ACUTE & CHRONIC OTITIS MEDIA

ACUTE SUPPURATVE OTITIS MEDIA

Defini tion Acute suppurative inflammation of the mucoperiosteal lining of the middle ear cleft (ET + tympanic cavity + mastoid antrum + mastoid air cell) with reversible pathology

ACUTE NECROTIZING OTITIS MEDIA

A severe form of otitis media occurring in ill,toxic children suffering from measles and other exanthemata children suffering from measles and other exanthemata (immunocompromised)

CHRONIC SUPPURATION OTITIS MEDIA

- IRREVERSIBLE form of ASOM - can be either : 1. active (discharging) 2. inactive (dry) - low socio-economic clases *Predisposing factors: 1. Acute necrotizing otitis media with destructive pathology 2. Persistent ET dysfunction 3. Persistent ME effusion causing atrophy of TM results in - TM perforation or retraction leading to cholesasteatoma, or - Infection of Acellular mastoid osteitis 2 types : TUBO-TYMPANIC gram + organism mucositis affects ET & tympanic cavity aka SAFE/ BENIGN type - infection confined to muco-periosteal layer - well-drained - less-likely to cause complications

Incide nce

Disease of children! at first 6 years of life *Contributing factors : 1. Anatomical features of Eustachian tube : ET is shorter, wider and more horizontal than in adults The orifices of ET are surrounded by lymphoid tissues 2. Frequent exposure to URTIs 3. Bottle feeding 4. Immature immune system 5. Infected tonsils & enlarged adenoids Common organisms: * Viral infection commonly precedes 2ry bacterial invasion Streptococcus pneumoniae Moraxilla catarrhalis H. influenzae * more frequent during infancy & early childhood Routes of infection Through the Eustachian tubes *commonest route! Through a drum perforation

Etiolo gy/ Cause s

virulent hemolytic streptococci *characterized by : 1. necrosis & sloughing of tissues 2. large tympanic perforation (SUBTOTAL) 3. predisposes: - CSOM (cholesteatoma) - foul smelling discharge - increase the risk of complications

ATTICO-ANTRAL - gram bacilli - anaerobes osteitis affects attic & mastoid antrum aka UNSAFE/ DANGEROUS type - risk of complications!!! 1.bone erosion, choleasteatoma 2.cranial complications

C/P

Patho tubal occlusion - blocked ET - negative pressure in ME catarrhal inflammation - hyperemia & transudation suppuration - collection of pus under pressure

Symptoms Sense of fullness in ear Earache May be mild fever Fever Increasing ear ache (esp in children & infants) b4 rupture of TM: High fever. Severe throbbing pain CHL

Signs - TM: appears retracted, congested & lustreless - Mild CHL - TM: retracted, congested (especially pars flaccida) + loss of cone of light - signs of fluid behind TM - mild CHL TM: markedly congested bulging, first in post 1/2 Later on a yellowish spot (ant. inf. quadrant) appears indicating impending rupture of TM - tenderness over mastoid process (mastoidism) *If it persists, it indicates bone involvement (mastoiditis) - mucopurulent discharge - small central perforation * frequently located in the anteroinferior quadrant but may be present anywhere in the pars tensa *discharge may appear pulsating in small perforatn

- severe ear pain - otorrhea (purulent offensive) - HL - large subtotal TM perforation

site

TUBOTYMPANIC (BENIGN/SAFE) - Eustachian tube - Tympanic cavity - odourless - profuse - muco-purulent - inter-mittent central

discharg e

perforati on

after rupture of TM: Rapid relief of pain, fever and CHL

cholasNo teatoma granulat Uncommon ions & polypi deafness Conductive - mild or moderate

ATTICO-ANTRAL (DANGEROUS/ UNSAFE) - Attic - Posterior part of middle ear - Mastoid antrum - offensive odour - scanty - purulent - continuous - attic - post-superior margin Yes Common

Conductive/ Mixed - moderate or severe

Resolution * unless complications occur

Resolution may occur with - treatment, or - after perforation

compl icatio ns treat ment

1. chronicity - facial nerve paralysis - mastoiditis 2. cranial & intracranial complications Before perforation: - Antibiotic, decongestant - Antipyretic- analgesic preparations After perforation : - Frequent cleaning of the ear - Culture & sensitivity of discharge Myringotomy Indications : Before perforation ; 1. Impending TM (yellowish spot) surgery heals better than pathological perforation 2. Persistent otalgia & fever after >48hrs treatment 3. Complications (eg: facial paralysis) 4. Recurrent AOM (>4 times/year) After perforation 1. Persistent discharge from small, non dependant perforation

2ry acquired cholesteatoma

Frequent aural toilets (cleaning) Culture and sensitivity of the discharge Systemic and local antibiotics Treatment of sequels and complications e.g. tympanoplasty

mastoi d Xray treatment

Cellular mastoid

Myringoplasty Tympanoplasty

A-cellular (sclerosed) mastoid Tympanomastoidectomy