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Acute otitis media
Acute otitis media (AOM) is an inflammation of the middle ear cleft mucosa that is classified as either acute (lasting up to 3 weeks), subacute (3 weeks to 3 months), or chronic (over 3 months). AOM is commonly caused by viruses that lead to upper respiratory tract infections in children ages 3 to 7. It is characterized by symptoms like earache, fever, and hearing loss. Diagnosis involves examining the red and bulging tympanic membrane. Treatment primarily involves antibiotics, analgesics, and ear drops if perforation is present. Surgery is rarely needed and includes procedures like myringotomy or mastoidectomy for complications or treatment failures.
Acute otitis media
- 1. Acute otitis media (AOM) 9/6/2014 AOM:IOMJuly2010 1
- 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
- 6. Stages of AOM Hyperemia Exudation Suppuration Coalescence & surgical mastoiditis Complication Resolution 9/6/2014 AOM:IOMJuly2010 6
- 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 : surgicalmanagement 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
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- 16. Mastoid abcess 9/6/2014AOM:IOMJuly2010 16
- 17. Simple mastoide ctomy 9/6/2014 AOM:IOMJuly2010 17
- 18. End result of simple mastoidectomy 9/6/2014 AOM:IOMJuly2010 18