Otitis Media.pptx ..

otitis media

1. ANATOMY OF EAR The Human ear is divided in to three main parts Outer Ear Middle Ear Inner Ear

2. The Human Pinna and its landmarks

3. OTITIS MEDIA is defined as an inflammation of the middle ear i.e., the area between the tympanic membrane and the inner ear. OTITIS EXTERNA Swimmer's ear or Otitis externa usually develops in ears that are exposed to moisture. Sometimes, in a person with a middle ear infection (Otitis media) pus collected in the middle ear can drain into the ear canal through a hole in the eardrum, causing Otitis extern

4. PATHOGENESIS Infection mostly occurs in infants and children because of the shorter and more horizontal orientation of the Eustachian tube which allows reflux from the pharynx.

5. ETIOLOGY BACTERIA L S . pneumonia. Incidence: 38 % Causes more severe cases with Otalgia and fever. H . influenza . Incidence : 27 % More often associated with eye redness and discharge. Moraxella catarrhalis. Incidence : 10%

6. VIRAL 35% of influenza A 18% of influenza B 28% of parainfluenza type 1 10% of parainfluenza type 2 33% of parainfluenza type 3 30% of adenovirus FUNGAL Aspergillus or Candida

7. SIGNS& SYMPTOMS Crying, Irritability, Tugging or pulling on the ear . Ear pain Rhinitis Cough Ear drainage Hearing loss Fever

8. COMPLICATIONS Acute mastoiditis – infection of the mastoid process . Cholesteatoma – cystic lesion within the middle ear . Hearing loss. Tympanic membrane perforation . Myringitis Brain abscess.

9. CHOLESTEATOMA

10. RUPTURED TM

11. MYRINGITIS - BLISTERS ON TM

12. TYPES OF OTITIS MEDIA 1-Acute Otitis Media Otitis Media without effusion Serous Otitis Media 2-Chronic Otitis Media Tubotympanic disease Atticoantral disease

13. ACUTE OTITIS MEDIA Most common type seen in children Occurs when there is fluid in the middle ear Occurs with inflammation of the TM May be bacterial or viral Phases of Acute Otitis Media 1st phase - exudative inflammation lasting 1–2 days, fever, severe pain (worse at night), muffled noise in ear, deafness, sensitive mastoid process, ringing in ears (tinnitus) 2nd phase - resistance lasting 3–8 days. Pus and middle ear exudate discharge spontaneously decrease and afterwards pain and fever also decrease. This phase can be shortened with topical therapy. 3rd phase - healing phase lasting 2–4 weeks. Aural discharge dries up and hearing becomes normal.

14. TYPES OF ACUTE OTITIS MEDIA Otitis Media without effusion Inflammation of the TM with fluid in the middle ear May cause myringitis (cyst on TM) Present during the beginning stages of Otitis media Formation of painful blisters on the eardrum (tympanum ). Serous Otitis Media or Otitis Media with effusion Inflammation of the TM with fluid in the middle ear Caused by vacuum created by malfunction of the Eustachian tube Can cause hearing impairment and delayed speech in children Since infants cannot hear they cannot learn how to talk

15. SEROUS OTITIS MEDIA

16. CHRONIC OTITIS MEDIA Occurs when the middle ear infection persists and causes significant hearing loss and damage to the middle ear May involve a perforation of the TM Pus may drain through the ear canal – a concept called otorrhea Chronic Otitis Media Types Tubotympanic disease Atticoantral disease

17. OTORRHEA

18. Tubotympanic Disease Called safe disease. The infection is limited to the mucosa and the antero inferior part of the middle ear cleft. This disease does not have any risk of bone eros ion. Atticoantral Disease Called unsafe disease. Fatal intra-cranial and extra-cranial complications can occur. Disease spreads by erosion of the bony wall of the attic.

