dr. arjun dass prof. & head department of ent lectures/ent/acute... · acute upto 3 weeks ......
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DR. ARJUN DASSPROF. & HEADDEPARTMENT OF ENT
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OTITIS MEDIA
Otitis MediaInflammation of middle ear cleft
Classification: (on duration; Senturia,1980)
Acute upto 3 weeks Subacute 3 week to 3 months Chronic greater than 3 months
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DEFINITION
Bacterial or viral infection
which affects mucosal lining
of the middle ear and mastoid
air cell system
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ETIOLOGY
< 5yrs; 50% in 1st year
Boys > girls
Cold climate, follows URI
Nurseries/ overcrowding
High number of siblings
Parental smoking
Non breast fed
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ROUTES OF INFECTION:Via Eustachian Tube-
Most common route
Causes of tubal obstruction:
Upper respiratory infections Allergic sinusitis Nasal polyps DNS Adenoid hypertrophy Nasopharyngeal carcinoma Cleft palate Submucous cleft palate Down syndrome Barotrauma
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ROUTES OF INFECTION Acute tubal blockage Absorption of ME gases Negative pressure in middle ear Retraction of TM Transudate/haemorrhage (AOM)
Via External Ear-
Perforated tympanic membrane
Via Blood Borne- uncommon
route
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MICROBIOLOGY
Viral (RSV, rhino, influenza)
S. pneumoniae -(< 3 months)
H. influenzae -(>1 year)
M. catarrhalis
S. pyogenes
S. aureus
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PATHOLOGY & CLINICAL FEATURES:a) STAGE OF HYPERAEMIA Prolonged tubal obstruction Negative middle ear pressure Retraction of TM Vasodilation of submucosal tissues Hyperaemia and edema of mucosa
SYMPTOMS Fever, Ear pain/ fullness With or without hearing loss
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PATHOLOGY & CLINICAL FEATURES:
SIGNS
Retracted and congested TM with leash
of blood vessels along HOM and at
periphery (cart-wheel appearance),
landmarks preserved
Tuning fork tests- CHL
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b) STAGE OF EXUDATIONEscape of inflammatory exudate from dilated permeable capillaries- serum, fibrin, red cells and polymorhoneutrophils
SYMPTOMS• Marked earache(throbbing with disturbed
sleep)
• Hearing loss,
• High grade fever in infants
PATHOLOGY & CLINICAL FEATURES
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SIGNS• TM thickened and landmarks obscured,
• Conductive hearing loss
• In infants- tenderness and edema over mastoid cortex.
• Radiologically, diffusely clouded air cells but without alterations of cell partitions
PATHOLOGY & CLINICAL FEATURES:
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c) STAGE OF SUPPURATIONFormation of pus in middle ear and to some extent in mastoid air cells
SYMPTOMS Excruciating pain, Deafness increases, Fever, toxicity increases
SIGNS TM is red and bulging to the point of
rupture, Mastoid tenderness present.
PATHOLOGY & CLINICAL FEATURES:
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d) STAGE OF RESOLUTION
TM ruptures(30% cases) with releaseof pus and subsidence of symptoms.Inflammatory process begins toresolve. Resolution may even startwithout rupture of TM
SYMPTOMS Earache relieved Fever subsides Ear discharge starts
PATHOLOGY & CLINICAL FEATURES
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SIGNS
• Discharge in EAC
(mucopurulent/bloodstained),
• Perforation of pars tensa
PATHOLOGY & CLINICAL FEATURES
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COMPLICATIONS
i) EXTRACRANIAL• Tympanic membrane
perforation• Acute mastoiditis• Facial nerve paralysis• Labyrinthitis• Acute petrositis
e) STAGE OF COMPLICATIONIf virulence of organism is high, or resistance of patient is poor
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COMPLICATIONS
ii INTRACRANIAL
• Meningitis• Extradural abscess• Subdural empyema• Sigmoid sinus
thrombosis• Brain abscess• Ottic hydrocephalus
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DIAGNOSIS Otoscopy
Colour – Opaque Yellow Blue Red Pink
Position Bulging Retracted
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DIAGNOSIS
Mobility Normal, Hypomobile, Negative pressure
Associated pathology Perforations, Cholesteatoma, Retraction pockets
Head & Neck examination
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DIAGNOSIS
Audiogram
Document CHL/SNHL
Impedance Audiometry
Radiology
X-ray mastoid,
HRCT temporal bone
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TREATMENT
MEDICAL
Bed rest
Antibacterial therapy
1st line- amoxycillin(40 mg/kg/d in divided
doses for 10 days)
2nd line- as amoxycillin and clavulanic acid
Others 2nd generation cephalosporins -
cefaclor, erythromycin, sulf/trimethoprim
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TREATMENT
MEDICAL
Decongestants(oral/nasal)To relieve ET oedema and promote ventilation of middle ear
Analgesics and antipyretics
Aural toilet
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SURGICALMyringotomy:
Indication: Unsatisfactory response to
antimicrobials Patient in acute pain with
bulging drum OM in immunodeficient,
newborn Suppurative complication like:
mastoiditis, labyrinthitis, facial paralysis, meningitis(as emergency procedure)
TREATMENT
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SURGICAL
Ventilation tube for recurrent OM
Adenoidectomy decrease the frequency for recurrent OM
TREATMENT
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THANK YOU