Acute suppurative otitis media Flashcards
Acute inflammation of middle ear by pyogenic organisms
Eustachian tube
Aditus Antrum attic mastoid air cells
Routes of infection
Eustachian tube External ear Blood borne S pneumonia H influenziae M cattarhalis
Stages
Tubal occlusion Presuppurution Suppuration Resolution Complications Antibacterial Dry heat Decongestant Ear toilet Myringotomy
Acute necrotizing otitis media
B hemolytic streptococcus
Destruction of whole of TM plus annulus, mucosa of promontory,ossicular chain, mastoid air cells.
Healing= secondary acquired cholesteatoma
Treatments
Antibacterial
Or cortical mastoidectomy
OM w effusion
Accumulated non purulent fluid in middle ear cleft
Causes
Malfunctioning of eustachian tube. Eustachian tube fails
to aerate the middle ear and is also unable to drain the fluid.
2. Increased secretory activity of middle ear mucosa.
AETIOLOGY
1. Malfunctioning of eustachian tube. The causes are:
(a) Adenoid hyperplasia.
(b) Chronic rhinitis and sinusitis.
2.allergy,
Symptoms
Hearing loss earache delayed speech
Otoscopic findings
Tympanic membrane is often dull
and opaque with loss of light reflex. It may appear yellow,
grey or bluish in colour.
Thin leash of blood vessels may be seen along the handle
of malleus or at the periphery of tympanic membrane and
differs from marked congestion of acute suppurative otitis
media.
Tympanic membrane may show varying degree of retrac-
tion. Sometimes, it may appear full or slightly bulging in its
posterior part due to effusion.
Fluid level and air bubbles may be seen when fluid is thin
and tympanic membrane transparent (Figure 10.2).
Mobility of the tympanic membrane is restricted.
HEARING TESTS
1. Tuning fork tests show conductive hearing loss.
2. Audiometry. There is conductive hearing loss of 20–40
dB. Sometimes, there is associated sensorineural hearing
loss due to fluid pressing on the round window mem-
brane. This disappears with evacuation of fluid.
Treatment
Decongestants Antibiotic Antiallergic measures. Antihistaminics or sometimes ste- roids may be used in cases Middle ear aeration Grommet insertion myringotomy Cortical mastoidectomy
Sequelae of CSOM
- Atrophic tympanic membrane and atelectasis of the
middle ear. In prolonged effusions, there is dissolution of
fibrous layer of tympanic membrane. It becomes thin and
atrophic and retracts into the middle ear. - Ossicular necrosis. Most commonly, long process of incus
gets necrosed. Sometimes, stapes superstructure also gets
necrosed. This increases the conductive hearing loss to
more than 50 dB. - Tympanosclerosis. Hyalinized collagen with chalky depos-
its may be seen in tympanic membrane, around the ossicles
or their joints, leading to their fixation. - Retraction pockets and cholesteatoma. Thin atrophic
part of pars tensa may get invaginated to form retraction
Recurring OM
Finding the cause and eliminating it, if possible.
2. Antimicrobial prophylaxis. Amoxicillin (20 mg/kg for 3–6
months) or sulfisoxazole have been used but they pre-
vent only 1–2 bouts of otitis media in a year and have
the disadvantage of creating antimicrobial resistance or
hypersensitivity reaction and thus not preferred by many
in favour of early insertion of tympanostomy tubes.
3. Myringotomy and insertion of tympanostomy tube. If the
child has 4 bouts of acute otitis media in 6 months or
6 bouts in 1 year, insertion of a tympanostomy tube is
recommended.
4. Adenoidectomy with or without tonsillectomy.
5. Management of inhalant or food allergy
Otitic barotrauma
Nonsuppurative
Failure of air equalizing pressure
ere nasopharyngeal air pressure is
high, air cannot enter the middle ear unless tube is actively
opened by the contraction of muscles as in swallowing, yawn-
ing or Valsalva manoeuvre. When atmospheric pressure is
higher than that of middle ear by critical level of 90 mm Hg,
eustachian tube gets “locked,” i.e. soft tissues of pharyngeal
end of the tube are forced into its lumen. In the presence
of eustachian tube oedema, even smaller pressure differen-
tials cause “locking” of the tube. Sudden negative pressure
in the middle ear causes retraction of tympanic membrane,
hyperaemia and engorgement of vessels, transudation and
haemorrhages.
Sometimes, though rarely, there is rupture of labyrinthine
membranes with vertigo and sensorineural hearing loss.
Treatment
LINICAL FEATURES
Severe earache, hearing loss and tinnitus are common com-
plaints. Vertigo is uncommon. Tympanic membrane appears
retracted and congested. It may get ruptured.
Middle ear may show air bubbles or haemorrhagic effu-
sion. Hearing loss is usually conductive but sensorineural
type of loss may also be seen.
TREATMENT
The aim is to restore middle ear aeration. This is done by
catheterization or politzerization. In mild cases, deconges-
tant nasal drops or oral nasal decongestant with antihis-
taminics are helpful. In the presence of fluid or failure of
the above methods, myringotomy may be performed to
