The document discusses otitis media (OM), inflammation of the middle ear. It describes the different types of OM including: acute otitis media (AOM), otitis media with effusion (OME), suppurative chronic otitis media (CSOM), and cholesteatoma. AOM is most common in young children and can be suppurative, nonsuppurative, or recurrent. OME is defined as the persistence of serous or mucoid secretion in the middle ear for 3 months or more. CSOM is persistent or intermittent discharge through an altered eardrum and can cause complications like mastoiditis.
Acute Otits Media in Infant by\ Eman Salman
It was used for student presentation in ENT course rotation
I Hope you find what is helpful for your knowledge ♥
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Incidence increased in children with: HIV , cleft palate, trisomy 21
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1. T a l l e r d e O R L
OTITIS MEDIA
Alumno:
Juan Pablo Sanchez Cabrera
2. Contenido
1. OTITIS MEDIA
2. OTITIS MEDIA AGUDA
3. OTITIS MEDIA SEROSA
4. OTITIS MEDIA SUPURATIVA
(CON SUBDIVISIONES)
5. COLESTEATOMA
2
3. OTITIS MEDIA
Otitis media (OM) se refiere a un proceso inflamatorio
dentro de la hendidura del oído medio.
Puede se aguda (<3 meses) o crónica (> 3
meses)
La trompa de Eustaquio parece tener un papel
central en todas las modalidades de OM.
Actividades Fisiológicas de la Trompa de Eustaquio
Mantener presión gaseosa del oído interno a la
del nivel atmosférico.
Prevenir el reflujo de contenido de la
nasofaringe al oído medio.
Eliminar secreciones por acciones mucociliares
Lalwani, Anil. CURRENT Diagnosis & Treatment Otolaryngology--Head and Neck Surgery, Fourth Edition. 4th ed. New York : Blacklick: McGraw-Hill
Education, 2020. 3
4. OTITIS MEDIA
Otitis media (OM) se refiere a un proceso inflamatorio dentro de la hendidura del oído medio.
CLASIFICACION
Lalwani, Anil. CURRENT Diagnosis & Treatment Otolaryngology--Head and Neck Surgery, Fourth Edition. 4th ed. New York : Blacklick: McGraw-Hill
Education, 2020. 4
Otitis media AGUDA
• Supurativa
• NO Supurativa
• Recurrente
Otitis media CRONICA
• Supurativa
• Tubo timpánica
• Colesteatoma
• NO Supurativa
• Otitis media con exudado
5. OTITIS MEDIA AGUDA
▫ La obstrucción anatómica esta ocasionada en su
mayor parte por inflamación de la mucosa de la
trompa de Eustaquio o compresión extrínseca por un
tumor o adenoides grandes.
▫ Puede haber obstrucción funcional por disfunción de
la musculatura normal de la trompa, presente en
pacientes con paladar hendido o en casos de rigidez
insuficiente de porción cartilaginosa (lactantes y
escolares)
▫ Proporción de OM elevada en pacientes con
Síndrome de Down.
▫ Cualquier ALTERACION DE LA FUNCION CILIAR:
Infecciones, toxinas bacterianas, discinecia ciliar.
Lalwani, Anil. CURRENT Diagnosis & Treatment Otolaryngology--Head and Neck Surgery, Fourth Edition. 4th ed. New York : Blacklick: McGraw-Hill
Education, 2020. 5
6. OTITIS MEDIA AGUDA
La OM Aguda es predominante en la infancia
Máxima incidencia en los primeros 2 años de vida.
Puede ocurrir en sus formas:
• Supurativa,
• NO Supurativa y
• Recurrente
Asistencia a guarderías: uno de los principales
factores de riesgo.
Lactancia materna como factor de protección.*
Expocision del humo de cigarro como factor
importante de riesgo.
Variabilidad estacional: Mas común en invierno.
Lalwani, Anil. CURRENT Diagnosis & Treatment Otolaryngology--Head and Neck Surgery, Fourth Edition. 4th ed. New York : Blacklick: McGraw-Hill
Education, 2020. 6
DATOS PARA EL
DIAGNOSTICO
• Otalgia
• Pirexia
• Membrana timpánica
hiperemica, abombada y
engrosada.
• Perdida Auditiva
• Otorrea
7. AOM - PATOGENIA
En la mayoría de los casos el antecedente de infección
viral en las vías respiratorias superiores supone una
alteración mucociliar.
