Acute Suppurative Otitis Media

Arooba Asmat

Introduction

Acute inflammation of middle ear. Caused by PYOGENIC ORGANISMS.

Aetiology

More common in infants and children f lower socioeconomic group.

Follows viral infection of upper respiratory tract.

Routes of infection

Via eustachian tube Via external ear Blood borne

Predisposing factors

Recurrent attacks of common cold. Upper respiratory tract infections. Extanthematous fever like measels ,

diaphtheria or wooping cough. Infections of tonsils and adenoids. Nasal allergy. Chronic rhinitis and sinusitis. Cleft palate Tumors of nasopharynx

Bacteriology

Streptococcus pneumoniae 30% Haemophilus influenza 20% Moraxella catarrhalis 12% Streptococcus pyrogenes Staphylococcus aureus Pseudomonas aeruginosa

Stages

Stage of tubal occlusion Stage of presuppuration Stage of suppuration Stage of resolution Stage of complication

1 . Stage of tubal occlusion

Oedema and hyperaemia of nasopharyngeal end of eustacian tube blocks the tube leading to absorption of air and negative intratumpanicpressure.

Retracted T.M

Symptoms and signs

Symptoms Deafness Earache No feverSigns Retracted T.M Loss of light reflex Conductive deafness

2. Stage of presuppuration

Prolonged Hyperaemia of lining Inflammatory exudate appears in

middle ear T.M become ingested

Symptoms and signs Symptoms Earache Disturbed sleep Deafness and tinnitus Fever in children and restlessness Signs Congestion of pars tensa Leash of blood vessels appear along the

handle of malleus Cart-wheel appearance T.M become red

3. Stage of suppuration

Formation of pus in middle ear. Tympanic membrane starts bulging

to the point of repture

Signs and Symptoms Symptoms Earache Deafness increases Fever 102-103 F Vomiting Signs T.M appears red and bulging Loss of landmarks Yellow spot on T.M Tenderness Clotting of air cells because of exudate

4. Stage of resolution

Tympanic membrane reptures with release of pus

Inflamation process begins to resolve

Symptoms Signs

Evacuation of pus Blood tinged discharge in external auditory meatus

Earache relieved Small perfoation in anteroinferior quadrant of pars tensa

Fever comes down Hyperaemia of T.M

Child feels better

5. Stage of complication Most complicated stage Can lead to Acute mastioditis Subperiosteal abscess Facial paralysis Labyrinthitis Petrositis Extradural absces Meningitis Brain abscess Laterazl sinus thrombophlebitis

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