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Acute Suppurative Otitis Media


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ASOM from Dhingra

Published in: Health & Medicine

Acute Suppurative Otitis Media

  1. 1. Acute Suppurative Otitis Media Acute inflammation of middle ear by pyogenic organisms
  2. 2. Aetiology Infants and children of lower socioeconomic group Follows viral infection of upper respiratory tract
  3. 3. Routes of Infection Via eustachian tube Via external ear Blood borne
  4. 4. Predisposing Factors Recurrent attacks of common cold, upper respiratory tract infections, exanthematous fevers Infections of tonsils or adenoids Chronic rhinitis and sinusitis Nasal allergy Tumours of nasopharynx, packing of nose, epistaxis Cleft palate
  5. 5. Bacteriology Streptococcus pneumoniae Haemophilus influenzae Moraxella catarrhalis Streptococcus pyogenes Staphylococcus aureus Pseudomonas aeruginosa
  6. 6. Pathology and Clinical Features Stage Pathology Symptoms Signs Tubal Occlusion • Oedema & hyperaemia of nasopharyng eal end of tube • Retraction of TM • Deafness • Earache • TM retracted • Handle of maleus more horizontal • Lateral process of maleus prominent • Loss of light reflex • Conductive deafness
  7. 7. Stage Pathology Symptoms Signs Presuppuration • Pyogenic organsims invade tympanic cavity • Hyperaemia of lining • Inflammatory exudate in middle ear • TM congested • Earache o Throbbing o Disturbs sleep • Adults – deafness & tinnitus • Children – Fever • Congestion of pars tensa • Cartwheel appearance of TM • Conductive deafness Suppuration • Pus in middle ear • TM bulges out • Severe earache • Deafness increases • Fever o Vomiting o Convulsions • TM o Red o Bulging o Loss of landmarks • Tenderness over mastoid antrum
  8. 8. Stage Pathology Symtoms Signs Resolution • TM ruptures • Release of pus • Subsidence of symptoms • Earache relieved • Fever subsides • EAC may contain blood-tinged discharge • Later becomes mucopurule nt Complication • Virulence of organism is high • Resistance of host is poor • Acute mastoiditis • Labyrinthitis • Subperiosteal abscess • Facial paralysis • Petrositis • Extradural abscess • Meningitis • Brain abscess • Lateral sinus thrombophlebitis
  9. 9. Treatment Antibacterial therapy Ampicillin 50mg/kg/day in 4 divided doses Amoxicillin 40mg/kg/day in 3 divided doses Decongestant nasal drops Ephedrine (1% in adults & 0.5% in children) Oxymetazoline Xylometazoline Oral nasal decongestants Pseudoephedrine 30mg twice daily
  10. 10.  Analgesics & antipyretics  Paracetamol  Ear toilet  Dry-mopping  Dry local heat  Relieves pain  Myringotomy  Drum is bulging; acute pain  Incomplete resolution despite antibiotics; persistent conductive deafness  Persistent effusion beyond 12 weeks
  11. 11. Acute Necrotising Otitis Media  Variety of ASOM seen in children suffering from exanthematous fevers  Caused by B-haemolyticus streptococci  Rapid destruction of entire tympanic membrane  Profuse otorrhea  Healing followed by fibrosis or secondary acquired cholesteatoma
  12. 12. Treatment Antibacterial therapy for a least 7-10 days Cortical mastoidectomy Medical treatment fails to control Condition gets complicated by acute mastoiditis
  13. 13. Thank you