Acute Otitis Media (AOM) is an infection of the middle ear caused by bacteria or viruses. It is common in young children, especially between 6-18 months of age. Risk factors include daycare attendance, lack of breastfeeding, exposure to tobacco smoke, and underlying conditions like cleft palate. AOM is diagnosed based on signs of bulging of the eardrum, fluid, or pus behind the eardrum seen on pneumatic otoscopy. Common bacteria that cause AOM include Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Recurrent AOM is defined as three or more episodes within 6 months or four episodes within
Provides detailed in formation on otitis media.It is subdivided into:
Table of content
Literature review
Patient information
medical and surgical management
nursing careplan
and it is well referenced.
It provides more information on better management of ENT patient.
Can be used by anyone in the medical or nursing field.
Thank you for selecting our 𝐨𝐭𝐢𝐭𝐢𝐬 𝐦𝐞𝐝𝐢𝐚 PPT
This medical PowerPoint template about 𝐨𝐭𝐢𝐭𝐢𝐬 𝐦𝐞𝐝𝐢𝐚
You can download our template by visiting our website:
https://www.rxslides.com/product/otitis-media-powerpoint-template
copy and paste this URL into the browser and download the full editable template.
This 𝐨𝐭𝐢𝐭𝐢𝐬 𝐦𝐞𝐝𝐢𝐚 animated template is designed by RxSlides, a medical professional team covering the following topics about 𝐨𝐭𝐢𝐭𝐢𝐬 𝐦𝐞𝐝𝐢𝐚:
𝐀𝐧𝐚𝐭𝐨𝐦𝐲 𝐚𝐧𝐝 𝐅𝐮𝐧𝐜𝐭𝐢𝐨𝐧 𝐨𝐟 𝐭𝐡𝐞 𝐌𝐢𝐝𝐝𝐥𝐞 𝐄𝐚𝐫
The ear consists of three parts: the outer ear, middle ear, and inner ear.
The middle ear transmits sound vibrations from the eardrum to the inner ear.
The Eustachian tube protects, aerates, and drains the middle ear.
𝐃𝐞𝐟𝐢𝐧𝐢𝐭𝐢𝐨𝐧
𝐨𝐭𝐢𝐭𝐢𝐬 𝐦𝐞𝐝𝐢𝐚 is an infection that causes inflammation and fluid buildup in the middle ear.
𝐩𝐫𝐞𝐯𝐚𝐥𝐞𝐧𝐜𝐞
Otitis media is a common condition, affecting millions of people worldwide.
𝐑𝐢𝐬𝐤 𝐅𝐚𝐜𝐭𝐨𝐫𝐬
Risk factors for otitis media include family history, smoking, pacifier use, bottle feeding, and male gender.
𝐜𝐚𝐮𝐬𝐞𝐬
Otitis media is most commonly caused by upper respiratory tract infections, viruses, and bacteria.
𝐏𝐚𝐭𝐡𝐨𝐩𝐡𝐲𝐬𝐢𝐨𝐥𝐨𝐠𝐲
Otitis media occurs when the Eustachian tube becomes blocked, allowing mucus to build up and bacteria or viruses to multiply.
𝐓𝐲𝐩𝐞𝐬
The three main types of otitis media are:
o Acute otitis media (AOM)
o Chronic suppurative otitis media (CSOM)
o Otitis media with effusion (OME)
𝐀𝐜𝐮𝐭𝐞 𝐨𝐭𝐢𝐭𝐢𝐬 𝐦𝐞𝐝𝐢𝐚 (𝐀𝐎𝐌)
is the most common type of otitis media, characterized by a sudden onset of inflammation and fluid buildup in the middle ear, typically within 48 hours
𝐂𝐡𝐫𝐨𝐧𝐢𝐜 𝐒𝐮𝐩𝐩𝐮𝐫𝐚𝐭𝐢𝐯𝐞 𝐎𝐭𝐢𝐭𝐢𝐬 𝐌𝐞𝐝𝐢𝐚 (𝐂𝐒𝐎𝐌)
Chronic suppurative otitis media (CSOM) is a persistent inflammatory condition of the middle ear characterized by chronic discharge from the ear (otorrhea), perforation of the eardrum (tympanic membrane perforation), and middle ear mucosal inflammation.
