2. OTITIS MEDIA : Definition
• Definition-Inflammation of middle ear cleft mucosa
• Classification (Senturia et al, 1980)
– Acute otitis media (upto 3 weeks)
– Subacute otitis media ( 3 weeks- 3 months )
– Chronic otitis media ( >3 months)
9/6/2014 AOM:IOMJuly2010 2
3. ACUTE OTITIS MEDIA
Definition- acute inflammation of the MEC
• AOM vs ASOM
ASOM is one of the types of AOM
• AOM vs OME
Acute OME may follow AOM
Incidence
50% in the 1st year of life.
Remains high in the first 5 yr of life
Thereafter tails off and infrequent in teenagers.
9/6/2014 AOM:IOMJuly2010 3
4. AOM : Aetiology
• Predisposing factors :
teething
poor sanitation & hygiene
ovecrowding
malnutrition
• Age – 3 to 7 years
• Risk factors – rhinosinusitis, adenoid, ET
dysfunction, chest diseases
9/6/2014 AOM:IOMJuly2010 4
5. AOM : etiology (contd..)
Viruses : causing URTI
Bacteriology:
– Streptococcus pneumoniae
– Hemophilus influenzae
– Moxerella catarrhalis
• Via Eustachian tube
ET in children – short, wide, horizontal
• Via a perforated TM
• Blood borne rarely
9/6/2014 AOM:IOMJuly2010 5
7. Symptoms of AOM
• H/O preceding URTI,
• Depends on the stage
• Earache - cardinal symptom
• hearing loss with or without ear discharge
• Fever
• symptoms of complications
• Classical scenario –
cough and cold leading to earache followed by
blood stained discharge and decrease in the
severity of pain
9/6/2014 AOM:IOMJuly2010 7
8. AOM : signs
• Depends on the stage
• red, bulged tympanic
membrane. There maybe
perforation and discharge
in 1/3rd cases.
• 85% of perforation in
anteroinferior quadrant,
15% in posteroinferior
quadrant.
• Signs of complications
• Reservoir sign Congested, bulged TM
9/6/2014 AOM:IOMJuly2010 8
9. AOM : investigations
• Uncomplicated AOM – no investigations
• AOM with complication :
Hb TC DC
BS LFT RFT
Urine : R/ME
Plain X-ray mastoids
CT/MRI of temporal bone and surroundings
9/6/2014 AOM:IOMJuly2010 9
10. AOM : MANAGEMENT
• Majority respond to Conservative management
• Rest, analgesic / antipyretic
• Antibiotics ( Amoxycillin- drug of choice) X 7-10 days
• Antibiotic ear drops if perforation
• No roles of antihistamines and decongestant. Maybe
given for symptomatic relief.
• In treatment failures
– Repeat the 1st line antibiotics for 10 days more
– 2nd line antibiotics
– Myringotomy / simple mastoidectomy
9/6/2014 AOM:IOMJuly2010 10
11. AOM : surgical management
Rarely needed when :
conservative management fails
complication occurs
1. Myringotomy +/- VTI
2. Simple (Cortical, Schwartze ) mastoidectomy
3. Surgery for complication
Recurrent acute otitis media
Long term antibiotics
VTI
? Adenoidectomy
9/6/2014 AOM:IOMJuly2010 11
12. Barotraumatic OM
• During or after descent from hills, aircraft
similar to AOM
• Due to ET block because of pressure differences
• Precautions
avoid flight during cold
frequent swallowing
? VTI
9/6/2014 AOM:IOMJuly2010 12
13. • C:Documents and
SettingspawanDeskt
opaom1.JPG
9/6/2014 AOM:IOMJuly2010 13
