It is an inflammation of the middle ear cleft (( not middle ear cavity)). Account for almost 1/3 of the office visit to pediatricians Peak incidence 6-24 month of life More common in boys and in low socioeconomic persons Incidence increased in children with: HIV , cleft palate, trisomy 21

1. Otitis Media
Musa Abu Sabha

2. Outline
 Definition
 Epidemiology
 Classification
 Risk factors
 Causes
 Pathophysiology
 Diagnosis
 Treatment
 Complication

3. Definition
It is an inflammation of the middle ear cleft ((
not middle ear cavity)).

4. Epidemiology
 Account for almost 1/3 of the office visit to
pediatricians
 Peak incidence 6-24 month of life
 More common in boys and in low
socioeconomic persons
 Incidence increased in children with: HIV ,
cleft palate, trisomy 21

5. Classification
1. Acute: less than 3 weeks (or one month roughly)
a. Nonsuppurative → There is No pus
b. Suppurative → There is pus & indicates
tympanic membrane perforation.
2. Subacute: 3 weeks- 3months (or up to 90 days)
a. Nonsuppurative
b. Suppurative

6. Classification
3. Chronic: More than 3 months (or more than 90 days)
a. Nonsuppurative : (AKA: Secretory OM / Serous OM/
Exudative OM/ OM with effusion (OME) / Blue ear)
In adults, unilateral secretory OM is nasopharengeal
carcinoma until proven otherwise.
b. Suppurative:
Type 1 (Safe type): Tubotympanic type,
there is central perforation & is not associated with
cholesteatoma.
Type 2 (Unsafe type): atticoantral type,
there is marginal or peripheral perforation & is associated
with cholesteatoma.

9. Risk factors
1. Young age
2-infected or enlarged adenoids
3. Bottle feeding
4. Day care attendance
5. Caretaker smoking
6. Craniofacial anomalies
7. Genetics tendency
8. Allergic disease
9. Immunodeficiency

10. Causes
80% bacterial:
1. S.pneumonia 50%
2. H.influenzae 25%
3. M.catarrhalis 12%
4. Group A strep 2-4%
20% viral:
RSV, Rhinovirus, Parainfluenza, Influenza viruses.

11. Eustachian tube dysfunction
(ETD) :obstruction and
swollen
Mucosa of middle ear not absorbe air so a
negative pressure is generated, which pulls
interstitial fluid into the tube and creates a
serous effusion
Microbial growth
Pathophysiology
Viral URTI

12. Clinical presentation
1-Concurrent or recent symptoms of upper respiratory infection
(URI), such as cough, rhinorrhea, or sinus congestion..
2-Otorrhea.
3-Otalgia
4-Headache.
5-fever.
6-irritability and poor feeding in neonate.
7-GIT symptoms: anorexia, Nausea, vomiting, diarrhea.
8-OME: hearing loss, otalgia, vertigo, Tinnitus .

13. Normal tympanic membrane

14. Diagnosis
Acute OM
1-Histroy
2-Pneumotic Otoscopy is the gold standard.
A-loss of all normal marks on tympanic membrane.
B- change color, bulging of membrane.
C-Decreased mobility is the most important sign.

15. Diagnosis
Chronic OM with effusion
Pneumatic Otoscopy shows :
1. Bulging tympanic membrane.
2. Retraction of tympanic membrane (prominent handle of
malleus).
3. Tympanic membrane mobility loss.
4. Air fluid level behind the tympanic membrane.
5. Air bubbles behind the tympanic membrane.
6. Bluish ear drum.

18. Treatment
Acute OM
 1st line therapy is amoxicillin (high doze 80-90 mg/kg/ day in 2 divided doses)
 2nd line therapy amoxicillin/clavulanic acid, 2nd or 3rd generation cephalosporin(oral),
IM ceftriaxone
 Acetaminophen and ibuprofen for fever.
Recurrent AOM
 Chemoprophylaxis
 Sulfisoxazole, amoxicillin, ampicillin, PNC
 Myringotomy and tube insertion
Adenoidectomy.
OME (OM with effusion)
 MEE > 3 moths or associated hearing loss, vertigo, frequency, , discomfort
 Antibiotics
 Antibiotics + steroid
o 21% improvement compared to ATB alone
o prednisone 1 mg/kg day x 7 days
 Myringotomy & tympanostomy +/- adenoidectomy

19. Complication of OM
 Intertemporal: hearing loss, TM perforation,
cholesteatoma, mastoiditis, labryrinthitis,
adhesive OM, facial paralysis.
 Intracranial: meningitis, extradural abscess,
subdural empyema, brain abscess, lateral sinus
thrombosis.
• The most common complication is mastoiditis.
• The most common cause of hearing loss is otitis
media.