𝐒𝐲𝐦𝐩𝐭𝐨𝐦𝐬
Symptoms of otitis media include:
o Loss of appetite
o Hearing impairment
o Earache
o Pus from the ear
o Headache
o Weakness
o Dizziness
o Fever
𝐃𝐢𝐚𝐠𝐧𝐨𝐬𝐭𝐢𝐜 𝐦𝐞𝐭𝐡𝐨𝐝𝐬
Otitis media is diagnosed using a combination of physical examination, otoscope exam, tympanometry, and audiometry.
𝐂𝐨𝐦𝐩𝐥𝐢𝐜𝐚𝐭𝐢𝐨𝐧𝐬
Complications of otitis media include:
o Spread of infection
o Hearing loss
o Speech delay
o Eardrum ruptures
𝐓𝐫𝐞𝐚𝐭𝐦𝐞𝐧𝐭 𝐎𝐩𝐭𝐢𝐨𝐧𝐬
Treatment options for otitis media include:
Antibiotics
Pain relief
Observation
Ear drainage
Managing underlying conditions
Tympanostomy
𝐏𝐫𝐞𝐯𝐞𝐧𝐭𝐢𝐯𝐞 𝐌𝐞𝐭𝐡𝐨𝐝𝐬
Stopping colds
Breastfeeding
Eliminating allergens
Managing stress
Chiropractic care
Visit our site for more animated templates
𝗵𝘁𝘁𝗽𝘀://𝘄𝘄𝘄.𝗿𝘅𝘀𝗹𝗶𝗱𝗲𝘀.𝗰𝗼𝗺
𝐑𝐱𝐒𝐥𝐢𝐝𝐞𝐬 PowerPoint icons and illustration
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
2. Objectives
1. To Review important middle ear anatomy and
physiology.
2. To get an idea about the differences in Eustachian
Tube between adults and pediatrics, and how that
can affect the pathogenesis of otitis media.
3. To define the otitis media and its different subtypes.
5. Anatomy
Tympanic membrane
Oval & thin ,semi-transparent, divided into 2 parts: the
pars flaccida & the pars tensa.
The manubrium of the malleus is firmly attached to the medial
tympanic membrane; where a concavity is formed. The apex of this
concavity is called the umbo.
The sensory nerve supply to the tympanic membrane
includes the following:
1. Auriculotemporal nerve (mandibular branch of
trigeminal nerve)
2. Auricular branch of vagus nerve.
3. Tympanic branch of glossopharyngeal nerve (Jacobson
nerve)
6. Otoscopic image (panel A) and schematic diagram (panel B) of a left tympanic
membrane. A line drawn along the manubrium of the malleus divides the tympanic
membrane into anterior and posterior halves (dashed line). A line drawn through the
umbo (perpendicular to the first line) divides the tympanic membrane into superior
and inferior halves (solid line).
http://0k10u05yn.y.https.www.uptodate.com.hu.proxy.coe-
elibrary.com/contents/image?imageKey=PEDS%2F57110&topicKey=PEDS%2F6009&source=see_link
8. Multiple structures are contained within the confines of
the tympanic cavity
The cavity is covered in mucoperiosteum.
The middle ear inhabits the petrous portion of the
temporal bone and is filled with air secondary to
communication with the nasopharynx via the auditory
(eustachian) tube
9. Anatomy
Tympanic cavity
The lateral wall contains the tympanic membrane ,lesser extend
by bony outer attic wall (SCUTUM)
The posterior wall contains the mastoid antrum and
communicates with the mastoid air cells
The medial wall contains promontory ,the oval window & the
round window this wall is also called the labyrinthine wall
The anterior wall is also termed the carotid wall, because a thin
plate of bone separates the carotid canal and tympanic cavity and
also houses the auditory tube
The roof of the tympanic cavity is the tegmental wall
The floor of the middle ear is the jugular wall; it separates the
tympanic cavity from the internal jugular vein
16. Anatomy
Eustachian tube
Eustachian tube is the communication between the middle
ear and the nasopharynx.
