Acute suppurative otitis media

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a brief review of acute suppurative otitis media for medical students and physicians

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  • ET, aditus, antrum, mastoid air cells.
  • Mucosa of nasopharyngeal end of ETThere is negative intratympanic pressure
  • Acute suppurative otitis media

    1. 1.  Acute suppurative otitis media is defined as suppurative infection involving the mucosa of the middle ear cleft.  By convention it is termed acute if the infection is less than 3 weeks in duration. nihar.gupta99@gmail.com 2
    2. 2. nihar.gupta99@gmail.com 3
    3. 3. It occurs more easily:  In children and infant  In winter and spring  After upper respiratory infection  Measles, diphtheria, tonsillitis, chronic infection of sinuses and nasal allergy are other predisposing factors nihar.gupta99@gmail.com 4
    4. 4.  Streptococcus pneumoniae (30%)  Haemophilus influenzae (20%)  Moraxella catarrhalis (12%)  Others: Streptococcus pyogenes, Staphylococcus aureus and Pseudomonas aerugenosa  No growth in 18-20% cases  Viruses: RSV, influenza, rhino & adeno virus nihar.gupta99@gmail.com 5
    5. 5. nihar.gupta99@gmail.com 6
    6. 6.  It is the most common route.  CHILDREN ARE MORE SUCCEPTIBLE: 1. Eustachian tube in infants and young children is shorter, wider, more horizontal and less stiff. 2. Large adenoids can interfere with the opening of the tube 3. Immune system is not fully developed nihar.gupta99@gmail.com 7
    7. 7.  A small tube connecting the middle ear to the nasopharynx  FUNCTIONS 1. Regulate and equalize pressure of middle ear 2. Prevent fluid from accumulating in the middle ear 3. Protect from the nasopharyngeal infection nihar.gupta99@gmail.com 8
    8. 8. •In children ET is at an angle of 10° while in adults it is at an angle of 45°. •ISTHMUS is a narrowing in the ET, at the junction of the cartilaginous and bony part. •It is only present in adults.nihar.gupta99@gmail.com 9
    9. 9.  Associated with TM perforation  Eg. TM trauma, insertion of tympanostomy tubes, tympanometry, myringotomy  This is an uncommon route nihar.gupta99@gmail.com 10
    10. 10.  The disease runs through the following stages: 1. Stage of tubal occlusion 2. Stage of pre-suppuration 3. Stage of suppuration 4. Stage of resolution or complication nihar.gupta99@gmail.com 11
    11. 11. Mucosa: Hyperemia, Swelling Eustachian tube is occluded Intratympanic pressure ↓ Air ↓ fluid ↑ Tympanic membrane retracts nihar.gupta99@gmail.com 12
    12. 12. TM RETRACTS Tinnitus Ear fullness Earache Hearing loss nihar.gupta99@gmail.com 13
    13. 13.  TM retracted 1. Foreshortened handle of malleus 2. No cone of light 3. Prominent lateral process of malleus  Conductive deafness in tuning fork test nihar.gupta99@gmail.com 14
    14. 14. Bacteria invade tympanic cavity Hyperemia Inflammatory exudate Congested TM nihar.gupta99@gmail.com 15
    15. 15.  EARACHE  Deafness  Tinnitus  High fever (children)  Cartwheel appearance of TM nihar.gupta99@gmail.com 16
    16. 16. Pus increases TM is compressed, ischemic TM is tense and bulges TM necrosis nihar.gupta99@gmail.com 17
    17. 17.  EXCRUCIATING PAIN  Deafness  Fever 102-103°F (Children)  Vomiting  Convulsions  X ray mastoid: clouding of air cells due to exudate. nihar.gupta99@gmail.com 18
    18. 18.  Follows TM perforation  Earache relieved at once  General condition(temp, wbc count) improves nihar.gupta99@gmail.com 19
    19. 19.  Intratemporal(within the confines of temporal bone) 1. Acute mastoiditis 2. Facial paralysis 3. Labyrinthitis 4. Petrositis  Intracranial: 1. Extradural abscess 2. Subdural abscess 3. Meningitis 4. Brain abscess 5. Lateral sinus thrombophlebitis 6. Otic hydrocephalous nihar.gupta99@gmail.com 20
    20. 20.  Control infection  Local therapy  Treat related disease nihar.gupta99@gmail.com 21
    21. 21.  Arrest & reverse inflammation  Prevent suppuration and perforation  Relieve symptoms, hasten resolution  Reduce risk of complications  AMPICILLIN (50 mg/kg/day in 4 divided doses)  AMOXICILLIN (40 mg/kg/day in 3 divided doses) nihar.gupta99@gmail.com 22
    22. 22.  BEFORE PERFORATION  Relieve earache & control inflammation: 1. Decongestant nasal drops(ephedrine, oxymetazoline, xylometazoline) 2. Oral nasal decongestant (pseudoephedrine) 3. Analgesic & antipyretic(paracetamol) nihar.gupta99@gmail.com 23
    23. 23.  Myringotomy is a surgical procedure in which a tiny incision is created in the eardrum to relieve pressure caused by excessive buildup of fluid, or to drain pus from the middle ear.  A tympanostomy tube is inserted into the eardrum to keep the middle ear aerated for a prolonged time and to prevent reaccumulation of fluid. nihar.gupta99@gmail.com 24
    24. 24. nihar.gupta99@gmail.com 25
    25. 25.  INDICATIONS : 1. Symptoms are not relieved by antibiotics 2. TM bulges significantly 3. TM perforation is too small 4. Incomplete resolution 5. Persistent effusion beyond 12 weeks nihar.gupta99@gmail.com 26
    26. 26.  AFTER PERFORATION 1. Clear external acoustic canal-Ear toilet 2. Control infection 3. Repair TM nihar.gupta99@gmail.com 27
    27. 27.  Chronic rhinitis  Chronic sinusitis  Chronic tonsillitis  Adenoid vegetation nihar.gupta99@gmail.com 28
    28. 28.  MEATAL FURUNCLE 1. No hearing loss 2. TM is normal  ACUTE MYRINGITIS 1. Severe earache 2. Hearing loss is slight 3. TM: hyperemia and bulla forms 4. After influenza or zoster infection nihar.gupta99@gmail.com 29
    29. 29. nihar.gupta99@gmail.com 30

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