#Acute & Chronic Otitis Media
#Acute & Chronic Otitis Media
#Acute & Chronic Otitis Media
Incide nce
Disease of children! at first 6 years of life *Contributing factors : 1. Anatomical features of Eustachian tube : ET is shorter, wider and more horizontal than in adults The orifices of ET are surrounded by lymphoid tissues 2. Frequent exposure to URTIs 3. Bottle feeding 4. Immature immune system 5. Infected tonsils & enlarged adenoids Common organisms: * Viral infection commonly precedes 2ry bacterial invasion Streptococcus pneumoniae Moraxilla catarrhalis H. influenzae * more frequent during infancy & early childhood Routes of infection Through the Eustachian tubes *commonest route! Through a drum perforation
virulent hemolytic streptococci *characterized by : 1. necrosis & sloughing of tissues 2. large tympanic perforation (SUBTOTAL) 3. predisposes: - CSOM (cholesteatoma) - foul smelling discharge - increase the risk of complications
ATTICO-ANTRAL - gram bacilli - anaerobes osteitis affects attic & mastoid antrum aka UNSAFE/ DANGEROUS type - risk of complications!!! 1.bone erosion, choleasteatoma 2.cranial complications
C/P
Patho tubal occlusion - blocked ET - negative pressure in ME catarrhal inflammation - hyperemia & transudation suppuration - collection of pus under pressure
Symptoms Sense of fullness in ear Earache May be mild fever Fever Increasing ear ache (esp in children & infants) b4 rupture of TM: High fever. Severe throbbing pain CHL
Signs - TM: appears retracted, congested & lustreless - Mild CHL - TM: retracted, congested (especially pars flaccida) + loss of cone of light - signs of fluid behind TM - mild CHL TM: markedly congested bulging, first in post 1/2 Later on a yellowish spot (ant. inf. quadrant) appears indicating impending rupture of TM - tenderness over mastoid process (mastoidism) *If it persists, it indicates bone involvement (mastoiditis) - mucopurulent discharge - small central perforation * frequently located in the anteroinferior quadrant but may be present anywhere in the pars tensa *discharge may appear pulsating in small perforatn
site
TUBOTYMPANIC (BENIGN/SAFE) - Eustachian tube - Tympanic cavity - odourless - profuse - muco-purulent - inter-mittent central
discharg e
perforati on
cholasNo teatoma granulat Uncommon ions & polypi deafness Conductive - mild or moderate
ATTICO-ANTRAL (DANGEROUS/ UNSAFE) - Attic - Posterior part of middle ear - Mastoid antrum - offensive odour - scanty - purulent - continuous - attic - post-superior margin Yes Common
1. chronicity - facial nerve paralysis - mastoiditis 2. cranial & intracranial complications Before perforation: - Antibiotic, decongestant - Antipyretic- analgesic preparations After perforation : - Frequent cleaning of the ear - Culture & sensitivity of discharge Myringotomy Indications : Before perforation ; 1. Impending TM (yellowish spot) surgery heals better than pathological perforation 2. Persistent otalgia & fever after >48hrs treatment 3. Complications (eg: facial paralysis) 4. Recurrent AOM (>4 times/year) After perforation 1. Persistent discharge from small, non dependant perforation
Frequent aural toilets (cleaning) Culture and sensitivity of the discharge Systemic and local antibiotics Treatment of sequels and complications e.g. tympanoplasty
Cellular mastoid
Myringoplasty Tympanoplasty