ear infections By : wala’ mosaPresented to: Dr. Ayham Abu Lila

Ear infections

Otitis externa

acute

chronic

malignant

Otitis media

Acute

chronic

With effusion

Labyrinthitis Mastoiditis

Acute Otitis media• Rapid onset of sign & symptom of

inflammation in the middle ear

Clinical manifestation

•90% of case have URI symptoms before develop

AOMSymptoms

•Otalgia (98.2%)•Fever (52.8%)•Hearing loss, Pressure in

ear (46%)•Rhinorrhea (58.3%)•Vomit & diarrhea

Eustachian tube dysfunction

can’t drain fluid from the middle ear

fluid build up within the normally air-filled middle ear

Bacteria or viruses that have entered the middle ear through the eustachian tube can also get trapped

in this way .

These germs can breed in the trapped fluid

leading to an ear infection .

Etiology

Eustachian tube dysfunction

•Mechanical

–Intrinsic : Inflammation of mucous membrane

of eustachian tube

–Extrinsic : Obstructing mass

•Adenoid tissue, Nasopharyngeal Tumor

•Functional

Etiology

•Functional –Found in younger children.

–Cartilage part is less stiff than in adult. So it

easily to collapse.

–More horizontal angle.

otitis media

• Chronic ear infection– persists or keeps coming back, and

causes long-term or permanent damage to the ear. 

• Otitis media with effusion– is fluid in the middle ear space– Almost every acute ear infection is

followed by days or weeks of OME.– it can cause the eardrum to perforate. – So the pain and pressure suddenly stops

and pus drains from the ear.  

• Doctors diagnose ear infection by otocsope

• Healthy eardrum appears pinkish-gray• Infected eardrum looks red and swollen.• Pneumatic otoscope is used to detect

fluid in the middle ear .

Clinical manifestation

Bulging tympanicNormal tympanic

• When too fluid build up in the middle ear, it can put pressure on the eardrum until it ruptures.

• Pain disappear• Although ruptured eardrum sounds

frightening , it usually heal itself in a couple of weeks .

Ear TubesIf these infections are not responsive

to antibiotics then a tympanostomy (tube insertion) may be recommended which removes fluid behind the ear drum and reverses hearing loss.

Comlication of otitis media

• Mastoiditis• Meningitis• Facial paralysis• Brain abscess

Vazquez E et al. Radiographics 2003;23:359-372©2003 by Radiological Society of North America

subperiosteal abscess (A) ,

epidural abscess (B) subdural empyema (C)

brain abscess (D)

meningitis (E)

lateral sinus thrombosis (F) carotid artery

involvement (G)

apical petrositis

(H)

Complication of Otitis media

(otitis externa)' Swimmer s ear

(otitis externa)' Swimmer s ear

Acute or chronic Otitis externa:– is inflammation, irritation, or infection of the

outer ear and ear canal.  • bacteria

Enterobacter aerogenes, Proteus mirabilis, Klebsiella pneumoniae, Staphylococcus epidermidis, Streptococci.

• fungi – Candida and Aspergillus.

• Viruses– herpesvirus hominis and varicella-zoster virus

http://familymedicinehelp.com/wp-content/uploads/2010/12/otitis-externa.jpg

• occurs most often in elderly patients with diabetes who have a recurrent history of non-resolving otitis externa.

• inflammation and damage of the bones and cartilage at the base of the skull.

• Pseudomonas aeruginosa is the predominant organism that causes this life-threatening infection.

Malignant otitis externa (Osteomyelitis of the skull) ,

• Edema,• ear pain• erythema cascade into

cellulitis,• chrondritis, • osteomyelitis of the

temporal bone,

• cranial neuropathies• meningitis,• or a brain abscess.

Labyrinthitis

• Inflammation of the inner ear.• cause sudden vertigo, tinnitus.• Causes: is not clear

– Auto-immune – Viral – Bacterial (it may start after a

middle ear infection.)– Tumor

• may also cause hearing loss

Mastoiditis•Infection of mastoid process, portion of temporal bone

of the skull that is behind the ear which contains open, air-containing spaces

•It is usually caused by untreated acute otitis media

• Bacteria that cause mastoiditis– pneumococcus (in children under age 6),– Hemophilus influenzae,– beta-hemolytic streptococci,

staphylococci, – and gram-negative organisms.

• if not treated promptly– lead to meningitis, facial paralysis, and

brain abscess, in addition to hearing loss and bone destruction.

– Abscess in sternocleidomastoid muscle where pus from mastoiditis

– Rare complication of acute otitis media

Bezold’s abscess