otitis-media.ppt

Ear infection

1. OTITIS MEDIA
Definition: inflammation of the middle ear
Very common in children but can occur in any age

2. Subtypes of OM
Acute otitis media (AOM)
Otitis media with effusion (OME)
Chronic suppurative otitis media
(CSOM)
Adhesive otitis media

3. Acute otitis media (AOM)develops
suddely due to a (viral or bacterial)upper
respiratory infectionwith blockage of
theEustachian tube.
The most common bacteria found in this
case areStreptococcus
pneumoniae,Haemophilus influenzae,
andMoraxella catarrhalis.

4. Otitis media with effusion (OME), also
called serous or secretory otitis media
(SOM) or GLUE ear.
itis simply a collection of fluid that occurs
within the middle ear space due to the
negative pressure produced by altered
Eustachian tube function.
This can occur purely from a viral URI, with
no pain or bacterial infection, or it can
precede and follow acute bacterial otitis
media.

5. Fluid in the middle ear sometimes
causes conductive hearing impairment,.
Over weeks and months, middle ear
fluid can become very thick and glue-
like (thus the name glue ear).

6. Chronic suppurative otitis media involves a
perforation (hole) in the tympanic membrane and
active bacterial infection within the middle ear
space for several weeks or more.
There may be enough pus that it drains to the
outside of the ear (otorrhea), or thepurulence
may be minimal enough to only be seen on
examination using a binocular microscope.
This disease is much more common in persons
with poor Eustachian tube function.
Hearing impairment often accompanies this
disease.

7. Adhesive otitis media –if fluid is
present within the ear for a protracted
period, the tympanic membrane retracts
and will adhesive to the middle ear, and
adhesive otitis media may develop.

8. Causative organisms
Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis
Group A Streptococcus
Staph. aureus
Pseudomonas aeruginosa
RSV

9. RISK FACTORS
Upper Respiratory Infections
Eustachian tube malformations
Allergies
Craniofacial abnormalities (cleft palate)
Smoking
Cholesteatoma

10. Pathophysioloy
This problem mainly deals with Eustachian
tube dysfunction.
Otitis Media usually follows an URI in which
there is edema of the eustacian tube, leading
to blockage. Stasis of these middle ear
secretions lead to infection and irritation
Other factors: allergic rhinitis, nasal polyps,
adenoidal hypertrophy

11. Causative factors (mainly URI)
Edema in the Eustachian tube
Blockage in the Eustachian tube
Stasis of middle ear secretions
Irritation
Inflammation
Signs and symptoms

12. SIGNS & SYMPTOMS
Otalgia –throbbing pain
Otorrhea
Headache
Fever
Irritability
Loss of appetite
Vomiting
Hearing loss
Tinnitus
Vertigo

13. Diagnostic measures
History collection
Physical examination
Pneumatic otoscopy –gold standard
mearsure
Tympanometry
Reflectometry
Mastoid x-rays

14. The classic description for Otitis Media is
an erythematic, opaque, bulging tympanic
membrane
Pneumatic Otoscopy: decreased tympanic
membrane mobility
Spectral Gradient Acoustic
Reflectometry: measures the condition
of the middle ear by assessing the
response of the TM to a sound stimulus.
Equivalent to tympanometry for diagnosing
middle ear effusions

15. Management
Antibiotics –assess for allergies and
hypersensitivity reactions, inform not to
miss any doses
Analgesics –do not drive after taking
codeine, inform to take increase fluid
Antihistamines -chlorpheniramine
Decongestants -pseudoephedrine

16. Analgesics –acetaminophen, ibuprofen
Amoxicillin (drug of choice): 20-40
mg/kg/day tid for 10-14 days or,
Augmentin: 45 mg/kg/day bid for 10-14
days
Auralgan: analgesic/adjunct for ear pain
2-4 drops tid

17. 2
nd
Line Treatment Regimen
Cefzil (cefprozil)
Pediazole ( erythromycin/sulfisoxazole)
Bactrim (trimethoprim/sulfamethoxazole
These medications are used as
secondary agents if the primary
antibiotic has failed after 10 days and
the symptoms persists.

18. Surgical management
Tympanocentesis & myringotomy
Tympanoplasty with mastoidectomy
Tympano –ossiculoplasty
Resection of the cholesteatoma

19. Tympanocentesis & myringotomy:
involves puncturing the tympanic membrane
and aspirating middle ear fluid to relieve
pressure. Only used if the primary and
secondary line treatment fail.

20. COMPLICATIONS
Hearing loss: conductive, sensorineural, mixed)
Acute mastoiditis
Chronic perforation of the TM
Tympanosclerosis
Cholesteatoma
Chronic suppurative OM
Facial nerve paralysis

21. Complications
Intracranial complications
Bacterial meningitis
Epidural abscess
Brain abscess
Hydrocephalus

22. Prevention
Most common in children so adequate
breast feeding should be given
OM follows a respiratory tract infection,
so treat the respiratory infections as
soon as possible
Day care centers is considered as a
source, so proper follow up should be
maintained.
Health awareness programme in day
care centers, schools can be helpful