chronic otitis media_2

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Otitis Media

Prepared by Miss Jeevitha

Verasamy


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INTRODUCTION

Infection of the middle ear

Types of OM:-

1. Suppurative OM

Acute - sudden in onset and short duration

middle ear infection


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Contd

Chronic Infection repeated, causingdrainage and perforation caused by

Pseudomonas, Staphylococcus and

Klebsiella. OM is the second most common clinical

problem in childhood after upper

respiratory infection.


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Pathophysiology

Prolonged obstruction of auditory tubeimpaired equalization of air in middle ear

Air in middle ear space graduallyabsorbed; tube obstruction prevents moreair entering middle ear.

This results in negative pressure in the

middle ear sterile serous fluid movefrom capillaries into the space, forming asterile effusion of the middle ear


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Middle ear infection (otitis media)


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Acute Otitis Media


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Chronic Otitis Media
http://www.eardoc.info/faq-2/myringotomy


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Complication

Hearing loss: COM can lead to tympanicmembrane retraction, adhesive OM, or

necrosis of the tympanic membrane(perforation)

Acute mastoiditis: before the advent of

antibiotics Tympanosclerosis


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Contd

Cholesteatoma is a mass that forms in themiddle ear as a result of the growth of epithelial

tissue implanted in the middle ear from the

collapsed part of the eardrum when it perforates

or a cyst / mass filled with epithelial cell debris in

the middle ear

Usually benign & slow-growing tumors

This mass compresses middle ear structures &mastoid cells necrosis & bone erosion

spreading to the inner ear hearing loss


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Cholesteatoma


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Contd

Cholesterol granuloma: Blue drum

syndrome

Facial nerve paralysis

Bacterial meningitis

Brain abscess


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Medical Management

Ear Irrigation

Cleanse the external auditory canal

Remove impacted wax, debris or foreign

bodies

Contraindication for clinical suspicion of

perforated eardrum client


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Ear Irrigation


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Contd

Antibiotics

Suction, irrigation or manual removal of

matter with a cotton-tipped swab

Antibiotic steroid eardrops


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Administration of antibiotic


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Cont


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Surgical Management

Myringoplasty closure of a simple

tympanic membrane perforation

Tympanoplasty surgical correction of aperforated tympanic membrane

Type I: Graft rests on malleus

Type II: Graft rests on incus Type III: Graft attaches to head of stapes

Type IV: Graft attaches to footplate of

stapes


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Myringotomy- tympanostomy tubes
http://www.eardoc.info/faq-2/myringotomy


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Contd

Ossiculoplasty surgical procedure of

ossicular reconstruction

Myringotomy (tympanocentesis) anincision in the tympanic membrane to

relieve the pressure & prevent

spontaneous rupture of the eardrum Mastoidectomy removes the contents of

the mastoid bone for control of infection

and cholesteatoma


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Patient care with OM

AOM will resolve spontaneously without

specific treatment.

Antibiotics should be avoided in mild tomoderate cases and when there is

diagnostic uncertainty in patients aged 2

years and under.


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Patients who should be

considered for antibiotics include:[

Patients with symptoms persisting for

more than 2-3 days. Children aged under 2 with bilateral AOM

or bulging drum and four or more

symptoms. Children of any age with otorrhoea.


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Cont

Patients at high risk of complications - eg,

significant heart, lung, renal, liver, or

neuromuscular disease,immunosuppression, or cystic fibrosis and

young children who were born

prematurely.


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Further Management

Hospital admission should be considered

for:

Any child younger than 3 months withsuspected AOM

Children younger than 3 months of age

with a temperature of 38C or more.


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Contd

Children aged 3-6 months or more with a

temperature of 39C.

Suspected complications such asmeningitis, mastoiditis, or facial paralysis.


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Referral should be considered for:

Children with persistent symptoms not

responding to antibiotics.

Children with discharging or perforatedears whose condition has not fully

resolved after 2-3 weeks.

Children with recurrent AOM (defined asthree or more episodes in six months or

four or more episodes in one year).


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Contd

Children with impaired hearing following

AOM and aged under 3 with OME,

bilateral effusions and hearing loss of lessthan 25 decibels but with no speech,

language or developmental problems,

observe initially.


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Contd

Children under the age of 3 who go on to

develop OM with bilateral effusions and

hearing loss of less than 25 decibels butwith no speech, language or

developmental problems may be observed

initially.


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Contd

Children over the age of 3 who go on to

develop OM or with language or

behavioural problems may benefit fromsurgical intervention such as the insertion

of grommets and should be referred for a

specialist opinion.[11]
http://www.patient.co.uk/search.asp?searchterm=INSERTION+OF+GROMMETShttp://www.patient.co.uk/search.asp?searchterm=INSERTION+OF+GROMMETShttp://www.patient.co.uk/doctor/acute-otitis-media-in-childrenhttp://www.patient.co.uk/doctor/acute-otitis-media-in-childrenhttp://www.patient.co.uk/search.asp?searchterm=INSERTION+OF+GROMMETShttp://www.patient.co.uk/search.asp?searchterm=INSERTION+OF+GROMMETS


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Prognosis

With the exception of the few

complications given above, there is

usually complete resolution in a few days.

chronic otitis media_2

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