1. Acute otitis media (AOM) is a pyogenic infection of the middle ear cleft lasting less than 3 weeks, which can occur via the Eustachian tube, tympanic membrane perforation, or hematogenous spread. Common causes include respiratory infections and exposure to cigarette smoke. 2. Otitis media with effusion is the presence of middle ear fluid without signs of infection. It is common in young children and can be caused by poor Eustachian tube function or follow AOM. 3. Treatment for AOM includes antibiotics, nasal decongestants, and analgesics while treatment for persistent or recurrent OME may include antibiotics, steroids, myringotomy

1. Acute Otitis Media
&
Otitis Media with effusion
Dr. B.P. Shah
Associate Professor
Dept. ORL & HNS
BPKIHS

2. AOM
Definition: Pyogenic infection of middle ear cleft
lasting for < 3 weeks.
Routes for infection:
1. Via Eustachian tube
2. Via Tympanic membrane perforation
3. Haematogenous (rare)

3. Predisposing Factors
1. Breast feeding in supine position
2. Recurrent upper respiratory tract infection
3. Nasal allergy
4. Chronic rhinitis & sinusitis
5. Tumours of nose & nasopharynx
6. Exposure to cigarette smoke
7. Cleft palate

4. Bacteriology
1. Haemophilus influenzae
2. Streptococcus pneumoniae
3. Moraxella catarrhalis
4. Staphylococcus aureus
5.  - Hemolytic streptococci (causes acute
necrotizing otitis media)

5. Stages

6. 1. Stage of Hyperaemia
 Synonym: Stage of tubal occlusion
 Mild earache
 T.M. retracted in early stage
 T.M. congested later stage
 Cartwheel appearance: radiating blood
vessels from handle of malleus

7. Cart wheel appearance

8. 2. Stage of Exudation
 High fever
 Severe earache
 Deafness
 Marked congestion + bulging of T.M.
 Mastoid tenderness
 P.T.A.: conductive deafness due to mass
effect of pus

9. Stage of Exudation

10. Nipple sign (impending perforation)
Localized protrusion
of tympanic
membrane due to
destruction of
fibrous layer by
continuous pressure
of pus

11. 3. Stage of Suppuration
Symptoms:
 Ear discharge (blood-stained  purulent)
 Increased deafness
 Decreased fever
 Decreased earache

12. Blood stained otorrhoea

13. Signs & Investigations
 Pinhole perforation + otorrhoea
 Light house sign: intermittent reflection of light
 Decreased mastoid tenderness
 Clouding of air cells in mastoid X-ray

14. Light House sign Pinhole perforation

15. Clouding of mastoid cells

16. 4. Stage of Resolution
 Otorrhoea
stops
 Normal
hearing
 Healed
perforation

17. Stage of Resolution
Healed TM Sterile exudates in middle

18. 5. Stage of Complications
 Sub-periosteal abscess
 Vertigo
 Headache + blurred vision + projectile vomiting
 Fever + neck rigidity + irritability
 Drowsiness
 Gradenigo syndrome (apex petrositis)

19. Coalescent Mastoiditis
 Otorrhoea > 2 weeks, otalgia & deafness
 Mastoid reservoir sign: pus fills up on mopping
 Sagging of postero-superior canal wall caused by
peri-osteitis due to pus in adjacent mastoid antrum
 Ironed out appearance of skin over mastoid due to
thickened periosteum

20. Sagging of posterior wall Ironed out appearance

21. Pathogenesis
Aditus Blockage
 Failure of drainage
 Stasis of secretions
 Hyperemic decalcification
 Resorption of bony septa of air cells
 Coalescence of small air cells to form cavity
 Empyema of mastoid cavity

22. Pathogenesis

23. Mastoid cavity

24. Treatment of AOM
1. Systemic Antibiotic
2. Nasal decongestants (systemic + topical)
3. H1 anti-histamines
4. Analgesic + anti-pyretic
5. Aural toilet for ear discharge
6. Heat application for severe earache
7. Review after 48 hours

25. On review after 48 hours
 Earache + fever persists: change to higher
antibiotic. If T.M. is bulging  perform myringotomy.
Send ear discharge for C/S.
 Earache + fever subside: continue same
treatment for 10-14 days
 Review after 3 months

26. On review after 3 months
 No effusion: no further treatment
 Effusion persists: treat as Otitis Media
with Effusion
 Presence of abscess or coalescent
mastoiditis: do cortical mastoidectomy

27. Myringotomy in ASOM
Curvilinear incision made in
postero - inferior quadrant.
Incision is curvilinear & not
radial (as in OME), to cut
fibers of TM. This keeps
opening patent for long time.

28. Why make incision in PIQ?
 Least vascular area
 T.M. bulge is
maximum
 Ossicles not damaged
 Easily accessible

29. Otitis Media with
effusion

30.  “Presence of middle ear fluid without signs
or symptoms of infection, previously named:
secretory, serous, or glue ear. ”
 Decreased TM mobility and barrier to sound
conduction
What is OME?

31. Etiology and Epidemiology
 Epidemiology:
 90% of children suffer from OME before
school age (usually 6 months to 4 years)
 30-40% of children with recurrent OME
 5-10% last greater than 1 year
 Etiology:
 Poor Eustachian Tube Function
 Inflammatory response following AOM

32. Pathogenesis

33. Diagnosis of OME
 signs and symptoms:
 Ear pain, popping, fullness
 Ear rubbing, irritability, sleep disturbances
 Failure to respond appropriately to voices or sounds
 Hearing loss
 Recurrent AOM
 Problems with school performance
 Balance problems, motor delay
 Delayed speech, language


34.  Pneumatic otoscopy
 PTA
 Tympanometry : to confirm
diagnosis
 Important to distinguish
from AOM – redness of
TM should not be
indication for antibiotics

35. Treatment - OME
 MEE > 3 month or assoc hearing loss, vertigo,
frequency, ME pathology, discomfort
 Antibiotics
 shown to be of benefit,
 Antibiotics + steroid
 21% improvement compared to abx alone
 prednisone 1 mg/kg day x 7 day
 Myringotomy & tympanostomy +/-
adenoidectomy

36. Tympanostomy tube insertion
 Unresponsive OME >3 months b/l, or >6 months
unilateral, sooner if assoc hearing problems
 Recurrent MEE with excessive cumulative duration
 Recurrent AOM - >3/6 mos or >4/12 mos
 Eustachian tube dysfunction
 Suppurative complication