Biofilms in chronic suppurative otitis media and cholesteatoma
Chronic Otitis Media_2
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Transcript of Chronic Otitis Media_2
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Otitis Media
Prepared by Miss Jeevitha
Verasamy
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INTRODUCTION
Infection of the middle ear
Types of OM:-
1. Suppurative OM
Acute - sudden in onset and short duration
middle ear infection
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Contd
Chronic Infection repeated, causingdrainage and perforation caused by
Pseudomonas, Staphylococcus and
Klebsiella. OM is the second most common clinical
problem in childhood after upper
respiratory infection.
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Pathophysiology
Prolonged obstruction of auditory tubeimpaired equalization of air in middle ear
Air in middle ear space graduallyabsorbed; tube obstruction prevents moreair entering middle ear.
This results in negative pressure in the
middle ear sterile serous fluid movefrom capillaries into the space, forming asterile effusion of the middle ear
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Middle ear infection (otitis media)
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Acute Otitis Media
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Chronic Otitis Media
http://www.eardoc.info/faq-2/myringotomy -
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Complication
Hearing loss: COM can lead to tympanicmembrane retraction, adhesive OM, or
necrosis of the tympanic membrane(perforation)
Acute mastoiditis: before the advent of
antibiotics Tympanosclerosis
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Contd
Cholesteatoma is a mass that forms in themiddle ear as a result of the growth of epithelial
tissue implanted in the middle ear from the
collapsed part of the eardrum when it perforates
or a cyst / mass filled with epithelial cell debris in
the middle ear
Usually benign & slow-growing tumors
This mass compresses middle ear structures &mastoid cells necrosis & bone erosion
spreading to the inner ear hearing loss
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Cholesteatoma
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Contd
Cholesterol granuloma: Blue drum
syndrome
Facial nerve paralysis
Bacterial meningitis
Brain abscess
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Medical Management
Ear Irrigation
Cleanse the external auditory canal
Remove impacted wax, debris or foreign
bodies
Contraindication for clinical suspicion of
perforated eardrum client
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Ear Irrigation
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Contd
Antibiotics
Suction, irrigation or manual removal of
matter with a cotton-tipped swab
Antibiotic steroid eardrops
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Administration of antibiotic
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Cont
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Surgical Management
Myringoplasty closure of a simple
tympanic membrane perforation
Tympanoplasty surgical correction of aperforated tympanic membrane
Type I: Graft rests on malleus
Type II: Graft rests on incus Type III: Graft attaches to head of stapes
Type IV: Graft attaches to footplate of
stapes
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Myringotomy- tympanostomy tubes
http://www.eardoc.info/faq-2/myringotomy -
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Contd
Ossiculoplasty surgical procedure of
ossicular reconstruction
Myringotomy (tympanocentesis) anincision in the tympanic membrane to
relieve the pressure & prevent
spontaneous rupture of the eardrum Mastoidectomy removes the contents of
the mastoid bone for control of infection
and cholesteatoma
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Patient care with OM
AOM will resolve spontaneously without
specific treatment.
Antibiotics should be avoided in mild tomoderate cases and when there is
diagnostic uncertainty in patients aged 2
years and under.
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Patients who should be
considered for antibiotics include:[
Patients with symptoms persisting for
more than 2-3 days. Children aged under 2 with bilateral AOM
or bulging drum and four or more
symptoms. Children of any age with otorrhoea.
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Cont
Patients at high risk of complications - eg,
significant heart, lung, renal, liver, or
neuromuscular disease,immunosuppression, or cystic fibrosis and
young children who were born
prematurely.
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Further Management
Hospital admission should be considered
for:
Any child younger than 3 months withsuspected AOM
Children younger than 3 months of age
with a temperature of 38C or more.
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Contd
Children aged 3-6 months or more with a
temperature of 39C.
Suspected complications such asmeningitis, mastoiditis, or facial paralysis.
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Referral should be considered for:
Children with persistent symptoms not
responding to antibiotics.
Children with discharging or perforatedears whose condition has not fully
resolved after 2-3 weeks.
Children with recurrent AOM (defined asthree or more episodes in six months or
four or more episodes in one year).
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Contd
Children with impaired hearing following
AOM and aged under 3 with OME,
bilateral effusions and hearing loss of lessthan 25 decibels but with no speech,
language or developmental problems,
observe initially.
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Contd
Children under the age of 3 who go on to
develop OM with bilateral effusions and
hearing loss of less than 25 decibels butwith no speech, language or
developmental problems may be observed
initially.
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Contd
Children over the age of 3 who go on to
develop OM or with language or
behavioural problems may benefit fromsurgical intervention such as the insertion
of grommets and should be referred for a
specialist opinion.[11]
http://www.patient.co.uk/search.asp?searchterm=INSERTION+OF+GROMMETShttp://www.patient.co.uk/search.asp?searchterm=INSERTION+OF+GROMMETShttp://www.patient.co.uk/doctor/acute-otitis-media-in-childrenhttp://www.patient.co.uk/doctor/acute-otitis-media-in-childrenhttp://www.patient.co.uk/search.asp?searchterm=INSERTION+OF+GROMMETShttp://www.patient.co.uk/search.asp?searchterm=INSERTION+OF+GROMMETS -
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Prognosis
With the exception of the few
complications given above, there is
usually complete resolution in a few days.