Lumen shaped like two cones with apex directed toward
middle
Mucosa has mucous producing cells and ciliated cells
Usually closed
Opens during swallowing, yawning, and sneezing
Lumen opens when attachment of tensor veli palatini muscle
pulls wall of tube laterally during swallow.
Auditory tube close by elastic recoil of cartilage, tissue
turgidity and tension of salpingopharyngeus muscle.
20. Anatomy
The pharyngeal opening is:
Below the level of the hard palate in the fetus.
Is level with the palate at birth.
Is 3 to 4 mm. above it at the fourth year.
Is 10 mm. Above it as an adult
Lumen of tube in child is more horizontal and wider
Functions :
Protection from nasopharyngeal sound and secretions
clearance of middle ear secretions
ventilation (pressure regulation) of middle ear
21. Anatomy
Eustachian tube
Two Parts :
1. Bony part (12mm)
2. Cartilagenous part(24mm)
Muscles attached:
1. Tensor veli tympani:
nerve supply from :mandibular
nerve separate tube from
otic ganglion
mandibular nerve
chorda tympani
middle meningeal artery
2. Salphingo pharyngeus:
3. Levator veli palati
Nerve supply for these muscles
=pharyngeal plexus
22. Nerve Supply
Sensory & parasympathetic : tympanic branch of
glossopharyngeal N
Tensor veli palatini: V3
Levator veli palatini pharyngeal plexus
Salpingopharyngeus (cranial part of XI N via vagus)
23. Anatomy
Muscles
Stapedius muscle, which connects the neck of the stapes to the
posterior tympanum.
Innervation is provided by the nerve to the stapedius from the facial
nerve
Contraction displaces the stapes posteriorly and functions to prevent
loud noises from injuring the inner ear.
The tendon of the tensor tympani attaches to the manubrium of the
malleus
Innervated by the mandibular branch of the trigeminal nerve
contraction of the tensor tympani displaces the malleus medially
24.
25. Eustachian tube obstruction
Anatomic obstruction is most commonly caused by inflammation of
the eustachian tube mucosa or extrinsic compression by tumor or large
adenoids.
Functional obstruction usually occurs as a result of either the failure
of the normal muscular mechanism of eustachian tube opening, as
seen in cleft palate, or insufficient stiffness o the cartilaginous
portion of the eustachian tube, often seen in infants and young
children.
The more acute angle of the eustachian tube seen in children,
compared with adults, may also result in the impaired function of the
eustachian tube opening.
These abnormalities are often seen in patients with Down syndrome,
which may account for the high rate of OM .
Normal function of the eustachian tube is also dependent on ciliary
function
26. Eustachian tube dysfunction
– Otalgia
– Hearing loss
– Popping sensation
– Tinnitus
– Disturbances of
equilibrium
– Retracted TM
– Congestion along the
handleof malleus and pars
tensa
– Transudate behind TM
30. TERMINOLOGY
MEE) —refers to fluid in the
middle ear cavity. MEE occurs in both otitis media
with effusion and AOM.
AOM) —refers to acute infection
of middle ear fluid.
— Otitis media with
effusion (OME) refers to middle ear fluid that is not
infected.
OME is also called serous, secretory, or nonsuppurative
otitis media.
OME frequently precedes the development of AOM or
follows its resolution.
32. AOM
RISK FACTORS A number of risk factors for AOM have been established, the
most of important of which is age.
1. Age – The age-specific attack rate for AOM peaks between 6
and 18 months of age
2. Family history
3. Day care – The transmission of bacterial and viral pathogens
is common in day care centers.