La inflamación provoca la generación de exudado por la
mucosa del oído medio, que es difícil de eliminar ante
disfunción tubarica.
Se produce un medio favorable para el crecimiento
bacteriano.
S. pneunmoniae (40%), Haemophilus influenzae (25-30%),
Moraxella catharralis (10-20%).
Algunos otros patógenos, gramnegativos, virus.
Papel importante de las amígdalas faríngeas (adenoides).
Lalwani, Anil. CURRENT Diagnosis & Treatment Otolaryngology--Head and Neck Surgery, Fourth Edition. 4th ed. New York : Blacklick: McGraw-Hill
Education, 2020. 7
8. AOM – MANIFESTACIONES CLINICAS
▫ Antes de la AOM (otitis media aguda) el paciente tiene
síntomas de infección del tracto respiratorio superior.
▫ Otalgia mas común en niños (lactantes se irritan y jalan el
oído afectado).
▫ Fiebre (puede haber otros síntomas de síndrome
infeccioso)
▫ Otoscopia: Membrana timpánica hiperemica, engrosada,
inmóvil.
▫ Otorrea: Ruptura de la membrana por progresión de la
infección (otalgia y fiebre ⬇⬇)
▫ Diagnostico clínico.
▫ Diagnostico diferencial: Verificar recurrencia, síntomas o
síndromes agregados**.
Lalwani, Anil. CURRENT Diagnosis & Treatment Otolaryngology--Head and Neck Surgery, Fourth Edition. 4th ed. New York : Blacklick: McGraw-Hill
Education, 2020. 8
10. AOM – TRATAMIENTO
▫ Observación expectante: Sin antibioticoterapia en niños
sanos de >2 años y enfermedad leve (Otalgia ligera y
fiebre <39 C)***
▫ Antibioticos: Amoxicilina 80 mg/kg/dia c/ 8 hrs durante 10
días* Evaluar antecedentes y considerar resistencia
microbiana.
▫ Tratamiento sintomático complementario: Analgesicos y
antipiréticos.
▫ En pacientes que no respondan al TX se puede optar por
una MIRINGOTOMIA (ineficaz en la AOM no complicada).
▫ Pronostico favorable y resolutivo en la mayoría de los
casos, SI persiste > Sospecha de otitis media CRONICA.
Lalwani, Anil. CURRENT Diagnosis & Treatment Otolaryngology--Head and Neck Surgery, Fourth Edition. 4th ed. New York : Blacklick: McGraw-Hill
Education, 2020. 10
11. OTITIS MEDIA CON EXUDADO
Se define como la persistencia de una secreción serosa o
mucoide en el oído medio durante 3 MESES o MAS.
También llamada OM Serosa Cronica, Secretora
Cronica o OM Adhesiva.
Es la causa mas común de perdida auditiva en
niños (mas común durante los 2 a 5 años)
Factores de riesgos ya descritos para la AOM
Patogenia: Alteración en la eliminación del moco y
sobreproducción del mismo
Aumento de viscosidad secundario a infecciones
virales y bacterianas.
Falta de abertura de la trompa de Eustaquio
Si el moco es demasiado mucoso o seroso habrá
mayor incompetencia ciliar.
Lalwani, Anil. CURRENT Diagnosis & Treatment Otolaryngology--Head and Neck Surgery, Fourth Edition. 4th ed. New York :
Blacklick: McGraw-Hill Education, 2020. 11
DATOS PARA EL
DIAGNOSTICO
• Perdida auditiva
persistente
• Membrana timpánica
inmóvil y opaca
• Timpanograma plano.
12. OTITIS MEDIA CON EXUDADO
PREVENCION
▫Medidas de cuidado de una AOM (evitar
progresión)
▫Evitar factores de riesgo.
MANIFESTACIONES CLINICAS
▫Puede ser asintomática
▫Reducción de la capacidad auditiva (hipoacusia)
▫Preescolares: Retraso del desarrollo del lenguaje o
problemas conductuales
▫Lactantes: Sensacion de bloqueo en el oído, los
pacientes tiran del mismo.
▫Otoscopia: Membrana timpánica OPACA,
AMARILLA/GRISACEA, movilidad reducida.
Lalwani, Anil. CURRENT Diagnosis & Treatment Otolaryngology--Head and Neck Surgery, Fourth Edition. 4th ed. New York :
Blacklick: McGraw-Hill Education, 2020. 12
13. OTITIS MEDIA CON EXUDADO
PRUEBAS ESPECIALES
▫Timpanometria: Si hay exudado del oído medio, entonces la distensibilidad no variara con
cambios de la presión del conducto (Timpanograma plano o Tipo B).
