Download - Acute Suppurative Otitis Media
Acute Suppurative Otitis Media
Acute inflammation of middle ear by pyogenic organisms
Aetiology
Infants and children of lower socioeconomic group
Follows viral infection of upper respiratory tract
Routes of Infection
Via eustachian tube
Via external ear
Blood borne
Predisposing Factors
Recurrent attacks of common cold, upper respiratory tract infections, exanthematous fevers
Infections of tonsils or adenoids
Chronic rhinitis and sinusitis
Nasal allergy
Tumours of nasopharynx, packing of nose, epistaxis
Cleft palate
Bacteriology
Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis
Streptococcus pyogenes
Staphylococcus aureus
Pseudomonas aeruginosa
Pathology and Clinical Features
Stage Pathology Symptoms Signs
Tubal Occlusion
• Oedema & hyperaemia of nasopharyngeal end of tube
• Retraction of TM
• Deafness• Earache
• TM retracted• Handle of
maleus more horizontal
• Lateral process of maleus prominent
• Loss of light reflex
• Conductive deafness
Stage Pathology Symptoms Signs
Presuppuration
• Pyogenic organsims invade tympanic cavity
• Hyperaemia of lining
• Inflammatory exudate in middle ear
• TM congested
• Earache o Throbbingo Disturbs
sleep
• Adults – deafness & tinnitus
• Children – Fever
• Congestion of pars tensa
• Cartwheel appearance of TM
• Conductive deafness
Suppuration • Pus in middle ear
• TM bulges out
• Severe earache
• Deafness increases
• Fevero Vomitingo Convulsions
• TM o Redo Bulgingo Loss of
landmarks• Tenderness
over mastoid antrum
Stage Pathology Symtoms Signs
Resolution • TM ruptures• Release of
pus• Subsidence
of symptoms
• Earache relieved
• Fever subsides
• EAC may contain blood-tinged discharge
• Later becomes mucopurulent
Complication • Virulence of organism is high
• Resistance of host is poor
• Acute mastoiditis• Labyrinthitis• Subperiosteal abscess• Facial paralysis• Petrositis• Extradural abscess• Meningitis• Brain abscess• Lateral sinus
thrombophlebitis
Treatment
Antibacterial therapy Ampicillin 50mg/kg/day in 4 divided
doses Amoxicillin 40mg/kg/day in 3 divided
doses
Decongestant nasal drops Ephedrine (1% in adults & 0.5% in
children) Oxymetazoline Xylometazoline
Oral nasal decongestants Pseudoephedrine 30mg twice daily
Analgesics & antipyretics Paracetamol
Ear toilet Dry-mopping
Dry local heat Relieves pain
Myringotomy Drum is bulging; acute pain Incomplete resolution despite antibiotics; persistent conductive
deafness Persistent effusion beyond 12 weeks
Acute Necrotising Otitis Media
Variety of ASOM seen in children suffering from exanthematous fevers
Caused by B-haemolyticus streptococci
Rapid destruction of entire tympanic membrane
Profuse otorrhea
Healing followed by fibrosis or secondary acquired cholesteatoma
Treatment Antibacterial therapy for a least 7-10
days Cortical mastoidectomy
Medical treatment fails to control Condition gets complicated by
acute mastoiditis
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