4. Lack of breastfeeding – Lack of or limited breastfeeding is
associated with an increased risk of AOM
5. Tobacco smoke and air pollution
6. Low income countries – Lack of access to medical care and
local environmental factors lead to severe suppurative
episodes of OM in children living in developing areas
33. Cont’ Risk factors
Other risk factors – Other important risk factors in the
development of single and recurrent episodes of AOM
include [18]:
•Social and economic conditions (poverty and household
crowding increase the risk)
•Season (increased incidence during the fall and winter
months)
•Altered host defenses and underlying disease (eg, HIV,
cleft palate, Down syndrome, allergic rhinitis)
34. AOM
Pathogenesis
The pathogenesis of AOM in at-risk children generally involves the
following sequence of events
1. The patient has an antecedent event (usually a viral upper
respiratory tract infection) while colonized with an
otopathogen(s) . Some evidence suggest that co-colonization
with bacterial otopathogens only, in the absence of viral
respiratory tract infection, may be sufficient to trigger the
cascade of events .
2. The event results in inflammatory edema of the respiratory
mucosa of the nose, nasopharynx, and eustachian tube.
3. Inflammatory edema obstructs the narrowest portion of the
eustachian tube, the isthmus.
35. 4. Obstruction of the isthmus causes poor ventilation and resultant
negative middle ear pressure. This leads to the accumulation
of secretions produced by the middle ear mucosa.
5. The secretions have no egress and accumulate in the middle ear
space.
6. Viruses and bacteria that colonize the upper respiratory tract
enter the middle ear via aspiration, reflux, or insufflation.
7. Microbial growth in the middle ear secretions often progresses to
suppuration with clinical signs of AOM (bulging tympanic
membrane [TM], middle ear fluid, erythematous TM).
8. The middle ear effusion may persist for weeks to months
following sterilization of the middle ear infection.
36. AOM
MICROBIOLOGY
Bacteria — Three species of bacteria account for most
of the bacterial isolates from middle ear fluid:
1. S. pneumoniae app. 50 % of severe
cases
2. Nontypeable H. influenzae (NTHi),
app 45% of severe cases
3. Moraxella catarrhalis.
37. AOM
MICROBIOLOGY
Bacterial and/or viral respiratory tract pathogens can be
isolated from most middle ear aspirates from children with
AOM.
The finding of combined bacterial and viral infections in
two-thirds of cases has important clinical implications
.Mixed viral and bacterial infections may respond
differently to antibiotic therapy than purely bacterial
infections. The presence of viruses may increase middle
ear inflammation ,decrease neutrophil function , and
reduce antibiotic penetration into the middle ear .
38. AOM
CLINICAL
MANIFESTATIONSSymptoms:
Children with AOM, particularly infants, may present with
nonspecific symptoms and signs, including fever, irritability,
headache, apathy, disturbed or restless sleep,
poor feeding/anorexia, vomiting, and diarrhea .
Fever occurs in one- to two-thirds of children with AOM,
though temperature >40°C (104°F) is unusual unless
accompanied by bacteremia or other focus of infection ,
However, ear pain and other ear-related symptoms (eg, ear
rubbing) are not always present
Otalgia is the most common complaint in
children with AOM and the best predictor of AOM
39. AOM
Diagnosis
Pneumatic otoscopy is gold standard.
IMPORTANCE OF ACCURATE DIAGNOSIS — The
importance of accurate diagnosis of AOM cannot be
overstated.
Accurate diagnosis ensures appropriate treatment for
children with AOM, who require antibiotic therapy, and
avoidance of antibiotics in children with otitis media
with effusion, in whom antibiotics are unnecessary.
Accurate diagnosis also prevents overuse of
antibiotics, which leads to the development of resistant
organisms
41. Accurate diagnosis of AOM requires
systematic evaluation of the tympanic
membrane for:
1. Color (eg, gray, white, pale yellow, amber, pink, red, blue)
2. Other conditions (eg, fluid level, bubbles, perforation, otorrhea,
bullae, tympanosclerosis [scars], atrophic areas, retraction
pockets, cholesteatoma)
3. Mobility
4. Position (eg, neutral, retracted, full, or bulging)
5. Lighting.
6. Entire surface (the four quadrants of the tympanic membrane
should be examined) (figure 1)
7. Translucency
8. External auditory canal and auricle (eg, deformed, displaced,
inflamed, foreign body)
9. Seal (a good seal requires an airtight pneumatic system and a
speculum that is large enough to prevent air leak)
42.
