OTITIS MEDIA(O.

M)

Definition: Mucosa part of middle ear infection

Types:
o Acute suppurative O. M. acute infection caused
by bacteria
o Acute infection by virus (viral otitis media)
o Acute necroticans O.M.
o Allergic O.M.
o Chronic tuberculous O.M.
o Chronic Suppurative O.M.

Predisposition Factors
o Age ( 6-12 year old)
o Socio-economic
o Season (winter)
o Respiratory tract diseases
o Allergy
o Deficiency syndrome
o Palatoschisis

Incidence of OM:
o Highest incidence 6-12 months
o second peak age 4-5 years
o Indonesia (National Survey 1996) 3.8%
Primary school 3.4%
o

Complications:
o Intracranial Complications:
1. Thrombophlebitis sinus sigmoideus
2. Perinus abscess
3. Meningitis
4. Sub-dural abscess
5. Epidural Abscess
6. Brain abscess
7. Hydrocephalus otitis
o Intratemporal complications:
1. Mastoiditis
2. Petrositis
3. Labyrintitis
4. Retroauricular abscess
5. Facial nerve Parese / paralysis
6. Bezold abscess
7. Citelli abscess

Types

Acute Suppurative O.M

(ASOM)

Chronic Suppurative O.M

(CSMOM)
Benign CSOM

Acute inflammation
bacteria

Etiology

Bacteria:

Strep.pneumoniae(18%)
H.influenza (18%)
M.catarrhalis(11%)
Bacteria enter the tympanic cav. via :
Eustachian tube
Tympanic membrane(perforation
/ruptur)
Hematogenous
1. Std. Hyperemic
2. Std. Exudation
( serum + fibrin + RBCs + PMN)
3. Std. Suppuration
(because of miringotomy/ perforation)
4. Std. Coalescence & mastoiditis
5. Std. Complication
6. Std. Resolution

Pathology

caused

by o Chronic inflammation
o a cool type
o without cholesteatoma

Description

Chronic Tuberculosis O.M

(CTOM)

Malignant CSOM
o Chronic inflammation
o dangerous type
o with cholesteatoma

ears of active benign CSOM

all are aerobic gram negative:
Proteus mirabilis
Klebsiella sp.
Proteus vulgaris

Rare
Characteristic: typical
tympanic membrane with
multiple
perforation
progressive hearing loss &
Severe
M.tuberculosis

Clinical
Features

1. Std. Hyperemic

Earache
Obstructive sensation in the ear
tube occlusion
Fever
Hearing : nearly normal
2. Std. Exudation
Earache & fever increased
Hearing loss
In baby : vomiting, seizure,
meningismus
Mastoid pain on palpation
3. Std. Suppuration
Ear discharged (serosanguinolent
mucopurulent)
Earache is decreased
Fever ( + / - )
Hearing loss
General status is good
4. Std. Coalescence & mastoiditis
Earache nokturnal
Fever +
Mastoid pain on palpation /
abscess (+)
Ear discharged > 2 weeks ( some
profused)
5. Std. Complication
Sigmoid sinus Thrombophlebitis
Brain abscess
Meningitis
Petrositis

Moderate hearing loss

Mucoid/mucopurulent
discharged

ear

Severe hearing loss

Ear discharged foetor

severe +
hearing loss

progressive

Subperiosteum
retro-aurikuler
abscess
Facial nerve Parese/paralysis
Labiryntitis
Perisinus/extradural abscess
6. Std. Resolution
Ear discharged diminished
Normal Hearing
Diagnosis

Ortoscopy:
1. Std. Hyperemic
arterial injection on tympanic
membran around manubruim M.
on the border of pars tensa and
flaccida
2. Std. Exudation
MT bombans, hyperemic
3. Std. Suppuration
Perforation (small) pars tensa +
ear discharged
4. Std. Coalescence & mastoiditis
narrowing of external meatus
caused by a sagging of the
postero-superior wall
5. Std. Complication
6. Std. Resolution
Perforation central/small
closed
X-ray mastoid :
cellulae mastoid become clouded(std.
exudation)

Ortoscopy:
Ortoscopy:
Typical perforation: Central Typical
Perforations:
( small -- wider/total )
marginal, post-sup, attic (pars
Mucosa
of
Tympanic
flaccida), total
cavity: hyperemic, thick
Granulation tissue /polyps
Exacerbation
of
acute
infection will recur
X-Ray mastoid :
radiolucent
area
(+)
(cholesteatoma)
White piece floating on ear
spooling water

Ortoscopy:
typical
tympanic
membrane with multiple
perforation

Chest x-ray, PPD, & culture /

swab, biopsy

Management

1. Antibiotic(attention to resistance)
ASOM limited episode:
First line antibiotic
Persistent infection :
Second line or broad spectrum
antibiotic
**Consider tympanocentesis if
unresponsive
Recurrent episodes
(> 3 episodes in 6 months):
Antibiotic prophylaxis
2. Symptomatic(antipiretic,
analgetic)
3. Nasal decongestant / allergy
treatment
4. Operation :
Myringotomy for drainage
Mastoidectomy in Coalescence
and complication std. (simple
mastoidectomy)
Otolaryngology referral
Failed medical therapies
Hearing loss (> 20 dB)
Tympanic membrane changes
Mastoiditis
Persistent ear discharge
Intracranial complications

Response medicine therapy

Unresponsive medicine therapy Suspected TB O.M. :

(unhealed )
Chronic O.M. unresponsive to
routine therapy / TB Patients
+ chronic infection in the ear

Treatment:
antibiotic(penicillin)
Eustachian tube dysfunction
(causative)

Treatment:
Treatment:
Radical mastoidectomy in order Anti-TB
to :
1. Stop bone erosion
2. Antrum + cellulae, and
tympanic cavity
(United together with exter.
meatus
to one bigger cavity,
dried,
inactive skin-lined
cavity)

Complication

Information

w/o complication
Sigmoid sinus Thrombophlebitis
Brain abscess
Meningitis
Petrositis
Subperiosteum
retro-aurikuler
abscess
Facial nerve Parese/paralysis
Labiryntitis
Perisinus/extradural abscess

Antimicrobial agents for ASOM:

First line(Amoxicillin)
Second line
Amoxicillin-clavulanate
Trimethoprimulfamethoxazole
Erythromycin sulfamethoxazole
Broad spectrum
Cefixime
Azithromycin
Clarithromycin

Associated with complication

Cholesteatoma:
Characteristic: epidermoid cyst
containing keratin
Two types (histological is not
differ):
1. Congenital Cholesteatoma
2. Acquired Cholesteatoma
akuisita :
a. Primary cholesteatoma

b. Secondary cholesteatoma

Erosive to bone layer