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Acute otitis media Acute otitis media (AOM)(AOM)

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OTITIS MEDIA : DefinitionOTITIS MEDIA : Definition

• DefinitionDefinition-Inflammation of middle ear cleft -Inflammation of middle ear cleft mucosamucosa

• ClassificationClassification (Senturia et al, 1980) (Senturia et al, 1980)– Acute Acute otitis media (upto 3 weeks)otitis media (upto 3 weeks)– SubacuteSubacute otitis media ( 3 weeks- 3 months ) otitis media ( 3 weeks- 3 months )– ChronicChronic otitis media ( >3 months) otitis media ( >3 months)

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ACUTE OTITIS MEDIAACUTE OTITIS MEDIA

DefinitionDefinition- acute inflammation of the MEC- acute inflammation of the MEC• AOM vs ASOMAOM vs ASOM ASOM is one of the types of AOMASOM is one of the types of AOM• AOM vs OMEAOM vs OME Acute OME may follow AOMAcute OME may follow AOMIncidenceIncidence

50% in the 150% in the 1stst year of life. year of life.Remains high in the Remains high in the first 5 yrfirst 5 yr of life of lifeThereafter tails off and infrequent in teenagers.Thereafter tails off and infrequent in teenagers.

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AOM : AetiologyAOM : Aetiology

• Predisposing factors :Predisposing factors :

teething teething

poor sanitation & hygienepoor sanitation & hygiene

ovecrowdingovecrowding

malnutritionmalnutrition

• Age – Age – 3 to 7 years3 to 7 years

• Risk factorsRisk factors – rhinosinusitis, adenoid, ET – rhinosinusitis, adenoid, ET

dysfunction, chest diseasesdysfunction, chest diseases

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AOM : etiology (contd..)AOM : etiology (contd..)

Viruses : Viruses : causing URTIcausing URTI

Bacteriology:Bacteriology:– Streptococcus pneumoniaeStreptococcus pneumoniae– Hemophilus influenzaeHemophilus influenzae– Moxerella catarrhalisMoxerella catarrhalis

• Via Eustachian tubeVia Eustachian tube

ET in children – short, wide, horizontalET in children – short, wide, horizontal

• Via a Via a perforated TMperforated TM

• Blood borne rarelyBlood borne rarely

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Stages of AOMStages of AOM

HyperemiaHyperemia

ExudationExudation

SuppurationSuppuration

Coalescence & surgical mastoiditisCoalescence & surgical mastoiditis

ComplicationComplication

ResolutionResolution

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Symptoms of AOMSymptoms of AOM

• H/O preceding URTI,H/O preceding URTI,• Depends on the stageDepends on the stage• Earache - Earache - cardinal symptom cardinal symptom• hearing loss with or without ear dischargehearing loss with or without ear discharge• Fever Fever • symptoms of complicationssymptoms of complications• Classical scenarioClassical scenario – – cough and coldcough and cold leading to leading to earacheearache

followed by blood stained followed by blood stained discharge discharge and and decrease in the severity of decrease in the severity of painpain

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AOM : signsAOM : signs

• Depends on the Depends on the stagestage• redred, , bulgedbulged tympanic tympanic

membrane. There membrane. There maybe maybe perforation and perforation and dischargedischarge in 1/3 in 1/3rdrd cases. cases.

• 85% of perforation in 85% of perforation in anteroinferior quadrant, anteroinferior quadrant, 15% in posteroinferior 15% in posteroinferior quadrant.quadrant.

• Signs of complicationsSigns of complications• Reservoir signReservoir sign

Congested, bulged TM

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AOM : investigationsAOM : investigations

• Uncomplicated AOM – no investigationsUncomplicated AOM – no investigations

• AOM with complication :AOM with complication :

Hb TC DCHb TC DC

BS LFT RFTBS LFT RFT

Urine : R/MEUrine : R/ME

Plain X-ray mastoidsPlain X-ray mastoids

CT/MRI of temporal bone and surroundingsCT/MRI of temporal bone and surroundings

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AOM : MANAGEMENTAOM : MANAGEMENT

• Majority respond to Majority respond to Conservative managementConservative management• Rest, Rest, analgesicanalgesic / antipyretic / antipyretic• Antibiotics Antibiotics ( Amoxycillin- drug of choice) X 7-10 ( Amoxycillin- drug of choice) X 7-10

daysdays• Antibiotic ear drops if perforationAntibiotic ear drops if perforation• No roles of antihistamines and decongestant. No roles of antihistamines and decongestant.

Maybe given for symptomatic relief.Maybe given for symptomatic relief.• In treatment failuresIn treatment failures

– Repeat the 1Repeat the 1stst line antibiotics for 10 days more line antibiotics for 10 days more– 22ndnd line antibiotics line antibiotics– Myringotomy / simple mastoidectomy Myringotomy / simple mastoidectomy

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AOM : surgical managementAOM : surgical management

Rarely needed when :Rarely needed when : conservative management failsconservative management fails complication occurscomplication occurs

1.1. Myringotomy +/- VTIMyringotomy +/- VTI2.2. Simple (Cortical, Schwartze ) mastoidectomySimple (Cortical, Schwartze ) mastoidectomy3.3. Surgery for complicationSurgery for complication

Recurrent acute otitis mediaRecurrent acute otitis media Long term antibiotics Long term antibiotics VTIVTI? Adenoidectomy? Adenoidectomy

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Barotraumatic OMBarotraumatic OM

• During or after descentDuring or after descent from hills, aircraft from hills, aircraft

similar to AOMsimilar to AOM

• Due to ET block because of Due to ET block because of pressure pressure differencesdifferences

• PrecautionsPrecautions

avoid flight during coldavoid flight during cold

frequent swallowingfrequent swallowing

? VTI? VTI

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• C:\Documents and Settings\pawan\Desktop\aom1.JPG

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Mastoid Mastoid abcessabcess

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SimpleSimplemastoidemastoidectomyctomy

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End result of End result of simplesimplemastoidectomymastoidectomy