43.
44. Experienced otoscopists at a tertiary care
children's hospital developed and validated a
classification scheme describing the signs and
symptoms that they use to diagnose AOM :
1. Bulging tympanic membrane (with or without
opacification or air-fluid level): AOM
2. Opacification of the tympanic membrane or air-
fluid level: OME
3. Absence of bulging, opacification, and air-fluid
level: no MEE
45. Cont’
AOM Diagnosis
Position — A bulging tympanic membrane is the
hallmark of AOM. The position of the tympanic
membrane is the most critical characteristic in
distinguishing AOM from OME.
Translucency — Translucency of the tympanic
membrane is another important aspect of the
examination.
46. The clinical diagnosis of AOM requires :
1. Bulging of the tympanic membrane, or
2. Very infrequently, other signs of acute
inflammation and middle ear effusion (MEE)
A diagnosis of AOM also can be established if there
is acute purulent otorrhea and otitis externa has
been excluded
AOM
Diagnosis
47. AOM
DIFFERENTIAL
DIAGNOSIS The main consideration in the differential diagnosis of AOM is
otitis media with effusion (OME).
Middle ear effusion (MEE) with decreased mobility and
opacification or cloudiness of the tympanic membrane occurs in
both AOM and OME. However, careful evaluation of the position,
color, and other findings of the tympanic membrane can help to
distinguish AOM from OME .
In AOM, the tympanic membrane is usually bulging; in OME, it is
usually retracted or in the neutral position.
In AOM, the tympanic membrane is typically white or pale yellow;
in OME, it is typically amber or blue.
In AOM, pus may be visualized behind the tympanic membrane;
the tympanic membrane may be perforated with acute purulent
otorrhea, or bullae may be present. In OME, a fluid level or
bubbles may be seen.
48.
49.
50.
51. RECURRENT AOM
Recurrent acute otitis media (AOM) is defined by the
development of signs and symptoms of AOM soon
after completion of successful treatment.
It is particularly important to establish the diagnosis of
recurrent AOM with bulging of the tympanic membrane
and signs of inflammation. Otherwise, persistent
middle ear effusion in a child with a febrile upper
respiratory infection may be misinterpreted as a
recurrent episode and the child may receive antibiotics
unnecessarily.
52. When recurrence occurs within 15 days of
completion of antimicrobial treatment for
the previous episode, we suggest:
Ceftriaxone 50 mg/kg per day intramuscularly (IM)
or intravenously (IV) for three days, or
Ceftriaxone 50 mg/kg per dose IM or IV every 36
hours for a total of two doses, or
Levofloxacin 10 mg/kg every 12 hours orally for
10 days for children six months to five years or 10
mg/kg per once daily for 10 days for children ≥5
years (maximum 500 to 750 mg/day) [78]
53. When the recurrence occurs more than 15
days after completion of the treatment for
the previous episode:
it is most often due to a different pathogen than the
previous episode. Although the child is at higher risk
for a nonsusceptible pathogen, we suggest high
dose amoxicillin-clavulanate as initial therapy, even
if the child received amoxicillin-clavulanate for the
previous episode.
Tympanostomy tube insertion may be warranted for
children with ≥3 distinct and well-documented
episodes of AOM within six months or ≥4 episodes
within 12 months if middle ear fluid is also present
54. AOM
Treatment
Watchful waiting : current practice guidelines advise on an initial watchful waiting
without antibiotic therapy for healthy 2-year-olds or older children with nonsevere illness
because AOM symptoms improve in most within 1–3 days .
* Watchful waiting is not recommended for children < 2 years old.
Antibiotics
Penicillin
In children < 5 years, when H. influenzae is likely to be present, amoxycillin is more effective
Analgesics
Nasal vasoconstrictors: The role of 0.5% ephedrine nasal drops is traditional but its
value is uncertain .
