute upto 3 weeks
 Subacute 3 week to 3 months
 Chronic greater than 3 months
DEFINITION

Bacterial or viral infection


which affects mucosal lining
of the middle ear and mastoid
air cell system
ETIOLOGY

 < 5yrs; 50% in 1st year

 Boys > girls

 Cold climate, follows URI

 Nurseries/ overcrowding

 High number of siblings

 Parental smoking

 Non breast fed


ROUTES OF INFECTION:
Via Eustachian Tube-
Most common route

Causes of tubal obstruction:

 Upper respiratory infections


 Allergic sinusitis
 Nasal polyps
 DNS
 Adenoid hypertrophy
 Nasopharyngeal carcinoma
 Cleft palate
 Submucous cleft palate
 Down syndrome
 Barotrauma
ROUTES OF INFECTION
 Acute tubal blockage
 Absorption of ME gases
 Negative pressure in middle ear
 Retraction of TM
 Transudate/haemorrhage (AOM)

Via External Ear-


Perforated tympanic membrane

Via Blood Borne- uncommon


route
MICROBIOLOGY

 Viral (RSV, rhino, influenza)

 S. pneumoniae -(< 3 months)

 H. influenzae -(>1 year)

 M. catarrhalis

 S. pyogenes

 S. aureus
PATHOLOGY & CLINICAL FEATURES:
a) STAGE OF HYPERAEMIA
 Prolonged tubal obstruction
 Negative middle ear pressure
 Retraction of TM
 Vasodilation of submucosal tissues
 Hyperaemia and edema of mucosa

SYMPTOMS
 Fever,
 Ear pain/ fullness
 With or without hearing loss
PATHOLOGY & CLINICAL FEATURES:

SIGNS

 Retracted and congested TM with leash


of blood vessels along HOM and at
periphery (cart-wheel appearance),
landmarks preserved

 Tuning fork tests- CHL


PATHOLOGY & CLINICAL FEATURES
b) STAGE OF EXUDATION
Escape of inflammatory exudate from
dilated permeable capillaries- serum,
fibrin, red cells and polymorhoneutrophils

SYMPTOMS
• Marked earache(throbbing with disturbed
sleep)
• Hearing loss,
• High grade fever in infants
PATHOLOGY & CLINICAL FEATURES:

SIGNS
• TM thickened and landmarks obscured,
• Conductive hearing loss
• In infants- tenderness and edema over
mastoid cortex.
• Radiologically, diffusely clouded air cells
but without alterations of cell partitions
PATHOLOGY & CLINICAL FEATURES:
c) STAGE OF SUPPURATION
Formation of pus in middle ear and
to some extent in mastoid air cells

SYMPTOMS
 Excruciating pain,
 Deafness increases,
 Fever, toxicity increases

SIGNS
 TM is red and bulging to the point of
rupture,
 Mastoid tenderness present.
PATHOLOGY & CLINICAL FEATURES
d) STAGE OF RESOLUTION

TM ruptures(30% cases) with release


of pus and subsidence of symptoms.
Inflammatory process begins to
resolve. Resolution may even start
without rupture of TM

SYMPTOMS
 Earache relieved
 Fever subsides
 Ear discharge starts
PATHOLOGY & CLINICAL FEATURES

SIGNS

• Discharge in EAC
(mucopurulent/bloodstained),

• Perforation of pars tensa


COMPLICATIONS
e) STAGE OF COMPLICATION
If virulence of organism is high, or resistance of patient
is poor

i) EXTRACRANIAL
• Tympanic membrane
perforation
• Acute mastoiditis
• Facial nerve paralysis
• Labyrinthitis
• Acute petrositis
COMPLICATIONS

ii INTRACRANIAL

• Meningitis
• Extradural abscess
• Subdural empyema
• Sigmoid sinus
thrombosis
• Brain abscess
• Ottic hydrocephalus
DIAGNOSIS
 Otoscopy
 Colour –
 Opaque
 Yellow
 Blue
 Red
 Pink

 Position
 Bulging
 Retracted
DIAGNOSIS
 Mobility
 Normal,

 Hypomobile,

 Negative pressure

 Associated pathology
 Perforations,

 Cholesteatoma,

 Retraction pockets

 Head & Neck examination


DIAGNOSIS

 Audiogram

 Document CHL/SNHL

 Impedance Audiometry

 Radiology

 X-ray mastoid,

 HRCT temporal bone


TREATMENT

MEDICAL

 Bed rest

 Antibacterial therapy

1st line- amoxycillin(40 mg/kg/d in divided


doses for 10 days)

2nd line- as amoxycillin and clavulanic acid

Others 2nd generation cephalosporins -


cefaclor, erythromycin, sulf/trimethoprim
TREATMENT

MEDICAL

 Decongestants(oral/nasal)
To relieve ET oedema and promote ventilation of middle ear

 Analgesics and antipyretics

 Aural toilet
TREATMENT
SURGICAL
Myringotomy:
Indication:
 Unsatisfactory response to
antimicrobials
 Patient in acute pain with
bulging drum
 OM in immunodeficient,
newborn
 Suppurative complication like:
mastoiditis, labyrinthitis, facial
paralysis, meningitis(as
emergency procedure)
TREATMENT

SURGICAL

 Ventilation tube for recurrent


OM

 Adenoidectomy decrease the


frequency for recurrent OM
THANK YOU

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