OTITIS MEDIAEsther ObedozaMelissa David

Objectives:

Know the etiology, risk factors, sign and symptoms, and pathophysiology

Differentiate the various types of inner ear disorder Identify the different types of surgical procedures and

management

Pathophysiology Precipitating Factors:-children w/ congenital

abnormalities-exposure to cigarette

smoking-URTI

-Allergy

Obstruction in the ET

Prevents drainage of normal secretions

Negative pressure

Pulls interstitial fluid

Pathogens from the URT enters the middle ear through the contaminated secretions

in the nasopharynx

Local infection in the middle ear

Pus Formation

Earache, swelling, redness

Decreased hearing

Predisposing Factors:-infants and young

children (6mos-3 y/o)

Acute Otitis Media An acute infection of the middle ear

Lasting less than 6 weeks

Most frequent in children

Pathogens: S. Pneumoniae, H. Influenzae, Moraxella catarrhalis

Enters the middle ear after Eustachian tube dysfunction r/t URTI, adenoid hypertrophy, allergic reactions, cigarette smoke

Acute Otitis Media: Symptoms

• Unilateral in adults• Otalgia

• Fever• Conductive hearing

loss• Normal external

auditory canal• No pain with

movement of auricle• Tympanic membrane

is erythematous and often bulging

Tympanic Membrane

NORMAL AOM

Acute Otitis Media: Management

Broad spectrum antibiotic Antibiotic otic preparations Condition may become subacute (3wks-3months) with

persistent purulent discharge Rarely permanent hearing loss Surgery:

Myringotomy/Tympanotomy

Serous Otitis Media Middle ear effusion

Involves fluid without active infection Results from (-) pressure in the middle ear Freq seen in: after radiation therapy or barotrauma

(sudden presssure change in the middle ear like scuba diving or airplane descent), eustachian tube dysfunction from respi infection or allergy

Serous Otitis Media: Symptoms Fullness in the ear or sensation of congestion Popping and crackling noises as the eustachian

tube attempts to open Air bubbles are visualized Conductive hearing loss

Serous Otitis Media: Management

Need not be treated medically unless infection occurs (AOM)

Myringotomy

Corticosteroids in small doses Valsava maneuver may be cautiously performed

Chronic Otitis Media Result of repeated AOM causing irreversible tissue

pathology and persistent perforation of the tympanic membrane

Damage the tympanic membrane, destroy the ossicles, and involve the mastoid

Chronic Otitis Media: Symptoms Symptoms may be minimal

Persistent or intermittent, foul-smelling otorrhea

Perforation of tympanic membrane Pain is usually not experienced, except in cases of

acute mastoiditis Cholesteatoma

Conductive hearing loss

Chronic Otitis Media: Management

Careful suctioning of the ear Instillation of antibiotic drops to treat purulent

discharge Systemic antibiotics are usually not prescribed except

in cases of acute infection Surgery: Tympanoplasty

Ossiculoplasty Mastoidectomy

Surgical Management

Myringotomy

-surgical opening of the eardrum Mastoidectomy

-to remove cholesteatoma, gain access to diseased structures and create a dry healthy ear Ossiculoplasty

-surgical reconstruction of the middle ear bones