3. • It is an acute inflammation of
middle ear by pyogenic organisms.
• Here, middle ear implies middle
ear cleft, i.e. eustachian tube,
middle ear, attic, aditus, antrum
and mastoid air cells.
4. • It is more common especially
in infants and children of
lower socioeconomic group.
• Typically, the disease follows
viral infection of upper
respiratory tract but soon the
pyogenic organisms invade
the middle ear.
5. Via eustachian tube:
• It is the most common route.
• Infection travels via the lumen of the tube
or along subepithelial peritubal lymphatics.
6. Via eustachian tube:
• Eustachian tube in infants and young
children is shorter, wider and more
horizontal and thus may account for higher
incidence of infections in this age group.
7. Via eustachian tube:
• Eustachian tube in infants and young
children is shorter, wider and more
horizontal and thus may account for higher
incidence of infections in this age group.
8. Via eustachian tube:
• Breast or bottle feeding in a young infant
in horizontal position may force fluids
through the tube into the middle ear and
hence the need to keep the infant propped
up with head a little higher.
9. Via eustachian tube:
• Swimming and diving can also force water
through the tube into the middle ear.
10. Via external ear.
• Traumatic perforations of tympanic
membrane due to any cause open a route
to middle ear infection.
12. • Recurrent attacks of common cold, upper
respiratory tract infections and exanthematous
fevers like measles,
• diphtheria or whooping cough.
• Infections of tonsils and adenoids.
• Chronic rhinitis and sinusitis.
13. • Nasal allergy.
• Tumours of nasopharynx, packing of
nose or nasopharynx
• for epistaxis.
• Cleft palate.
15. 1. Stage of tubal occlusion:
• Oedema and hyperaemia of nasopharyngeal end of
eustachian tube blocks the tube leading to absorption
of air and negative intratympanic pressure.
16. 1. Stage of tubal occlusion:
Symptoms:
• Deafness
• Earache
Signs:
Tympanic membrane is retracted with handle of malleus assuming
a more horizontal position, prominence of lateral process of malleus
and loss of light reflex. Tuning fork tests show conductive deafness.
17. 2. Stage of presuppuration:
• If tubal occlusion is prolonged, pyogenic organisms invade
tympanic cavity causing hyperaemia of its lining.
• Inflammatory exudate appears in the middle ear.
• Tympanic membrane becomes congested.
18. 2. Stage of presuppuration:
Symptoms:
• Earache
• Disturb sleep
• Throbbing nature
• Deafness and tinnitus are also present, but complained only by
adults.
• Child runs high degree of fever and is restless.
19. 2. Stage of presuppuration:
Signs:
• Congestion of pars tensa
• Leash of blood vessels appear along the handle of malleus
• Periphery of tympanic membrane imparting it a cart-wheel
appearance.
• Tuning fork tests will again show conductive type of hearing loss.
20. 3. Stage of suppuration:
• This is marked by formation of pus in the middle ear and to some
extent in mastoid air cells.
• Tympanic membrane starts bulging to the point of rupture.
21. 3. Stage of suppuration:
Symptoms:
• Earache becomes excruciating
• Deafness increases, child may run fever of 102–103°F.
• This may be accompanied by vomiting and even convulsions.
22. 3. Stage of suppuration:
Signs:
• Tympanic membrane appears red and bulging with loss of
landmarks.
• Handle of malleus swollen
• A yellow spot may be seen on the tympanic membrane where
rupture is imminent.
• Nipple-like protrusion of tympanic membrane with a yellow spot on
its summit.
• X-rays of mastoid will show clouding of air cells because of
exudate.
23. 4. Stage of resolution:
• The tympanic membrane ruptures with release of
pus and subsidence of symptoms. Inflammatory
process begins to resolve.
• If proper treatment is started early or if the
infection was mild, resolution may start even
without rupture of tympanic membrane.
24. 4. Stage of resolution:
Symptoms:
• With evacuation of pus
• Earache is relieved
• Fever comes down and child feels better
25. 4. Stage of resolution:
Signs:
• External auditory canal may contain blood-tinged
discharge which later becomes mucopurulent.
• small perforation is seen in anteroinferior quadrant of
pars tensa.
26. 5. Stage of complication.
• If virulence of organism is high or resistance of patient
poor, resolution may not take place and disease spreads
beyond the confines of middle ear.
• It may lead to acute mastoiditis, subperiosteal abscess,
facial paralysis, labyrinthitis, petrositis, extradural
abscess, meningitis, brain abscess or lateral sinus
thrombophlebitis.
27. Belladonna:
• Throbbing and beating pain in ear, child cries
out in sleep.
• Sudden and violent attack of pain with redness,
over sensitiveness to slightest draft of
air/touch, rush of blood to head and face.
28. Belladonna:
• Pain causes delirium.
• Burning heat, bright redness and dryness are
very marked.
• The pain comes and goes in repeated attacks.
• Noises in ear and Autophony- hearing one’s
voice in the ear.
29. Chamomilla:
• Earache with soreness; swelling and heat driving
patient frantic. Stitching pain and ears feel
stopped.
• Sensitive to cold wind about ears, or noise.
• Earache amelioration from warmth.
• Roaring in the ears as of rushing water.
30. Dulcamara:
• Ear ache, buzzing and stitches.
• Ache with nausea; whole night, preventing sleep.
• Ailments from exposure to cold and damp weather.
31. Ferrum-phos:
• Noises and throbbing.
• First stage of otitis.
• Membrana tympani red and bulging.
• Acute otitis when belladonna fails prevents
suppuration.
• Deafness from colds.
• Tinnitus aggravated on lying.
32. Hepar Sulphur:
• Whizzing and throbbing in the ears, with hardness of
hearing.
• Discharge of fetid pus from the ears.
• Chilliness, hyper sensitiveness, craving for cold and
strong things are very characteristic.
• Slightest pain causes fainting.
• All the discharges are profuse; foul; like old cheese,
sour. Sweats profusely, easily without any relief.
33. Pulsatilla:
• Otorrhoea is thick, bland, yellowish green and
offensive.
• Otalgia is worse at night, diminishes acuteness of
hearing.
• Thirst less, peevish and chilly. Hearing difficulty, as if
the ear were stuffed.
34. Rhus tox:
• Pain in ear with sensation as if something were in
them.
• Lobules swollen and discharge of pus.
• Fever is associated with otalgia.
35. Verbascum Thapsus:
• Otalgia with a sense of obstruction, stoppage of ears.
• Tearing in ears, sometimes when eating, with
lancinations.
• Numbness sensation in the ear.
