Definition
Otitis Media
* Otitis Media is defined as an inflammatory condition of the
middle ear due to microorganisms
* Common childhood diseases
Types of Otitis Media:
1. Acute Otitis Media
2. Chronic suppurative otitis media
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Acute otitis Media
Acute otitis media (AOM) is an acute inflammation of
middle ear
Characterized by the presence of fluid in the middle ear and
inflammation of the mucosa lining the middle ear space.
Fluid may persist in the middle ear for weeks to months after
appropriately treated AOM and is termed otitis media with
effusion
Risk factors of AOM
• Age. Infants and toddlers are more severely affected
• Exposure to group day care with subsequent increase in
respiratory infections.
• Lack of breast feeding
• Malnutrition
• Immune deficiency.
Etiology of AOM
• Can be due to viral or bacterial infection
• very common in children under 3 years
Most commonly associated pathogens:-
• Streptococcus pneumoniae
• Haemophilus influenzae
• Moraxella catarrhalis
Clinical presentation
• fever
• Rapid onset of ear pain
• Crying and irritability
• ear discharge (otorrhoea)
• Feeding problem
• Crying
Complications of AOM
– Meningitis
– Brain abscess
– Chronic suppurative OM
– Perforation of the TM
– Tympanosclerosis which May lead to conductive hearing
loss.
– Mastoiditis
Complications are more common and serious in children
with:-
1. Malnutrition
2. Immunodeficiency
3. Ear malformations
Diagnosis of AOM
History
- Ear pain
- Fever
- Fussiness
Examination
- Otoscopy is the standard diagnostic method of AM
- cardinal signs of inflammation
- bulging of the Tympanic membrane
- perforated tympanic
Tympanocentesis
- aspiration of the contents of the middle ear
- Culture and sensitivity
Treatment of AOM
Anti-biotic of Choice
• Amoxicillin cap PO for 5 days
- Children: 30 mg/kg x 3 times daily (max. 3 g daily)
- Adults: 1000 mg x 3 times daily
amoxicillin/clavulanic acid (co-amoxiclav) PO for 5 days
For penicillin-allergic patients:
- azithromycin PO
Paracetamol tab
- 16 years and adult: 300 mg every 4 to 6 hours
- (max. 4 g daily), for 1 to 3 days
- < 12 yrs 15mg/kg, paramol syrup 120mg/ml
Chronic suppurative Otitis Media
“CSOM”
Chronic Suppurative Otitis Media
• CSOM is a chronic inflammation of the middle ear and
mastoid cavity
• Progresses from AOM
• presents with recurrent ear discharges (otorrhoea)through a
tympanic perforation.
• CSOM) is one of the leading causes of preventable disabling
hearing impairment
Risk factors of CSOM
• Inadequate Anti-biotic therapy with AOM
• Poor access to medical care
• Drug resistant s.aurius
• Poor nutritional status
• Weakened immune system
• Low socio economic status
Causative agents
The two most commonly cause CSOM are :
• Pseudomonas aeruginosa
• Staphylococcus aureus
• E.coli
Clinical Presentation of CSOM
• Headache
• Ear pain
• Vertigo
• Crying and feeding difficulties in children
• Painless mucoid otorrhoea
• Hearing loss
• Facial palsy
DIAGNOSIS OF CSOM
• Medical History
- headache, no fever
- ear pain suggests eardrum perforation in CSOM
- ear discharge
- Infants crying when the ear is touched
- Hx of chronic ear discharge
- CSOM produces painless mucoid otorrhoea without fever
Ear Examination
- Otoscopy
- tympanic perforation with discharge
Culture and sensitivity
Complications of CSOM
Erosion of the walls of the middle ear
Followed by facial nerve damage & paralysis
Labyrinthitis
Vertigo
Haematogenous spread of infection to the brain
- Meningitis
- Brain abscess
• CSOM-associated hearing loss
Treatment of CSOM
Medical Treatment
Aural toilet
this procedure is contra-indicated in case of any of the
followings:
. severe ear pain
. recent surgery or
. any perforation
Topical treatment
• topical ofloxacin 0.3% ear drop, 2x daily, 7 days or
• Ciprofloxacin ear drops 0.3% drops, twice daily, 7 days
Oral / Topical
• clindamycin suspension + neomycin-polymyxin-steroid otic
drops
• Parenteral antibiotic of choice
- ceftazidime 2 g/vial given at 30 mg/kg every 8 hours or 2 g
daily for 14 days
Parenteral/oral antibiotic option:
- gentamicin inj IV 2mg/kg q 8 hrs 8 h, 14 days +
- clindamycin suspension for 2 weeks
Surgical Treatment
- Repairing perforated tympanic membrane
Otitis externa
Definition of OE:
• Otitis externa is an infection and inflammation of the external
auditory canal.
Classification od OE:
1. localized otitis externa
- May occur as a pustule or furuncle that is visualized in the
canal
- Presents as Edema, swelling, and erythema of the canal wall
• Malignant otitis externa
- Associated with severe pain and tenderness of the tissues
around the pinna
- pus may be present in the canal.
Etiological agents
• staphylococcal.
• Pseudomonas aeruginosa
- commonly causes swimmer’s ear & malignant
otitis ext.
Clinical presentation
• Edema of external canal
• Swelling of the canal
• erythema of the canal wall
• Fever
• Malaise
• Headache
• severe pain and tenderness on the pinna
Diagnosis of OE
• Clinical diagnosis
• Hx and physical examination
- S & S of OE
In cases of Acute localized otitis
- edema, swelling, and erythema of the canal wall
In cases of Malignant otitis externa
- severe pain, tenderness of the tissues around the pinna and +
pus in the canal.
Treatment of OE
• Localized OE:
- gentle cleansing and irrigation of the external canal.
- topical ofloxacin 0.3% ear drop, 2x daily, 7 days
- Ciprofloxacin tab PO q 12 h for 7 days
Malignant otitis externa
- 4-6 weeks of treatment
- Antipseudonals agents should be used
- Ciprofloxacin inj 400 mg IV q12h or
- Ciprofloxacin tab PO q 12 h 4-6 weeks
Or
- Imipenem inj 0.5 g IV q 6 h for 4-6wk
Or
- Cefepime inj 2 g IV q 12 h for 4-6wk
Thank You
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