A 7-year-old boy presented with severe right ear pain that began the previous night. His mother had given him paracetamol and ear drops without relief. On examination, he continued to complain of severe right ear pain. The document discusses acute otitis media, including its pathophysiology, causes, signs and symptoms, diagnostic workup, and management. It describes the stages of the disease from initial Eustachian tube obstruction to potential complications if left untreated. The treatment plan involves medical management with antibiotics, analgesics and local decongestants or surgical myringotomy depending on the stage of infection and severity of symptoms.

1. Acute otitis media
Dr. Junaid Shahzad
Assistant Professor
ENT department

2. Case Scenario
 A mother brought her 7 years old son with the complaint that his son was not
looking well since yesterday, when he went to bed early. At midnight he woke
up with the complaint that he has severe pain in his right ear. She gave him
syrup paracetamol and put some eardrops in his right ear, after that he slept
again. Next morning when he woke up, he was again complaining of severe
pain in his right ear.

3. Learning
Objective
• Define the disease
• Describe Pathophysiology
• Describe Etiology
• Elicit sign and symptoms
• Order the investigations
• Outline the management plan
• Identifies the complications

5. Types of otitis media
Suppurative
Acute otitis media
Chronic suppurative media
Non Suppurative
Otitis media with effusion
Specific
Tuberculosis
Syphilis

6. Duration
Acute → up to 3 weeks
Sub acute → 3weeks- 3months
Chronic → 3 months onwards

7. Types of Acute Otitis Media
1. Acute Suppurative otitis media
2. Acute non-Suppurative otitis media

8. Acute Suppurative otitis media
Infection of middle ear cleft mucosa

9. Aetiology
Predisposing factors :
 Children (2 YRS) more prone due to Short, wider and horizontal Eustachian tube
 Adenoids
 Recumbent position during feeding
 Poor general resistance
 Poor socio-economic group,
 Unhygienic , over crowding & poor living

10. Routes of
infection
Eustachian tube
Infection
Nasopharyngeal conditions
Vascular

11. Causative
organisms
Primary invaders → viruses
 Common cold
 Adenovirus
 Influenza virus
 Resp. syncytial virus
Common micro-organisms
 Streptococcus pneumonia
 Haemophilius influenza
 Staph aureus
 Beta –hemolytic streptococcus
 Moraxella catarhallis

12. Pathology
1. Eustachian tube obstruction (Catarrhal stage)
2. Stage of exudation/transudation (Pre Suppurative stage)
3. Suppurative stage
4. Perforation of tympanic membrane
5. Stage of resolution & complications

13. Stage of tubal occlusion/Catarrhal stage
 Sense of blockage
 Decreased hearing
 Own voice sounds unusually loud in affected ear
 Slight pain
 Retraction of tympanic membrane
 Light reflux disappears
 Fluid level/bubbles may appear but mostly not visible due
to progressive loss of transluncy due to progressive disease

14. Pre-suppuration
Invasion by pyogenic organisms
 Increasing earache & deafness
 Pain intense throbbing & prevents sleep
 Tinnitus may be present
 Progressive hyperemia of ear drum
 Temperature rises

15. Stage of suppuration
Tympanic membrane red looking and bulging.
Handle of malleus invisible

16. Suppurative
stage
After perforation
 Spontaneous rupture of TM
 Escape of blood-stained purulent discharge
 Spontaneous relief of pain
 Pus discharge slows & ceases with in 2
days

17. Stage of
resolution
 High resistance of patient & low virulence
of organisms
 Complete restoration of function/partial
recovery of function

18. Stage of Complications
Inadequate
treatment
High
virulence of
organisms
Poor
resistance of
host

19. Treatment
Treatment depends on the stage of
infection
Medical
Surgical
Stage of tubal obstruction
Tubal opening
. Local decongestants nasal
drops/spray
. Analgesic

20. Treatment Pre
Suppurative
Local decongestants
Analgesic
Antibiotics

21. Treatment Stage of suppuration
 Before perforation
Medical
Surgical
Medical :
 Antibiotics
 Analgesics
 Local decongestants
 Rest

22. Surgical Myringotomy indications :
1. Severe pain persistency 12 - 24 hours inspite of
adequate
antibiotics
2. Convex red bulging ear drum 24-36 hour adequate
antibiotics treatment
3. Delayed resolution despite antibiotics for 3 weeks
4. Small perforation within adequate drainage &
impeding
intracranial complications

23. Treatment after perforation
1. Pus swab C/S
2. Aural toilet
3. Antibiotic ear drops
4. Antibiotics
5. Local decongestants

26.  Thank you for Listening