Nihar GuptaSMS&R

Roll No:38

ACUTE SUPPURATIVEOTITIS MEDIA

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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.

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MIDDLE EAR CLEFT

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AETIOLOGYIt 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

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CAUSATIVE ORGANISM

Streptococcus pneumoniae (30%) Haemophilus influenzae (20%) Moraxella catarrhalis (12%) Others: Streptococcus pyogenes,

Staphylococcus aureus and Pseudomonas aerugenosa

No growth in 18-20% cases Viruses: RSV, influenza, rhino &

adeno virus

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ROUTES OF INFECTION

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EUSTACHIAN TUBE WAY

It is the most common route. CHILDREN ARE MORE SUCCEPTIBLE:1. Eustachian tube in infants

and young children is shorter, wider, more horizontal and less stiff.

2. Large adenoids can interfere with the opening of the tube

3. Immune system is not fully developed

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EUSTACHIAN TUBE

A small tube connecting the middle ear to the nasopharynx

FUNCTIONS1. Regulate and equalize pressure of

middle ear2. Prevent fluid from accumulating

in the middle ear3. Protect from the nasopharyngeal

infection

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•In children ET is at an angle of 10° while in adults it is at an angle of 45°.•ISTHMUS is a narrowing in the ET, at the junction of the cartilaginous and bony part.•It is only present in adults.

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EXTERNAL ACCOUSTIC MEATUS WAY

Associated with TM perforation Eg. TM trauma, insertion of

tympanostomy tubes, tympanometry, myringotomy

BLOOD BOURNE This is an uncommon route

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CLINICAL FEATURES &PATHOPHYSIOLOGY The disease runs through the

following stages:

1. Stage of tubal occlusion2. Stage of pre-suppuration3. Stage of suppuration4. Stage of resolution or complication

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STAGE OF TUBAL OCCLUSION

Mucosa: Hyperemia, Swelling

Eustachian tube is occluded

Intratympanic pressure ↓

Air ↓ fluid ↑

Tympanic membrane retracts

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C/F

TM RETRACTS

TinnitusEar fullness

EaracheHearing loss

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CLINICAL SIGNS

TM retracted1. Foreshortened

handle of malleus2. No cone of light3. Prominent lateral

process of malleus

Conductive deafness in tuning fork test

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STAGE OF PRE-SUPPURATION

Bacteria invade tympanic cavity

Hyperemia

Inflammatory exudate

Congested TM

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C/F

EARACHE Deafness Tinnitus High fever

(children) Cartwheel

appearance of TM

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STAGE OF SUPPURATION

Pus increases

TM is compressed, ischemic

TM is tense and bulges

TM necrosis

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C/F EXCRUCIATING PAIN

Deafness Fever 102-

103°F (Children)

Vomiting Convulsions X ray mastoid:

clouding of air cells due to exudate.

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STAGE OF RESOLUTION

Follows TM perforation

Earache relieved at once

General condition(temp, wbc count) improves

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STAGE OF COMPLICATION

Intratemporal(within the confines of temporal bone)

1. Acute mastoiditis2. Facial paralysis3. Labyrinthitis4. Petrositis

Intracranial:1. Extradural

abscess2. Subdural abscess3. Meningitis4. Brain abscess5. Lateral sinus

thrombophlebitis6. Otic

hydrocephalous

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TREATMENT Control infection Local therapy Treat related disease

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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)

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LOCAL THERAPY

BEFORE PERFORATION Relieve earache & control

inflammation:1. Decongestant nasal

drops(ephedrine, oxymetazoline, xylometazoline)

2. Oral nasal decongestant (pseudoephedrine)

3. Analgesic & antipyretic(paracetamol)

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MYRINGOTOMY

Myringotomy is a surgical procedure in which a tiny incision is created in the eardrum to relieve pressure caused by excessive buildup of fluid, or to drain pus from the middle ear.

A tympanostomy tube is inserted into the eardrum to keep the middle ear aerated for a prolonged time and to prevent reaccumulation of fluid.

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MYRINGOTOMY

INDICATIONS :1. Symptoms are not relieved by

antibiotics2. TM bulges significantly3. TM perforation is too small4. Incomplete resolution5. Persistent effusion beyond 12

weeks

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LOCAL THERAPY

AFTER PERFORATION1. Clear external acoustic canal-Ear

toilet2. Control infection3. Repair TM

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TREAT RELATED DISEASE

Chronic rhinitis Chronic sinusitis Chronic tonsillitis Adenoid vegetation

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DIFFERENTIAL DIAGNOSIS

MEATAL FURUNCLE1. No hearing loss2. TM is normal ACUTE MYRINGITIS1. Severe earache2. Hearing loss is slight3. TM: hyperemia and bulla forms4. After influenza or zoster infection

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THANK YOU