1. BY : WAEL ALHALABI
OTITIS MEDIA

2. OTITIS MEDIA
• Definition: Presence of a middle ear infection
• Acute Otitis Media: occurrence of bacterial
infection within the middle ear cavity.
• Otitis Media with Effusion: presence of nonpurulent
fluid within the middle ear cavity
• OM is the second most common clinical problem in
childhood after upper respiratory infection.

3. EPIDEMIOLOGY
• Peak incidence in the first two years of life (esp. 6-12
months)
• Boys more affected girls
• 50% of children 1 yr of age will have at least 1
episode.
• 1/3 of children will have 3 or more infections by age
3
• 90% of children will have at least one infection by
age 6.
• Occurs more frequently in the winter months

4. MICROBES AT FAULT!!!
• Streptococcus pneumoniae
• Haemophilus influenzae(non-typeable)
• Moraxella catarrhalis
• Group A Streptococcus
• Staph aureus
• Pseudomonas aeruginosa
• RSV assoc. with Acute Otitis Media

5. CLASSIFICATION OF OTITIS MEDIA
• Acute Otitis Media: presents with fever, otalgia,
and hearing loss
• Otitis Media with Effusion: evidence of middle
ear effusion on pneumatic otoscopy
• Recurrent Otitis Media: inability to clear middle
ear effusions
• Chronic Serous Otitis Media: presents as
‘fullness in the ear’, tinnitus, or another acute
disease.

6. RISK FACTORS
• Upper Respiratory Infections
• Allergies
• Craniofacial abnormalities (cleft palate)
• Down’s Syndrome
• Passive smoking

7. PATHOGENESIS
• This problem mainly deals with eustacian
tube dysfunction. Otitis Media usually
follows an URI in which there is edema of the
eustacian tube, leading to blockage. Stasis
of these middle ear secretions lead to
infection and irritation
• Other factors: allergic rhinitis, nasal polyps,
adenoidal hypertrophy

8. SIGNS & SYMPTOMS
• Neonates/Infants: change in behavior, irritability,
tugging at ears, decreased appetite, vomiting.
• Children(2-4): otalgia, fever, noises in ears,
cannot hear properly, changes in personality
• Children (>4): complain of ear pain, changes I
personality

9. ON PHYSICAL EXAM…
• The classic description for Otitis Media is an
erythematic, opaque, bulging tympanic membrane
with loss of anatomic landmarks including a
dull/absent light reflex.
• Pneumatic Otoscopy: decreased tympanic
membrane mobility

10. DIAGNOSIS
Pneumatic Otoscopy: standard tool for diagnosis
Impedance Tympanometry: useful for MEE. Measures
the resonance of the ear canal for a fixed sound as
the air pressure is varied.
Spectral Gradient Acoustic Reflectometry:
measures the condition of the middle ear by
assessing the response of the TM to a sound
stimulus. Equivalent to tympanometry for dx of
middle ear effusions

11. DIFFERENTIAL DIAGNOSIS
• Otitis externa
• Bullous myringitis
• Cerumen impaction
• Dental abscess
• Foreign body in ear canal
• Referred pain (parotid/tooth/lymphadenitis)
• Tonsilitis

12. TREATMENT
• Amoxicillin: 20-40 mg/kg/day tid for 10-14 days or,
• Augmentin: 45 mg/kg/day po bid for 10-14 days
• Auralgan: analgesic/adjunct for ear pain 2-4 drops
tid

13. 2ND
LINE TREATMENT REGIMEN
• Cefzil
• Pediazole ( erythromycin/sulfisoxazole)
• Bactrim (trimethoprim/sulfamethoxazole
• These medications are used as secondary agents if
the primary antibiotic has failed after 10 days and
the symptoms persists.

14. TREATMENT CONT.
• tympanocentesis & myringotomy: involves
puncturing the tympanic membrane and aspirating
middle ear fluid to relieve pressure. Only used if the
primary and secondary line treatment fail.
• With the increasing incidence of drug resistant
strains of S. pneumoniae, CDC recommends the
capacity of clinicians to be efficient in using
tympanocentesis.

15. INDICATIONS FOR TYMPANOCENTESIS
• Toxic appearing child
• Failed treatment regimen with antibiotics
• Suppurative complications
• Immunosuppressed pt.
• Newborn infant in which the usual pathogens may
not be the case.

16. COMPLICATIONS
• Hearing loss: conductive, sensoneural, mixed)
• Acute mastoiditis: before the advent of antibiotics
• Chronic perforation of the TM
• Tympanosclerosis
• Cholesteatoma
• Chronic suppurative OM
• Cholesterol granuloma: ‘Blue drum syndrome’
• Facial nerve paralysis

17. COMPLICATIONS CONT…
• Intracranial complications
• Bacterial meningitis
• Epidural abscess
• Subdural empyema
• Brain abscess
• Otitic hydrocephalus
• Lateral sinus thrombosis

18. REFERENCES
• Dornbrand, Laurie. Manual of Clinical Problems in
Adult Ambulatory Care.
• Nelson. Textbook of Pediatrics Pocket Companion
• Wetmore, R. Complications of Otitis Media.
• Wiley_black well . 11th
edition .

19. THANK YOU FOR YOUR
LISTENING