Otitis media

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Otitis media

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Otitis media

  1. 1. OTITIS MEDIA
  2. 2. DEFINITION Inflammation of the middle ear. May also involve inflammation of mastoid, petrous apex, and perilabyrinthine air cells
  3. 3. Classification  Acute OM - rapid onset of signs & symptoms, < 3 wk course  Sub-acute OM - 3 wks to 3 months  Chronic OM - 3 months or longer
  4. 4. Etiology  Age: Common among children due to shorter Eustachian tube
  5. 5.  Adenoiditis, Tonsillitis, Rhinitis, Sinusitis, Pharyngitis & infections secondary to cleft palate  Trauma to the TM  Head injury  Barotrauma
  6. 6. Pathology 1. Catarrhal stage: is characterized by occlusion of Eustachian tube and congestion of middle ear. 2. Stage of exudation: Exudate collects in the middle ear and ear drum is pushed laterally. Initially the exudate is mucoid, later it becomes purulent.
  7. 7. Pathology 3. Stage of suppuration: Pus in the middle ear collects under tension, stretches the drum & perforates it by pressure necrosis & the exudate starts escaping into external auditory canal 4. Stage of healing: The infection starts resolving from any of the stages mentioned & usually clears up completely without leaving any sequelae.
  8. 8. Pathology 5. Stage of complications: Infection may spread to the mastoid antrum. Initially it causes Catarrhal mastoiditis [congestion of the mastoid mucosa], stage of Coalescent mastoiditis & later empyeme of the mastoid
  9. 9. Clinical manifestations: ASOM 1. Catarrhal stage (stage of congestion)  Fullness or heaviness in the ear  Severe ear pain at night  Deafness  Tinnitus (ringing or buzzing in the ear)  Autophony (spoken words of patient echo in his ears)  TM (ear drum) gets retracted  Cart wheel appearance of ear drum  Absence of light reflex
  10. 10. 2. Stage of exudation  All symptoms becomes more severe.
  11. 11. 3. Stage of suppuration  Perforation of Ear drum  Otorrhoea with mucoid purulent discharge  Pulsatile discharge (ear discharge with each arterial dilation) [Lighthouse sign]
  12. 12. 4. Stage of healing  Healing starts in this stage
  13. 13. 5. Stage of complication  Spread of infection to mastoid
  14. 14. Diagnosis  Tuning fork test and audiometry  Radiography  Bacteriological examination of the ear discharge  Pneumatic otoscopy is gold standard
  15. 15. Treatment - AOM  Systemic  Antibiotics: Tetracycline, erythromycin, ampicillin or penicillin for 6 days  Systemic decongestants: Phenylephrine HCl  Local  Glycerine carbolic ear drops or warm olive oil reduces pain before perforation of TM.  Antibiotic drops : Chloramphenicol, spirit boric drops is used after perforation of TM.
  16. 16. Surgery  Myringotomy: The TM is incised to drain the middle ear cavity.  Myringo-puncture: Puncturing the ear drum with a long thick injection needle & aspirating the middle ear contents.
  17. 17. Chronic Otitis Media  It is the chronic infection of middle ear cleft mucosa.  Chronic Suppurative Otitis Media (CSOM): accompanied by continuous or intermittent otorrhoea  Chronic Non-Suppurative Otitis Media: No otorrhoea  Chronic Specific Otitis Media: Tb OM or syphilitic OM
  18. 18. CSOM 1. Benign or tubotympanic type with central perforation of the ear drum: The disease is limited to the TM & the Eustachian tube. No complications occur as a rule. 2. Dangerous or Attico-antral type with attic and marginal perforation: It is characterised by the presence of destructive cholesteatoma, which may spread beyond the ear cleft causing life threatening complications
  19. 19. Etiology:CSOM  AOM which fails to heal.  Acute necrotic OM  Traumatic large perforation  Congenital cholesteatoma
  20. 20. Pathology Benign or tubotympanic type Etiological factors Necrosis of ear drum portion which has poor blood supply Necrosis of ossicular chain Sclerosis of mastoid bone Polyp formation
  21. 21. Dangerous / Attico-antral type Cholesteatoma formation Polyps and granulation Perforation and retraction of ear drum Partial or complete damage of Ossicles
  22. 22. Cholesteatoma
  23. 23. Clinical stages  Benign perforation  Active stage : discharge is actively flowing  Quiescent stage : ear remains dry for up to 6 months  Inactive stage : Ear remains dry for > 6 months  Dangerous perforation  Active stage  Inactive stage
  24. 24. Diagnosis  Examination of nose and pharynx to find any septic focus or an obstruction around the Eustachian tube  Hearing test [voice test, tuning fork test, audiometry]: Conductive deafness up to 60 db hearing loss  Radiology of the mastoid
  25. 25. Diagnosis  Testing the patency of Eustachian tube:  Using ear drops  Using Valsalva maneuver  Otomicroscopy: perforation, cholesteatoma, polyps
  26. 26. Management of Benign Perforation  Adenoidectomy, tonsillectomy; treatment of      sinusitis & DNS to remove the septic focci Antibiotic ear drops Chemical cautery using 50% trichloro acetic acid TT injection Tympanoplasty: Reconstruction of middle ear and ossicular chain after removing the active disease Myringoplasty : repair of defect in TM
  27. 27. Management of dangerous perforation  Suction and cleaning of cholesteatoma  Excision of polyps and granulomas  Mastoidectomy  Atticotomy & atticoantrostomy  tympanoplasty
  28. 28. Complications Mastoid infection  Mastoiditis  Mastoid abscess Extracranial complications Intracranial complications  Petrositis  Extradural abscess  Facial nerve  Subdural abscess palsy  Labyrinthitis  Meningitis  Sigmoid sinus thrombophlebitis  Brain abscess  Otitis hygrocephalus
  29. 29. THANK YOU

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