▫Audiometria: Perdida auditiva por conducción moderada.
Lalwani, Anil. CURRENT Diagnosis & Treatment Otolaryngology--Head and Neck Surgery, Fourth Edition. 4th ed. New York :
Blacklick: McGraw-Hill Education, 2020. 13
14. OTITIS MEDIA CON EXUDADO
DX DIFERENCIAL
Superpocision considerable entre la AOM y
OME (Otitis media con exudado)
Si hay exudado unilateral del odio medio
(ADULTOS) sospechar de un carcinoma
nasofaríngeo.
TRATAMIENTO
OBSERVACION: En afecciones leves, se
recomienda de tres meses a partir del inicio.
MEDIDAS NO QUIRURGICAS: Autoinflacion
con globos nasales (poco adherible al px).
Antibioticos*, antihistamínicos
NO SE RECOMIENDAN ESTEROIDES.
Lalwani, Anil. CURRENT Diagnosis & Treatment Otolaryngology--Head and Neck Surgery, Fourth Edition. 4th ed. New York : Blacklick:
McGraw-Hill Education, 2020.
14
15. OTITIS MEDIA CON EXUDADO
MEDIDAS QUIRURGICAS
▫Insercion de tubos de timpanostomia: Tubos
para corto plazo (tipo ojal) y tubos para largo
plazo (Tubos en T)
▫Adenoidectomia*
PRONOSTICO
A medida que los niños crecen (>7 anios de edad)
se nota disminución de la prevalencia de la
enfermedad, debido a mejoría funcional y
desarrollo de la trompa de Eustaquio.
Lalwani, Anil. CURRENT Diagnosis & Treatment Otolaryngology--Head and Neck Surgery, Fourth Edition. 4th ed. New York :
Blacklick: McGraw-Hill Education, 2020. 15
16. OTITIS MEDIA SUPURATIVA CRONICA
Se define como un exudado persistente o intermitente a
través de la membrana timpánica alterada (perforación,
tubo de timpanostomia).
Puede ocurrir la perforación sin supuración (CSOM
Inactiva).
PATOGENIA
Consecuencia de episodio de AOM con perforación.
Correlación entre la OME y degeneración del
estrato fibroso = Ruptura.
Perforación traumática
Contaminación a partir del oído externo o
exposición de bacteria de la nasofaringe.
Lalwani, Anil. CURRENT Diagnosis & Treatment Otolaryngology--Head and Neck Surgery, Fourth Edition. 4th ed. New York :
Blacklick: McGraw-Hill Education, 2020. 16
17. OTITIS MEDIA SUPURATIVA CRONICA
MANIFESTACIONES CLINICAS
▫Otorrea intermitente o continua.
▫Reduccion auditiva
▫Exudado mucopurulento
▫Pueden aparecer pólipos o tejido de granulación
▫Dolor no suele ser usual de CSOM
▫Cicatrices por antecedentes Qx
▫Mucosa edematosa
▫Discontinuidad osicular (puede haber necrosis)
PRUEBAS ESPECIALES
▫Frotis de exudado (cultivo, antibiograma)
▫Valoracion audiológica
▫Investigacion radiográfica.
Lalwani, Anil. CURRENT Diagnosis & Treatment Otolaryngology--Head and Neck Surgery, Fourth Edition. 4th ed. New York :
Blacklick: McGraw-Hill Education, 2020. 17
18. OTITIS MEDIA SUPURATIVA CRONICA
TRATAMIENTO
Higiene auricular
Antibioticos tópicos (OJO: Se incluyen los
aminoglucosidos, evaluar riesgo-beneficio).
Antibioticos sistémicos: P. aureginosa es de los
patógenos mas comunes > Quinolonas
(ciprofloxacina, ofloxacina). NINOS CUIDADO:
Cambiar por penicilinas como piperacilina o
cefalosporinas parenterales.