Ear drops : Ear drops are of no value in acute otitis media with an intact drum.
AOM fail to respond to medical therapy or develop a complication. Myringotomy is then
indicated to allow the drainage ofpus
55. Do not consider acute otitis media to be cured until
the hearing and the appearance of the membrane
have returned to normal.
uncomplicated episodes of AOM resolves without any
adverse outcome
AOM
Treatment
56. Antibiotic
First line
Amoxil - 60-90 mg/kg divided tid
Ceftin - B lactam stable
Augmentin - B lactam stable
Bactrim, Pediazole
Second line
Augmentin
Ceftin
Rocephin
Macrolides - Zithromax, Biaxin
AOM
Treatment
57. If resolution does not occur, suspect:
Nose, sinuses or nasopharynx Infection
the choice or dose of antibiotic
low-grade infection in the mastoid cells.
Of patients who develop a perforation of the
tympanic membrane with otorrhea, a small
proportion go on to develop CSOM because of the
failure of the tympanic membrane to heal.
AOM
Treatment
Editor's Notes
The distinction between OME and AOM may be difficult, since they are part of a continuous spectrum. (See "Acute otitis media in children: Treatment", section on 'Clinical course' and 'Otitis media with effusion' below.)
3.Day care .Multiple observational studies indicate that children attending day care centers, especially with four or more other children, have a higher incidence of AOM than children who receive care at home [13,25-28]. In pooled analysis of six studies (1972 children), the RR of AOM for children who attended day care outside the home compared with children who received care at home was 2.45 (95% CI 1.51-3.98) [19]. In pooled analysis of four studies (1030 children), the RR of AOM for children who attended family day care versus h
Lack of breastfeeding – Lack of or limited breastfeeding is associated with an increased risk of AOM [13,19,25,29-31]. In pooled analysis of six studies (2548 children), the risk of AOM was decreased among children who were breastfed for at least three months (RR 0.87, 95% CI 0.79-0.95) [19].
Breastfeeding diminishes colonization of the nasopharynx by bacterial otopathogens [19,30]. Additional reasons for the lower incidence of AOM among breastfed infants are uncertain but may be related to immunologic or nonimmune protective factors in breast milk, the facial musculature associated with breastfeeding, or the position maintained during feeding from the breast contrasted with bottle feeding [32,33]. An observational study suggests that the nasopharyngeal microbiome in breast fed children is different from that in formula fed children, with a reduction in colonization patterns with high densities of Streptococcus pneumoniae or nontypeable Haemophilus influenzae [34]. (See "Infant benefits of breastfeeding", section on 'Anti-microbial components'.)
ome care was 1.59 (95% CI, 1.19-2.13) [19].
S. pneumoniae — S. pneumoniae accounts for approximately 50 percent of bacterial isolates from the middle ear fluid of young children with severe, persistent, or refractory AOM [68]. The proportion of pneumococcal isolates resistant to penicillin varies worldwide, but resistance is more likely to be found in children with recurrent and/or persistent AOM and in those recently exposed to antimicrobial agents [48,68]. S. pneumoniae is commonly associated with first or early OM episodes, although any of the three pathogens may be causative of early disease [75,76], as well as with greater clinical severity as reflected by high fever, more intense otalgia, and the potential for complications such as bacteremia and mastoiditis [77]. Pneumococcal OM is also associated with a greater inflammatory response with both elevated peripheral blood and middle ear fluid white blood cell counts compared with other pathogens [75].
H. influenzae — H. influenzae accounts for approximately 45 percent of bacterial isolates from the middle ear fluid of young children with severe, persistent, or refractory AOM [9,68,81]. H. influenzae AOM is more often bilateral than unilateral [71,72,88]. OM caused by NTHi is frequently associated with concurrent conjunctivitis and less severe symptoms such as lower fever and a less inflamed tympanic membrane (TM) [72,75]. NTHi infection is also associated with more complex OM, including increased risk for treatment failure, recurrence despite appropriate antibiotic therapy, and chronicity [88