19. DIAGNOSIS CT scan of the temporal bones MRI is more helpful in depicting fluid collections Tympanometry may help diagnosis OM with effusion

20. DIAGNOSTIC CRITERIA FOR OM Bulging TM Retracted TM Impaired mobility of the TM Erythematous TM Purulent otorrhea Opacification of the TM

21. NORMAL TM and ACUTE OTITIS MEDIA-TM

22. TREATMENT WITH PENICILLIN Antibiotic duration 1. Age under 6 years First Line 1 . Amoxicillin 80-90 mg/kg/day PO divided twice daily for 10 days (7 days if age>6) 2 . If Penicillin Allergy, use Macrolide (e.g. Azithromycin) 2. Second Line (10 day course) 1 . Amoxicillin or Augmentin 90 mg/kg/day divided twice daily for 10 days 2 . Zinacef 30 mg/kg/day divided twice daily for 10 days 3 . Cefprozil (Cefzil) 30 mg/kg/day divided twice daily for 10 days 4. Omnicef 14 mg/kg/day divided one to two times daily for 10 days 5. Cefpodoxime 30 mg/kg once daily for 10 days

23. 3. Third Line 1. Strongly consider Tympanocentesis for bacterial culture 2. Ceftriaxone (Rocephin) 50 mg/kg IM daily for 3 days 3. Clindamycin 30-40 mg/kg/day divided four times daily for 10 days. TREATMENT IF ALLERGIC TO PENICILLIN 1 . Consider Tympanocentesis 2 . Clindamycin 30-40 mg/kg/day ( max 1800 mg) divided four times daily for 10 days 3 . Macrolide antibiotics (High bacterial resistance rate) Erythromycin Clarithromycin Azithromycin

24. Epistaxis Is defined as bleeding from the nostril, nasal cavity, or nasopharynx. Nosebleeds are due to the bursting of a blood vessel within the nose. This may be spontaneous or caused by trauma. Nosebleeds can be divided into 2 categories, based on the site of bleeding: Anterior (in the front of the nose) Posterior (in the back of the nose). 

25. CAUSES LOCAL CAUSES Trauma, Mucosal Irritation, Septal Abnormality, Inflammatory Diseases, Tumors. SYSTEMIC CAUSES Blood Disorders, Arteriosclerosis. IDIOPATHIC (UNKNOWN) CAUSES .

26. MANAGEMENT DIRECT PRESSURE Sit patient upright, leaning slightly forward. Patient squeezes the bottom part of the nose (NOT the bridge of the nose) for 10-20 minute Monitor HR and BP If bleeding has stopped after this time inspect the nose using a nasal speculum and consider cautery.

27. Cauterisation Apply a silver nitrate cautery stick for 10 seconds working from the edge and moving radially Never both sides of the septum at the same session . Cream (Naseptin) Cautery and cream are equally effective for the treatment of epistaxis. Application of a cream-based treatment may initially be easier and more practical, particularly in children

28. Anterior packing Nasal tampon Absorbs blood, swells and the tight fit reduces flow. Lubricate the tampon with Jelly or Naseptin cream Secure the tampon thread to the cheek Pack the other side as well. Packs are generally left in place for 24 hours. Posterior Packing packing and a balloon catheter can be useful Opiate analgesics to relieve discomfort and reduce elevated blood pressure due to posterior pack. Ligation of the sphenopalatine artery endoscopically .

29. CONCLUSION Non-surgical treatments are effective for control of most cases of nosebleeds. Holding Pressure Nasal Packing Chemical Cautery Use Of Nasal Decongest Sprays For persistent epistaxis Surgical Ligation More recently, endoscopic approaches to the sphenopalatine artery and ethmoid arteries have been utilized.

30. DEVIATED NASAL SEPTUM Failure of the nasal septum to be in the center of the nose and divide the nasal passages evenly. Deviation  of the nasal septum may be congenital (present at birth) or acquired (occur later). The major problem it causes is airway obstruction .

31. TYPES OF NASAL SEPTUM Normal Nasal Septum S-shaped Nasal Septum C-shaped Nasal Septum Displaced lower edge of Septal C artilage

32. TREATMENT Submucous resection of the Nasal Septum (SMR) or Septoplasty