Acute Suppurative Otitis Media

ASOM from Dhingra

1. Acute Suppurative Otitis Media Acute inflammation of middle ear by pyogenic organisms

2. Aetiology Infants and children of lower socioeconomic group Follows viral infection of upper respiratory tract

3. Routes of Infection Via eustachian tube Via external ear Blood borne

4. Predisposing Factors Recurrent attacks of common cold, upper respiratory tract infections, exanthematous fevers Infections of tonsils or adenoids Chronic rhinitis and sinusitis Nasal allergy Tumours of nasopharynx , packing of nose, epistaxis Cleft palate

5. Bacteriology Streptococcus pneumoniae Haemophilus influenzae Moraxella catarrhalis Streptococcus pyogenes Staphylococcus aureus Pseudomonas aeruginosa

6. Pathology and Clinical Features Stage Pathology Symptoms Signs Tubal Occlusion Oedema & hyperaemia of nasopharyngeal end of tube Retraction of TM Deafness Earache TM retracted Handle of maleus more horizontal Lateral process of maleus prominent Loss of light reflex Conductive deafness

7. Stage Pathology Symptoms Signs Presuppuration Pyogenic organsims invade tympanic cavity Hyperaemia of lining Inflammatory exudate in middle ear TM congested Earache Throbbing Disturbs sleep Adults – deafness & tinnitus Children – Fever Congestion of pars tensa Cartwheel appearance of TM Conductive deafness Suppuration Pus in middle ear TM bulges out Severe earache Deafness increases Fever Vomiting Convulsions TM Red Bulging Loss of landmarks Tenderness over mastoid antrum

8. Stage Pathology Symtoms Signs Resolution TM ruptures Release of pus Subsidence of symptoms Earache relieved Fever subsides EAC may contain blood-tinged discharge Later becomes mucopurulent Complication Virulence of organism is high Resistance of host is poor Acute mastoiditis Labyrinthitis Subperiosteal abscess Facial paralysis Petrositis Extradural abscess Meningitis Brain abscess Lateral sinus thrombophlebitis

9. Treatment Antibacterial therapy Ampicillin 50mg/kg/day in 4 divided doses Amoxicillin 40mg/kg/day in 3 divided doses Decongestant nasal drops Ephedrine (1% in adults & 0.5% in children) Oxymetazoline Xylometazoline Oral nasal decongestants Pseudoephedrine 30mg twice daily

10. Analgesics & antipyretics Paracetamol Ear toilet Dry-mopping Dry local heat Relieves pain Myringotomy Drum is bulging; acute pain Incomplete resolution despite antibiotics; persistent conductive deafness Persistent effusion beyond 12 weeks

11. Acute Necrotising Otitis Media Variety of ASOM seen in children suffering from exanthematous fevers Caused by B- haemolyticus streptococci Rapid destruction of entire tympanic membrane Profuse otorrhea Healing followed by fibrosis or secondary acquired cholesteatoma

12. Treatment Antibacterial therapy for a least 7-10 days Cortical mastoidectomy Medical treatment fails to control Condition gets complicated by acute mastoiditis

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