Otitis Media

Prepared by Miss Jeevitha Verasamy

INTRODUCTION

Infection of the middle ear

Types of OM:1.Suppurative OM Acute - sudden in onset and short duration middle ear infection

Contd

Chronic Infection repeated, causing drainage and perforation caused by Pseudomonas, Staphylococcus and Klebsiella. OM is the second most common clinical problem in childhood after upper respiratory infection.

Pathophysiology

Prolonged obstruction of auditory tube impaired equalization of air in middle ear Air in middle ear space gradually absorbed; tube obstruction prevents more air entering middle ear. This results in negative pressure in the middle ear sterile serous fluid move from capillaries into the space, forming a sterile effusion of the middle ear

Middle ear infection (otitis media)

Acute Otitis Media

Chronic Otitis Media

Complication

Hearing loss: COM can lead to tympanic

membrane retraction, adhesive OM, or necrosis of the tympanic membrane (perforation) Acute mastoiditis: before the advent of antibiotics Tympanosclerosis

Contd

Cholesteatoma is a mass that forms in the middle 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

Cholesteatoma

Contd

Cholesterol granuloma: Blue drum syndrome Facial nerve paralysis Bacterial meningitis Brain abscess

Medical Management
Ear Irrigation Cleanse the external auditory canal Remove impacted wax, debris or foreign bodies Contraindication for clinical suspicion of perforated eardrum client

Ear Irrigation

Contd
Antibiotics Suction, irrigation or manual removal of matter with a cotton-tipped swab Antibiotic steroid eardrops

Administration of antibiotic

Cont

Surgical Management
Myringoplasty closure of a simple tympanic membrane perforation Tympanoplasty surgical correction of a perforated 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

Myringotomy- tympanostomy tubes

Contd

Ossiculoplasty surgical procedure of ossicular reconstruction Myringotomy (tympanocentesis) an incision 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

Patient care with OM

AOM will resolve spontaneously without specific treatment. Antibiotics should be avoided in mild to moderate cases and when there is diagnostic uncertainty in patients aged 2 years and under.

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.

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.

Further Management
Hospital admission should be considered for: Any child younger than 3 months with suspected AOM Children younger than 3 months of age with a temperature of 38C or more.

Contd

Children aged 3-6 months or more with a temperature of 39C. Suspected complications such as meningitis, mastoiditis, or facial paralysis.

Referral should be considered for:

Children with persistent symptoms not responding to antibiotics. Children with discharging or perforated ears whose condition has not fully resolved after 2-3 weeks. Children with recurrent AOM (defined as three or more episodes in six months or four or more episodes in one year).

Contd

Children with impaired hearing following AOM and aged under 3 with OME, bilateral effusions and hearing loss of less than 25 decibels but with no speech, language or developmental problems, observe initially.

Contd

Children under the age of 3 who go on to develop OM with bilateral effusions and hearing loss of less than 25 decibels but with no speech, language or developmental problems may be observed initially.

Contd

Children over the age of 3 who go on to develop OM or with language or behavioural problems may benefit from surgical intervention such as the insertion of grommets and should be referred for a specialist opinion.[11]

Prognosis

With the exception of the few complications given above, there is usually complete resolution in a few days.