Acute Otitis Media

A common cause of pain in children with complications like discharging ear.

1. [email protected] 1 ACUTE OTITIS MEDIA BRIG ANWAR UL HAQ 00923018513303

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9. DEFINITION Acute suppurative otitis media is defined as suppurative infection involving the mucosa of the middle ear cleft. By convention it is termed acute if the infection is less than 3 weeks in duration . [email protected] 10

10. MIDDLE EAR CLEFT 11

11. AETIOLOGY It occurs more easily: In children and infant In winter and spring After upper respiratory infection Measles, diphtheria, tonsillitis, chronic infection of sinuses and nasal allergy are other predisposing factors [email protected] 12

12. CAUSATIVE ORGANISM Streptococcus pneumoniae (30%) Haemophilus influenzae (20%) Moraxella catarrhalis (12%) Others: Streptococcus pyogenes Staphylococcus aureus Pseudomonas aerugenosa No growth in 18-20% cases Viruses: RSV, Influenza, Rhino & Adeno Virus [email protected] 13

13. ROUTES OF INFECTION [email protected] 14

14. EUSTACHIAN TUBE WAY It is the most common route CHILDREN ARE MORE SUCCEPTIBLE: ET in infants & young children Shorter Wider More horizontal Less stiff Large adenoids interfere with the opening of the tube Immune system not fully developed 15

15. EUSTACHIAN TUBE A small tube connecting Middle ear to the nasopharynx Functions Regulate and equalize Pressure of middle ear Prevent fluid Accumulating in the middle ear Protect from Nasopharyngeal infection 16

16. Children ET 10 ° Adults ET 45° ISTHMUS(narrowing of ET) junction of the cartilaginous and bony part. It is only present in adults. [email protected] 17 Shorter Wider More horizontal Less stiff

17. EXTERNAL ACCOUSTIC MEATUS WAY Associated with TM perforation Infection Tm trauma Tympanostomy tubes, Tympanometry , Myringotomy [email protected] 18 BLOOD BOURNE Uncommon route

18. EXTERNAL ACCOUSTIC MEATUS Associated with TM perforation Infection TM trauma Tympanostomy tubes Tympanotomy Myringotomy 19

19. CLINICAL FEATURES & PATHOPHYSIOLOGY 1. Stage of tubal occlusion 2. Stage of pre-suppuration 3. Stage of suppuration 4. Stage of Resolution Complication [email protected] 20

20. STAGE OF TUBAL OCCLUSION 21

21. SYMPTOMS 22

22. CLINICAL SIGNS TM retracted short handle of malleus No cone of light Prominent lateral process of malleus Conductive deafness in tuning fork test 23

23. STAGE OF PRE-SUPPURATION [email protected] 24

24. C/F EARACHE Deafness Tinnitus High fever (children) Cartwheel appearance of TM [email protected] 25

25. STAGE OF SUPPURATION [email protected] 26

26. C/F EXCRUCIATING PAIN Deafness Fever 102-103 °F (Children) Vomiting Convulsions X ray mastoid: clouding of air cells due to exudate. [email protected] 27

27. STAGE OF RESOLUTION Earache relieved General condition Temp decreases WBC Count Improves [email protected] 28

28. STAGE OF COMPLICATION Intratemporal (within temporal bone) Acute mastoiditis Facial paralysis Labyrinthitis Petrositis Intracranial : Extradural abscess Subdural abscess Meningitis Brain abscess Lateral sinus thrombophlebitis Otic hydrocephalous [email protected] 29

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30. TREATMENT Control infection Local therapy Treat related disease 31

31. CONTROL INFECTION: ANTIBIOTICS Arrest & reverse inflammation Prevent suppuration and perforation Relieve symptoms, Hasten resolution Reduce risk of complications AMPICILLIN (50 mg/kg/day in 4 divided doses) AMOXICILLIN (40 mg/kg/day in 3 divided doses) 32

32. LOCAL THERAPY BEFORE PERFORATION Relieve earache control inflammation Prevent perforation(spontaneous) Decongestant nasal drops(ephedrine, oxymetazoline, xylometazoline) Oral nasal decongestant (pseudoephedrine) Analgesic & antipyretic(paracetamol) [email protected] 33

33. MYRINGOTOMY Myringotomy   Tiny incision eardrum   Relieve pressure Drain  pus  from the  middle ear . A tympanostomy tube   Keep the middle ear aerated Prevent re accumulation of fluid. 34

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35. MYRINGOTOMY INDICATIONS : Symptoms are not relieved by antibiotics TM bulges significantly TM perforation is too small Incomplete resolution Persistent effusion beyond 12 weeks 36

36. LOCAL THERAPY AFTER PERFORATION Clear external acoustic canal toilet Control infection Repair TM 37

37. TREAT RELATED DISEASE Chronic rhinitis Chronic sinusitis Chronic tonsillitis Adenoid vegetation 38

38. DIFFERENTIAL DIAGNOSIS MEATAL FURUNCLE No hearing loss TM is normal ACUTE MYRINGITIS Severe earache Hearing loss is slight TM: hyperemia and bulla forms After influenza or zoster infection [email protected] 39

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