Managemant of otitis media

Middle ear cleft

PathogenesisEustachian tube

obstruction

Negative Middle ear pressure

Transudation

Transudation

Collection of fluid in Middle ear (SOM, MEE, ME)

OTITIS MEDIA

Aim of Management

• To re-establish ventilation of Middle ear cleft

Incidence

• 5.2% General population• 9.4% Low socio-economic group

children• 0.67% High socio-economic

group children

Predisposing factors

• In children– Short horizontal

ET– Adenoids– Cleft palate– Weak Palate

– Allergy– Immunodeficiency– Day care school– Bottle feeding– Down’s syndrome

Symptoms

• Acute pain• Excessive crying• Irritability• Fever• Discharging ear

Diagnosis

• Proper cleaning of the ear canal

• Otoscopy

• Naso-pharyngoscopy

Pathogens

• S. Pneumoniae• H. Influenzae• M. Catarrhalis• Gram –ve bacilli• Respiratory Syncitial Virus

Role of Viruses

• Release of inflammatory mediators• Colonization of bacteria• Suppressive effects on host’s

immunity

Drug resistance

• Resistant pathogens 20 – 25%

• Beta lactamase producing strains 40 – 50%

• Regional prevalence

Antibiotic of choice

• Should be given for 10 – 14 days– Amoxycillin 30 mg/kg– Amoxycillin – Clavulinic acid 30 mg/kg– Cefaclor 30 mg/kg– Other fourth generation cephalosporins– Quinolones– Trimethoprime - Sulphonamide

Local therapy

• Ear drops – Betnesol N,Ofloxacin, Ciprofloxacin

• Nasal drops• Inhalations• Local application 1% G V• Wick soaked in Hydrocortisone +

Antibiotic ointment• Antifungal drops

Surgery for Otitis Media

• Myringotomy

• Tympanostomy tube

• Adenoid removal :

C.S.O.M

• Tubotympanic

• Attico-antral

• Cholesteatoma

Surgery for CSOM

• Myringoplasty

• Tympanoplasty

• Ossiculoplasty

• Canal wall up/down Mastoidectomy

Prevention

• Vaccines• To keeps ear dry• Not to use ear buds• Prompt treatment of URTI• Adenoids removal• Tympanostomy tubes