Acute suppurative otitis media
30
Nihar Gupta SMS&R Roll No:38 ACUTE SUPPURATIVE OTITIS MEDIA
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a brief review of acute suppurative otitis media for medical students and physicians
Transcript of Acute suppurative otitis media
Nihar GuptaSMS&R
Roll No:38
ACUTE SUPPURATIVEOTITIS MEDIA
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.
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 and Pseudomonas aerugenosa
No growth in 18-20% cases Viruses: RSV, influenza, rhino &
adeno virus
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
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
•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.
EXTERNAL ACCOUSTIC MEATUS WAY
Associated with TM perforation Eg. TM trauma, insertion of
tympanostomy tubes, tympanometry, myringotomy
BLOOD BOURNE This is an uncommon route
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
STAGE OF TUBAL OCCLUSION
Mucosa: Hyperemia, Swelling
Eustachian tube is occluded
Intratympanic pressure ↓
Air ↓ fluid ↑
Tympanic membrane retracts
CLINICAL SIGNS
TM retracted1. Foreshortened
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
Follows TM perforation
Earache relieved at once
General condition(temp, wbc count) improves
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
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:1. Decongestant nasal
drops(ephedrine, oxymetazoline, xylometazoline)
2. Oral nasal decongestant (pseudoephedrine)
3. Analgesic & antipyretic(paracetamol)
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.
MYRINGOTOMY
INDICATIONS :1. Symptoms are not relieved by
antibiotics2. TM bulges significantly3. TM perforation is too small4. Incomplete resolution5. Persistent effusion beyond 12
weeks
LOCAL THERAPY
AFTER PERFORATION1. Clear external acoustic canal-Ear
toilet2. Control infection3. Repair TM
TREAT RELATED DISEASE
Chronic rhinitis Chronic sinusitis Chronic tonsillitis Adenoid vegetation
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
