Acute and chronic middle otitis prophylaxis

acute otitis media
pathogenesis
etiology
prophylaxis
diagnosis
management
treatment
prognosis
follow up

1. External ear diseases. Acute and chronic
otitis media. Otogenic intracranial
complications.

2. Othematoma
•Complaints of a painful spheric-
shape edema at the upper part of
the conchae
•Clinical signs : spheric-shape
edematous lump, fluctuated during
palpation. The skin above the lump
is blueish or sometimes with
hyperemia.
•Collection of blood between the
skin and the layers of cartilage
of the ear.
•Treatment: obligatory wide
dissection of hematoma with
evacuation of blood (clot) and
pressure dressing

3. Perichondritis
•Complaints of pain, edema, hyperemia.
Lobe is intact.
•In some cases there is a fluctuation.
•Inflammation of the perichondrium.
•There are two forms: catarrhal and
purulent.
•Treatment of catarrhal form is
conservative (physical therapy and
antibiotics).
•Treatment of purulent form is surgical
(dissection and damaged cartilage
resection).
•In severe cases perichondritis may lead
to pinna deformity.

4. Erysipelas
•Cause: Streptococcal infection
may enter the skin through minor
trauma or chap.
•Complaints of pain, edema, well-
demarcated rashof the pinna.
•Treatmentinvolves either oral or
intravenous antibiotics,
usingpenicillins,clindamycin,
orerythromycin. Physical treatment
can be used.

5. Eczema
•The most common predictor is
purulent discharge in patients with
chronic otitis media. Risk factors
include diabetes mellitus and allergy.
•There are two different types of
eczema:«dry» and«moist» eczema.
•The skin of the pinna, external
auditory canal and postauricular region
may be involved in a process.
•Symptoms: persistent itching (patients
damage the skin due to scratchingand
provoke the disease elongation)
•Treatment: ointments with
corticosteroids.

6. Furunculosis
•Causes: local (different traumas of
the external auditory canal) and
common (diabetes mellitus).
•There are two stages: infiltration and
suppuration.
•Symptoms: severe pain, that is made
much worse by movement of the
pinna or pressure on the tragus or
mouth opening and chewing.
•There is often no visible lesion during
infiltration stage but the introduction of
an aural speculum causes intense
pain.
•If the furuncle is larger, it will be seen
as a red swelling in the outer meatus.
At a more advanced stage, the
furuncle will be seen to be pointing or
may present as a fluctuant abscess.
•Treatment may be conservative
(infiltration stage) or surgical
(suppuration stage).

7. Otitis externa
•Disease may be acute, subacute
or chronic
•The infection may be bacterial
(Staphylococcus, Pseudomonas)
or fungal. The most severe cases
are usually caused by
Pseudomonas aeruginosa and
Proteus.
•Diffuse inflammation of the skin
lining the external auditory
meatus.

8. Fungal otitis externa (otomycosis)
•Complaints of itch, pain and,
sometimes, deafness.
•Clinical signs depend on the
etiological agent.
•Microbiological investigation of
the swab.
•Treatment: antifungal ointments,
physical treatment.

9. Malignant otitis externa
(necrotizing otitis externa)
•Soft tissue, auricular cartilage and bone
are involved in a pathology.
•The process may spread into the cranial
base and even to the other side.
•More common in elderly patients with
diabetes mellitus or immunodeficiency.
•Treatment: antibiotics, in case of resistant
to antibiotics or significant tissue damage
(surgical excision of the damaged
tissue).

10. Acute otitis media
acute inflammation of the middle-ear cavity (tympanic cavity, mastoid cells,
Eustachian tube)
Acute otitis media is about 25 % of acute diseases of ear, nose and throat
Infection pathways to tympanic cavity:
•Transtubarius
•Contact
•Haematogenic
Stages:
•Before tympanic membrane perforation
•After tympanic membrane perforation, purulent discharge
•Reparation stage

11. Pre-perforation stage
•Symptoms: pain, deafness,
tinnitus.
•Otoscope signs: redness of
the tympanic membrane (at
the beginning localized only
around the malleus handle,
after that radial and then total);
bulging of tympanic membrane
with loss of landmarks.

12. Perforative stage
After perforation or paracentesis purulent
discharge is decreasing or discontinued,
pain resolves, but the deafness and
tinnitus still present.
•Otoscopy: redness and fullness of the
drum, perforation with otorrhoea, which
will often be blood-stained. Profuse and
mucoid at first, later becoming thick and
yellow.

13. Treatment of acute otitis media
•The restoration of the Eustachian tube function(nasal
vasoconstrictors).
•Antibiotic therapy.
•Topical treatment (ear drops).
•At the stage of purulent discharge topical antibiotics
and corticosteroids.
•Paracentesis (miringotomy)–the incision at the
posterior-inferior part of the tympanic membrane.

14. Paracentesis
Indications: bulging of the tympanic
membrane at the stage of pre-perforative
acute purulent otitis media

15. Mastoiditis–acute purulent inflamation ot
the mastoid
•primary (posttraumatic, specific infections,
infectious disease)
•secondary (complication of acute otitis media
or the exaceboration of the chronic otitis)

16. Signs and symptoms of
mastoiditis
•Pain worsening
•Conductive hearing loss
•Local signs:
-redness of tympanic membrane,
-swelling and hanging of the posterior-
superior external auditory canal wall,
-purulent discharge( «reservoir»symptom)–
not obliratory,
-swelling in the postauricular region, with
obliteration of the sulcus
-pinna is pushed down and forward
•Radiological features:
-opacification of the mastoid air cells
-erosion of mastoid air cell bony septum may
be present in coalescent mastoiditis

17. Occasional features of acute mastoiditis
•Subperiosteal abscess over the mastoid
process.
•Bezold’s abscess —pus breaks through
the mastoid tip and forms an abscess in
the neck.
•Zygomatic mastoiditis —results in
swelling over the zygoma.

18. Types of surgical treatment
•Partial antromastoidectomy (mastoid trepanation for
pathological tissues removing and tympanic cavity
drainage)
•Expanded antromastoidectomy (trepanation of all
mastoid cells with the dura mater and/or sigmoid sinus
wall revision)
•Antrotomy (in case pf so called antritis in children
under 1 year old)

19. Antromastoidectomy

20. Indications to expanded
antromastoidectomy
•Intracranial complications (otogenic meningitis,
sigmoid sinus trombosis (otogenic sepsis), brain
abscess ( temporal lobe abscess or cerebellum
abscess, occurred as an outcome of acute purulent
otitis media)