Acute otitis media

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Acute otitismedia
(AOM)

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OTITIS MEDIA : Definition
•Definition-Inflammation of middle ear cleft mucosa
•Classification(Senturia et al, 1980)
–Acute otitis media (upto 3 weeks)
–Subacuteotitis media ( 3 weeks-3 months )
–Chronicotitis media ( >3 months)

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ACUTE OTITIS MEDIA
Definition-acute inflammation of the MEC
•AOM vs ASOM
ASOM is one of the types of AOM
•AOM vs OME
Acute OME may follow AOM
Incidence
50% in the 1
st
year of life.
Remains high in the first 5 yrof life
Thereafter tails off and infrequent in teenagers.

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AOM : Aetiology
•Predisposing factors :
teething
poor sanitation & hygiene
ovecrowding
malnutrition
•Age –3 to 7 years
•Risk factors–rhinosinusitis, adenoid, ET
dysfunction, chest diseases

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AOM : etiology (contd..)
Viruses : causing URTI
Bacteriology:
–Streptococcus pneumoniae
–Hemophilus influenzae
–Moxerella catarrhalis
•Via Eustachian tube
ET in children –short, wide, horizontal
•Via a perforated TM
•Blood borne rarely

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Stages of AOM
Hyperemia
Exudation
Suppuration
Coalescence & surgical mastoiditis
Complication
Resolution

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Symptoms of AOM
•H/O preceding URTI,
•Depends on the stage
•Earache -cardinal symptom
•hearing loss with or without ear discharge
•Fever
•symptoms of complications
•Classical scenario–
cough and coldleading to earachefollowed by
blood stained discharge and decrease in the
severity of pain

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AOM : signs
•Depends on the stage
•red, bulgedtympanic
membrane. There maybe
perforation and discharge
in 1/3
rd
cases.
•85% of perforation in
anteroinferior quadrant,
15% in posteroinferior
quadrant.
•Signs of complications
•Reservoir sign Congested, bulged TM

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AOM : investigations
•Uncomplicated AOM –no investigations
•AOM with complication :
Hb TC DC
BS LFT RFT
Urine : R/ME
Plain X-ray mastoids
CT/MRI of temporal bone and surroundings

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AOM : MANAGEMENT
•Majority respond to Conservative management
•Rest, analgesic/ antipyretic
•Antibiotics ( Amoxycillin-drug of choice) X 7-10 days
•Antibiotic ear drops if perforation
•No roles of antihistamines and decongestant. Maybe
given for symptomatic relief.
•In treatment failures
–Repeat the 1
st
line antibiotics for 10 days more
–2
nd
line antibiotics
–Myringotomy / simple mastoidectomy

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AOM : surgical management
Rarely needed when :
conservative management fails
complication occurs
1.Myringotomy +/-VTI
2.Simple (Cortical, Schwartze ) mastoidectomy
3.Surgery for complication
Recurrent acute otitis media
Long term antibiotics
VTI
? Adenoidectomy

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Barotraumatic OM
•During or after descentfrom hills, aircraft
similar to AOM
•Due to ET block because of pressure differences
•Precautions
avoid flight during cold
frequent swallowing
? VTI

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•C:\Documents and
Settings\pawan\Deskt
op\aom1.JPG

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Mastoid
abcess

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Simple
mastoide
ctomy

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End result of
simple
mastoidectomy