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E:\PRESENTATIONS\Animations\EAR\Hearing.flv
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
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
CAUSATIVE ORGANISM Streptococcus pneumoniae (30%) Haemophilus influenzae (20%) Moraxella catarrhalis (12%) Others:
Streptococcus pyogenes Staphylococcus aureus Pseudomonas aerugenosa
No growth in 18-20% cases Viruses: RSV, Influenza, Rhino &
Adeno Virus
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EUSTACHIAN TUBE WAY It is the most common route CHILDREN ARE MORE SUCCEPTIBLE:1. ET in infants & young children
1. Shorter 2. Wider3. More horizontal4. Less stiff
2. Large adenoids1. interfere with the opening of the tube
3. Immune system 1. not fully developed
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EUSTACHIAN TUBE A small tube connecting
Middle ear to the nasopharynx Functions Regulate and equalize
Pressure of middle ear Prevent fluid
Accumulating in the middle ear
Protect from Nasopharyngeal infection
•Children ET 10° •Adults ET 45°•ISTHMUS(narrowing of ET)• junction of the cartilaginous and bony part.• It is only present in adults.
ShorterWiderMore
horizontalLess stiff
EXTERNAL ACCOUSTIC MEATUS WAY
Associated with TM perforation Infection Tm trauma Tympanostomy tubes, Tympanometry, Myringotomy
BLOOD BOURNE Uncommon route
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EXTERNAL ACCOUSTIC MEATUS
Associated with TM perforation Infection TM trauma Tympanostomy tubes Tympanotomy Myringotomy
CLINICAL FEATURES &PATHOPHYSIOLOGY1. Stage of tubal occlusion
2. Stage of pre-suppuration3. Stage of suppuration4. Stage of Resolution Complication
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STAGE OF TUBAL OCCLUSIONMucosa: Hyperemia, Swelling
Eustachian tube is occluded
Intratympanic pressure ↓
Air ↓ fluid ↑
Tympanic membrane retracts
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SYMPTOMS TM RETRACTS
TinnitusEar fullness
EaracheHearing loss
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CLINICAL SIGNS TM retracted1. short handle of
malleus2. No cone of light3. Prominent lateral
process of malleus
Conductive deafness in tuning fork test
STAGE OF PRE-SUPPURATION
Bacteria invade tympanic cavity
Hyperemia
Inflammatory exudate
Congested TM
STAGE OF SUPPURATION
Pus increases
TM is compressed, ischemic
TM is tense and bulges
TM necrosis
C/F EXCRUCIATING PAIN
Deafness Fever 102-103°F
(Children) Vomiting Convulsions X ray mastoid:
clouding of air cells due to exudate.
STAGE OF RESOLUTION
Earache relieved
General condition Temp decreases WBC Count
Improves
STAGE OF COMPLICATION Intratemporal
(within temporal bone)
1. Acute mastoiditis
2. 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)
LOCAL THERAPY BEFORE PERFORATION
Relieve earache control inflammation Prevent perforation(spontaneous)
1. Decongestant nasal drops(ephedrine, oxymetazoline, xylometazoline)
2. Oral nasal decongestant (pseudoephedrine)
3. Analgesic & antipyretic(paracetamol)
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MYRINGOTOMY Myringotomy
Tiny incision eardrum Relieve pressure Drain pus from the middle ear.
A tympanostomy tube Keep the middle ear aerated Prevent re accumulation of fluid.
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MYRINGOTOMY INDICATIONS :
1. Symptoms are not relieved by antibiotics
2. TM bulges significantly
3. TM perforation is too small
4. Incomplete resolution
5. Persistent effusion beyond 12 weeks
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LOCAL THERAPY AFTER PERFORATION
1. Clear external acoustic canal
toilet
2. Control infection
3. Repair TM
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TREAT RELATED DISEASE
Chronic rhinitis
Chronic sinusitis
Chronic tonsillitis
Adenoid vegetation
DIFFERENTIAL DIAGNOSISMEATAL FURUNCLE
1. No hearing loss2. TM is normal
ACUTE MYRINGITIS3. Severe earache4. Hearing loss is slight
1. TM: hyperemia and bulla forms2. After influenza or zoster
infection
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