acute suppurative otitis media
DESCRIPTION
middle ear disorder-ENTTRANSCRIPT
ACUTE SUPPURATIVE OTITIS MEDIA
BY:NEHIL NIGAM
CLASSIFICATION OF OTITIS MEDIA
Otitis media
suppurative
acute Chronic
Tubotympanic(safe
type)
Atticoantral (unsafe
type)
Non-suppurative
Acute Chronic
adhesive
OTITIS MEDIA
Inflammation of the middle ear.
Middle ear implies middle ear cleft, which includes:
Eustachian tubeMiddle earAtticAdditusAntrumMastoid air cells
Anatomy of ear
AETIOLOGY
•More common especially in infants and children of lower socioeconomic group.
•The disease typically follows viral infection of upper respiratory tract:
RhinovirusRSVInfluenza virusenterovirus
BACTERIOLOGY
•Streptococcus pneumoniae•Haemophilus influenzae•Moraxella catarrhalisAlso,•Streptococcus pyogens•Staphylococcus aureus•Pseudomonas aeruginosa
ROUTES OF INFECTION1. Via Eustachian tube.
2. Via external ear.
3. Blood-borne.
Ant. Cranial fossa
Middle cranial fossa
Posterior cranial fossa
Jugular fossa
Sphenoid sinus
nasopharynx
Understanding position of Eustachian tube:
Normal functions of Eustachian tube
• Normally Eustachian tube is closed.• Functions:
Ventilation and thus regulation of middle ear pressure
Protection against
Nasopharyngeal reflux of nasopharyngeal
sound pressure secretions
Clearance of middle ear secretions
Via Eustachian tube•Most common route.•In infants and young children, tube is:
Shorter Wider
More horizontal
Via External ear•Due to traumatic perforation of tympanic membrane.
Blood-borne
PREDISPOSING FACTORS
Anything that interferes with the normal functioningof Eustachian tube, predisposes to middle earinfection, like:1. Recurrent attacks of common cold2. URI3. Measles, diphtheria or whooping cough4. Infection of tonsils and adenoids5. Chronic rhinitis6. Sinusitis7. Nasal allergy8. Tumors of nasopharynx, packing of nose or
nasopharynx for epistaxis9. Cleft palate.10.Down syndrome
Acute tubal blockage
Absorption of middle ear gases
Negative pressure in middle ear
Transudate in middle ear/ haemorrhage
Prolonged tubal blockage
OME (thin watery or mucoid discharge)
Atelactatic ear/perforation
Retraction pocket/ cholesteatoma
Erosion of incudostapedial joint
PREDISPOSI
NG FACTORS
(A) incomplete unilateral cleft of the lip, (B) unilateral cleft of the lip, alveolus, and palate, (C) bilateral cleft of the lip, alveolus, and palate, (D) isolated (median) cleft palate.
Tensor veli palatini muscle
Torus tubarius
PATHOLOGY AND CLINICAL FEATURES
STAGE OF TUBAL OCCLUSION
STAGE OF PRESUPPURATION
STAGE OF SUPPURATION
STAGE OF RESOLUTION
STAGE OF COMPLICATIONS
STAGE OF TUBAL OCCLUSION
PATHOLOGY SYMPTOMS SIGNS
Tubal blockage due to edema and hyperemia of nasopharyngeal end of Eustachian tube
Deafness Earache
NOT markedGenerally no fever
T.M. retractedHandle of malleus – horizontalProminence of lateral process of malleusLoss of light reflexTuning fork test- conductive deafness
Normal tympanic membrane
As the drum becomes increasingly retracted, it drapes over the ossicular chain, and the incus and stapes head may be outlined.
STAGE OF PRESUPPURATION
PATHOLOGY SYMPTOMS SIGNS
Pyogenic organisms invade tympanic cavity
Hyperemia of lining of tympanic cavity
Inflammatory exudate in middle ear
Tympanic membrane-congested
Marked throbbing headacheAdults – deafness and tinnitusChildren – high degree of fever and restlesness
Congestion of pars tensaCartwheel appearance of pars tensaLater- congestion of whole tympanic membraneTuning fork test- conductive deafness found
Normal Congested tympanic membrane
STAGE OF SUPPURATIONPATHOLOGY SYMPTOMS SIGNS
Marked pus formation in middle ear
May extend upto mastoid air cells
Excruciating earache
Deafness increases
Children- fever 102-103 degree F
Vomiting
Convulsions
Redness and bulging in tympanic membrane
handle of malleus- engulfed
Yellow spot on T.M. where rupture imminent
X-ray of mastoid- clouding of air cells
STAGE OF RESOLUTIONPATHOLOGY SYMPTOMS SIGNS
T.M. – ruptures with release of pus
Hence subsidence of symptoms
Earache relieved
Fever – down
EAC- blood tinged discharge may be present
Small perforation in anteroinferior quadrants of pars tensa
Hyperemia of T.M. subsides- normal colour and landmarks
STAGE OF COMPLICATIONS
Acute MastoiditisPetrositis GRADENIGO’S
SYNDROMESub-periosteal abscessFacial paralysisLabyrinthitisExtradural abscessMeningitisBrain abscess or lateral sinus thrombophlebitis
• Gradenigo's syndrome, also called Gradenigo-Lannois syndrome and petrous apicitis
is a complication of otitis media and mastoiditis involving the apex of the petrous temporal bone.
SYMPTOMS: triad of symptoms consisting of periorbital unilateral pain related to trigeminal
nerve involvement, diplopia due to sixth nerve palsy (Dorello’s
canal) persistent otorrhea, associated with bacterial
otitis media with apex involvement of the petrous part of the temporal bone (petrositis).
retroorbital pain due to pain in the area supplied by the ophthalmic branch of the trigeminal nerve (fifth cranial nerve),
Bell's palsy caused by invo lvement of the facial nerve (seventh cranial nerve), and
otitis media.Other symptoms can include photophobia, excessive
lacrimation, fever, and reduced corneal sensitivity.The syndrome is usually caused by the spread of an infection into the petrous apex of the temporal bone.
TREATMENT:Mastoid exploration.Exeneration of the cell tracts leading to petrous apex
TREATMENT
Acute otitis media
Antibacterial therapy
Earache and fever
Complete resolution
Good response
Persistent fluid but earache and
fever abate
Complete resolution
(no effusion)
Persistent effusion
Treat as otitis media with effusion
Complete resolution
Review after 48-72hours
Another antibacterial therapy therapy for 10 days or myringotomy and culture and specific antimicrobial
for 10 days Periodic checks for 12 weeks
DRUGS Antimicrobial agents: Amoxicillin Ampicillin co-amoxiclav Erythromycin Cephalosporins
Decongestant nasal drops: Ephedrine
Oral nasal decongestants:Pseudoephedrine
Analgesics:Paracetamaol
Ear toilet:
Dry local heat
Myringotomy: incising the drum to evacuate pus.
•Indications of myringotomy: Bulging drum and acute pain Incomplete resolution drum remains full with persistent
conductive deafness Persistent effusion beyond 12 weeks Onset of complications like facial nerve
paralysis or labyrinthitis Serous otitis media Non suppurative otitis media
PREVENTIONRoutine childhood vaccination against:pneumococci (with pneumococcal
conjugate vaccine), H. influenzae type B, and influenza decreases the incidence of AOM.
Infants should not sleep with a bottle, and elimination of household smoking may
decrease incidence.