Asom
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  • 1. Acute Suppurative otitis media Dr. T. Balasubramanian M.S. D.L.O. drtbalu
  • 2. Definition It is defined as suppurative infection involving the mucosal lining of middle ear cleft. The term acute is used to indicate infections of less than 3 weeks duration drtbalu
  • 3. Pathophysiology Obstructed Eustachean tube Recurrent upper respiratory infections can lead to microbial contamination of middle ear via the Eustachean tube Naso pharyngitis Nasal allergy drtbalu
  • 4. Microbiology Commonly viral (Viral infections help bacteria to adhere to the middle ear mucosa) Bacteria implicated include: S. Pneumoniae H. Influenza M. Catarrhalis These infections commonly affects children because their Eustachean tubes are shorter, wider and straighter facilitating easy efflux of contaminants in to the middle ear cavity from Nasopharynx drtbalu
  • 5. Role of Eustachean tube Patulous Eustachean tube Hypotonic Eustachean tube Congenital abnormalities of 1st and 2nd arch drtbalu
  • 6. Flask model ET, Middle ear, and mastoid air cell system can be likened to be that of a flask with a narrow neck The mouth of the flask is the nasopharyngeal end of ET Narrow neck is the isthmus of the ET Bulbous portion is the middle ear chamber and mastoid system drtbalu
  • 7. Flask model Fluid flow through the neck of the flask is dependent on: 1. Pressure at either end 2. Radius & length of the neck 3. Viscosity of the liquid When a small amount of liquid is instilled into the mouth of the flask, liquid flow stops somewhere in the narrow neck owing to capillarity within the neck and the relative positive air pressure that develops in the chamber of the flask. drtbalu
  • 8. Flask model drtbalu
  • 9. Protective function of ET ET protects middle ear from nasopharyngeal contamination The basic geometry of the ET is considered to be critical for this function Reflux of liquid into the body of the flask occurs if the neck of the flask is wide / length of the neck of flask is short as is the case in children drtbalu
  • 10. Differences between ET in adult / child drtbalu
  • 11. Why ASOM is common in children? Because of ET geometry Because of recumbent position commonly occupied by the child drtbalu
  • 12. Diagram showing pathophysiology of ASOM drtbalu
  • 13. ASOM (Stages) Stage of Hyperemia Stage of exudation Stage of suppuration Stage of resolution The progression of these stages are dependent on: 1. Virulence of infecting organism 2. Host immunity 3. Adequacy of antibiotic therapy drtbalu
  • 14. Hyperemia Hyperemia of mucous membrane Otalgia / fever / fullness common Antibiotics during this stage will help in the resolution of disease drtbalu
  • 15. Exudation Out pouring of fluid from the blood vessels of mucoperiosteum of middle ear Fluid is initially serous in nature The whole middle ear cavity is tense Suppuration eventually follows Ear drum starts to bulge These patients have mastoid tenderness drtbalu
  • 16. Suppuration Exudate present in the middle ear suppurates due to superadded infection This stage needs to be treated with antibiotics drtbalu
  • 17. Resolution This stage is preceded by rupture of ear drum Discharge from the middle ear starts to flow out (Light House sign) These patients have reduced Otalgia Fever if present subsides Patients show excellent clinical improvement drtbalu
  • 18. Complications Presence of middle ear infections for more than 2 weeks cause complications This is due to obstruction of normal drainage of middle ear due to thickening of mucoperiosteum Complications commonly include coalescent mastoiditis, subperiosteal abscess These patients have low grade fever and Otalgia drtbalu
  • 19. Management Antibiotics (Amoxicillin / Cephalosporins) In resistant cases Myringotomy Subperiosteal abscess if present should be treated surgically Treatment of focal sepsis (sinusitis / adenotonsillitis) drtbalu
  • 20. drtbalu