dr. sudeep k.c.. acute inflammation of middle ear by pyogenic organisms. etiology: infants and child...
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DISORDERS OF MIDDLE EAR
DR. SUDEEP K.C.
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Acute suppurative otitis Media
•Acute inflammation of middle ear by pyogenic organisms.
•Etiology:• Infants and child of lower socioeconomic group . • • Routes of infection: Via Eustachian tube(Most common route)Via External earBlood borne
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PREDISPOSING FACTORS:
Recurrent attacks of common cold , URTI, measles , Diptheria, whooping cough.Infections of tonsils and adenoids.Chronic rhinitis and sinusitisNasal allergyTumours of nasopharynx , packing of nose
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Bacteriology:
Streptococcus pneumoniae – 30%Haemophilus influenza-20% Moraxella catarrhalis -12%Other organisms : streptococus pyogenes, staph. aureus , pseudomonas aeruginosa.
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Pathology and clinical features:
1)Stage of tubal occlusion: Oedema and hyperemia of nasopharyngeal end of Eustachian tube blocks the tube negative intra tympanic pressureretraction of TM.
Symptoms:
Deafness and ear ache , no fever.
Signs:
TM is retracted with shortening of handle of malleus and loss of the light reflex.
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2)STAGE OF PRE-SUPPURATION: prolonged tubal occlusioninvasion of tympanic cavity by pyogenic organism causing hyperaemia of its lininginflamatory exduate appearTM congested.
Symptoms: Marked ear ache that disturbs sleep.Deafness and tinnitus.High fever.
Signs: Congestion of pars tensa , cart wheel apperance of TM, finally it get uniformly red.
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3)STAGE OF SUPPURATION:This is marked by formation of pus in middle ear and mastoid air cells.TM starts bulging to a point of rupture.
Symptoms: Excruciating Ear ache.Increasing Deafness.High fever with vomiting and even convulsion.
Signs:Tm is red and bulging with loss of landmarks .Handle of malleus is engulfed by swollen and protuding TM.yellow spot is seen where rupture is imminent.x-ray mastoid show clouding of air cells.
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4)STAGE OF RESOLUTION:
TM ruptures with release of pus and subsidence of symptoms . Inflammatory process begins to resolve.
Symptoms:With evacuation of pus Earache is relieved , fever comes down .
Signs:External auditory canalcontain blood tinged or mucopurulent discharge.Perforation on TM .
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5)STAGE OF COMPLICATION:
If the virulence of organism is high or resistance of patient is poor , resolution may not take place and disease spreads beyond middle ear.
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TREATMENT:
1)Antibacterial Therapy: It is indicated in all cases with fever and severe ear ache.It should be continued at least for 10 days.
2)Decongestant nasal drops: Ephedrine , oxy or xylo metazoline.
3)Oral nasal decongestant : Pseudoephedrine 30 mg twice daily .or combination of decongestant with anti histamin.
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4)Analgesics and antipyretics:
5)Ear toilet:
6)Dry local heat:
7)Myringotomy : It is incising drum to evacuate pus .
Indications:
a)Drum is bulging and there is acute pain.
b)Incomplete resolution despite antibiotics when drum remain full with persistent conductive deafness.
c)Persistent effusion beyond 12 weeks
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OTITIS MEDIA WITH EFFUSION(GLUE EAR) This is an
insidious condition characterized by accumulation of non purulent effusion in middle ear cleft.
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Pathogenesis:
1)Malfunctioning of Eustachian tube:
2)Increased secretory activity of middle ear mucosa:
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ETIOLOGY:
1)Malfunctioning of Eustachian tube : The causes are Adenoid hyperplasia.Chronic sinusitis and rhinitisChronic tonsillitisTumours of nasopharynx 2)Allergy 3)Unresolved otitis media 4)Viral infections
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CLINICAL FEATURES:
Symptoms : The disease affects 5-8 yrs of age.Hearing lossDelayed and defective speechMild ear ache
Otoscopic findings:
TM is often dull and opaque with loss of light reflex .a) It may appear yellow , grey or bluish colour . B)Thin leash of blood vessel is seen along handle of malleus and periphery of TM . C)Retraction of TM with Air fluid level .Mobility of TM get restricted .
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Treatment:
A)Medical DecongestantsAnti allergic MeasuresAntibioticsMiddle ear aeration
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B)Surgical: Myringotomy and aspiration of fluidGrommet insertionTympanotomy or cortical matoidectomySurgical treatment of causative factor
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THE END