Otitis media

2.  First level
 Second level
 Third level
 Fourth level
 Fifth level

3. EXTERNAL EAR
MIDDLE EAR
INTERNAL EAR
Middle ear(focused)

4. External Ear
 Consists of the auricle, or pinna,
which lies at the outer end of a short
tube called the external acoustic
meatus.
 The auricle funnels sound waves
through the external acoustic
meatus to the tympanic membrane.
Middle Ear
 An air-filled chamber that
transmits sound waves from air
to the auditory ossicles and then
to the fluid filled inner ear.
 Consists of:
• Tympanic cavity proper
• Eustachian tube
• Ear ossicles
Tympanic membrane, a 3-layered structure is the borderline between
these two.
Eustachian tube connects middle ear with nasopharynx. It maintains
pressure on either side of tympanic membrane.
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5.  The inner ear contains the
functional organs for hearing
and equilibrium.
 It consists of a series of bony
cavities (bony
labyrinth),within which is a
series of membranous ducts
(membranous labyrinth),
fluids (outer perilymph and
inner endolymph).

6. The term otitis media is composed of otitis, ancient Greek for
“inflammation of ear", and media Latin for “middle”.
Otitis media is a group of inflammatory disease of the middle ear.
PREVALANCE
 A patient with otitis media (middle ear infection) will present with a red bulging tympanic
membrane, which is usually due to a buildup of fluid or mucus.
 Because the auditory tube is shorter and more horizontal in children, it is easier for infection
to spread from the nasopharynx to the middle ear, resulting in a higher prevalence of otitis
media in children compared to adults.
 Acute otitis media affects 11% of people each year with half occurring in those below 5 years.
TYPES
1. Acute otitis media(for <3 weeks)
2. Chronic otitis media(for >3 months)

7. Otitis media for <3 weeks
PEAK INCIDENCE = First 3-18 months
ROUTES OF INFECTION
1. Via Eustachian Tube  most common
2. Via External Ear  traumatic perforation of tympanic
membrane
3. Blood Borne uncommon

8. • Recurrent common cold, URTI
• measles, diphtheria, whooping cough
• Infection of tonsils & adenoids
• Chronic rhinitis & sinusitis
• Nasal allergy
• tumors of nasopharynx

9. • BACTERIAL Streptococcus pneumoniae(40-50%),
Hemophilus influenza(25%),Moraxella
catarrhalis(10%),Staphylococcus aureus
• VIRAL Respiratory syncytial virus, Influenza virus, Rhino
virus, Enterovirus
• FUNGI Candida and Aspergillus

11. Inflammation and edema of
respiratory mucosa of nose,
nasopharynx and eustachian tube
Obstruction of eustachian tube
Accumulation of secretions of middle ear
Air in middle ear is resorbed into
circulation creating negative pressure
Negative pressure pulls virus and bacteria
into middle ear causing infection and
inflammation of middle ear

12. Inflammation
Release of inflammatory
cytokines that disrupts
hypothalamic set point
fever
pressure in middle ear that
stretches tympanic membrane
Bulging TM
Neutrophilic infiltration
in middle ear
Yellow or white
pus behind TM
Vasodilation of TM
blood vessels
TM Erythema
TM  Tympanic
membrane

13. • TM Perforation
• Hearing loss
• Mastoiditis
• Abscess