Discussion

• Otitis media is an infection of the middle section of the ear, as compared to external otitis (also known as swimmer's ear), which is an infection of the outer ear.

Pathogenesis

Trapping of bacteria and viruses in effusion

Increased pressure causing bulging of TM

Viral upper respiratory tract infection

Swelling and fluid accumulation

Increased pressure in the middle ear

Ear pain, pressure, temporary decreased in hearing

Pathogenesis

The ear on the left is normal, without signs of infection. The infected ear on the right shows a bulging ear drum (tympanic membrane), infected fluid in the middle ear, and swelling in the eustachian tube, which prevents fluid drainage.

Classification of OM• Otitis media - "Inflammation of the middle ear, with or

without signs of fluid or infection."

• Acute Otitis Media -"fluid in the middle ear accompanied by signs or symptoms of ear infection (bulging eardrum usually accompanied by pain; or perforated eardrum, often with drainage of purulent material)".

• Otitis Media with Effusion -"fluid in the middle ear without signs or symptoms of ear infection".

• Chronic Otitis Media - is "OME that is unresponsive to medical management and has persisted for three months bilateral or six months unilateral."

According to Agency for Health Care Policy and Research (AHCPR)

Acute Otitis MediaHallmark• Recent onset of a middle ear

infection manifesting one or more of the following signs or symptoms:

– otalgia (tugging or rubbing of the ear in children <2yrs),

– fever, irritability, anorexia, nausea, vomiting ,diarrhea, rhinitis or more rarely, purulent discharge in the ear canal accompanied by decreased mobility of the tympanic membrane (TM).

– Otoscopy findings:– an eardrum that is full,

bulging and opaque– follows shortly after the onset of an upper respiratory

infection.

Otitis Media with Effusion

• relatively asymptomatic presence of fluid in the middle ear

• fluid air level

Etiology

• Streptoccocus pneumoniae

• Haemophilus influenzae

• Moraxella catarrhalis

Complications• Hearing loss (conductive/sensorineural-long

term)• Cholesteatoma• Mastoiditis• Meningitis*• Intracranial abscesses*

– *Spread via preformed channels( blood vessels, diploic veins)

– *Through labyrinth tympanogenic labyrinthitis– *Through bone gaps– *Contiguous spread from infected osteitis or

cholesteatoma

Management—please add to treatment…..nice pic lang