MEDIDAS Qx
Timpanoplastia
Cirugia timpanomastoidea
Lalwani, Anil. CURRENT Diagnosis & Treatment Otolaryngology--Head and Neck Surgery, Fourth Edition. 4th ed. New York :
Blacklick: McGraw-Hill Education, 2020. 18
19. SECUELAS Y COMPLICACIONES DE LAS OM
SECUELAS
▫Timpanoesclerosis
▫Atelectasias
COMPLICACIONES
▫Mastoiditis (Aguda, subaguda )
▫Paralisis del nervio facial
▫Laberintitis supurativa
▫Meningitis
▫Abceso intracraneal
▫Abceso subdural
▫Abceso extradural
▫Trombosis del seno lateral
▫Hidrocefalia otica
Lalwani, Anil. CURRENT Diagnosis & Treatment Otolaryngology--Head and Neck Surgery, Fourth Edition. 4th ed. New York :
Blacklick: McGraw-Hill Education, 2020.
19
Intratemporales
Intracraneales
20. COLESTEATOMA
El Colesteatoma es la presencia de epitelio
escamoso en el oído medio, la apófisis mastoides
o el epitimpano..
▫Puede ser adquirido o congénito
▫Colesteatoma adquirido primario (EL
MAS COMUN) se produce por una
retracción de la membrana timpánica
(pars fláccida)
▫Colesteatoma congénito no hay
retracción de la membrana timpánica,
sin antecedentes infecciosos.
Lalwani, Anil. CURRENT Diagnosis & Treatment Otolaryngology--Head and Neck Surgery, Fourth Edition. 4th ed. New York :
Blacklick: McGraw-Hill Education, 2020. 20
21. COLESTEATOMA
PATOGENIA
Funcion anómala de la trompa de
Eustaquio.
Inflamacion crónica del oído medio.
La presión negativa crónica del Oido medio
origina retracciones de la pars fláccida (mas
débil).
Acumulacion de detritos de queratina en el
saco del Colesteatoma,.
Aumento de actividad osteoclastica >
Aumento de resorción osea.
Se promueve el crecimiento de patógenos.
P. aureginosa, Streptococcus,
Staphylococcus, proteus.
Lalwani, Anil. CURRENT Diagnosis & Treatment Otolaryngology--Head and Neck Surgery, Fourth Edition. 4th ed. New York :
Blacklick: McGraw-Hill Education, 2020. 21
22. COLESTEATOMA
MANIFESTACIONES CLINICAS
▫Otorrea purulenta recurrente o persistente.
▫Acufenos son frecuentes
▫Verrtigo (pocos casos, por erosion
laberíntica directa)
▫Tension, parestesia o paralisis del nervio
facial.
▫Retraccion de la pars fláccida
▫Presencia de matriz de epitelio escamoso
con detritos queratinicos.
▫Polipos, tejido de granulación.
▫Los colesteatomas se tornan visibles detrás
de la membrana timpánica en la mayoría de
px.
Lalwani, Anil. CURRENT Diagnosis & Treatment Otolaryngology--Head and Neck Surgery, Fourth Edition. 4th ed. New York :
Blacklick: McGraw-Hill Education, 2020. 22
23. COLESTEATOMA
ESTUDIOS DE IMAGEN Y PRUEBAS
▫Rastreo por CT: Datos sugieren
presencia de Colesteatoma por
erosion del hueso (escudo
timpánico y cadena osicular)
▫Apoyo para intervención Qx (CT)
▫Imagen por resonancia magnética:
Considerar implicaciones.
▫Audiometria: Reduccion auditiva
por conducción.
Lalwani, Anil. CURRENT Diagnosis & Treatment Otolaryngology--Head and Neck Surgery, Fourth Edition. 4th ed. New York :
Blacklick: McGraw-Hill Education, 2020. 23
24. COLESTEATOMA
COMPLICACIONES:
Mastoiditis aguda, abceso subperiostico, trombosis del seno sigmoideo, meningitis, abceso
cerebral.
TRATAMIENTO
Reducción de actividad inflamatoria e infecciosa: Ototopicos (ofloxacina, -neomicina-polimicina
B)
Medidas quirúrgicas.
Lalwani, Anil. CURRENT Diagnosis & Treatment
Otolaryngology--Head and Neck Surgery, Fourth Edition.
4th ed. New York : Blacklick: McGraw-Hill Education,
2020. 24
25. REFERENCIAS BIBLIOGRAFICAS
Lalwani, Anil. CURRENT Diagnosis & Treatment Otolaryngology--Head
and Neck Surgery, Fourth Edition. 4th ed. New York : Blacklick:
McGraw-Hill Education, 2020.
MUCHAS GRACIAS POR SU
ATENCION (:
25
😄