OTITIS MEDIA

Esther Obedoza
Melissa David

Objectives:
Know the etiology, risk factors, sign and symptoms,
and pathophysiology
Differentiate the various types of inner ear disorder
Identify the different types of surgical procedures and
management

Pathophysiology

Predisposing Factors:
-infants and young
children (6mos-3 y/o)

Obstruction in the ET

Prevents drainage of
normal secretions

Negative pressure
Pathogens from the URT
enters the middle ear through
the contaminated secretions
in the nasopharynx

Local infection in the

middle ear

Pulls interstitial fluid

Earache, swelling,
redness

Pus Formation
Decreased hearing

Precipitating Factors:
-children w/ congenital
abnormalities
-exposure to cigarette
smoking
-URTI
-Allergy

Acute Otitis Media

An acute infection of the middle ear
Lasting less than 6 weeks

Most frequent in children

Pathogens: S. Pneumoniae, H. Influenzae, Moraxella

catarrhalis
Enters the middle ear after Eustachian tube dysfunction
r/t URTI, adenoid hypertrophy, allergic reactions,
cigarette smoke

Acute Otitis Media: Symptoms

Unilateral in adults
Otalgia
Fever
Conductive hearing
loss
Normal external
auditory canal
No pain with
movement of auricle
Tympanic membrane
is erythematous and
often bulging

Tympanic Membrane

NORMAL

AOM

Acute Otitis Media: Management

Broad spectrum antibiotic
Antibiotic otic preparations
Condition may become subacute (3wks-3months) with
persistent purulent discharge
Rarely permanent hearing loss
Surgery:

Myringotomy/Tympanotomy

Serous Otitis Media

Middle ear effusion
Involves fluid without active infection
Results from (-) pressure in the middle ear
Freq seen in: after radiation therapy or barotrauma
(sudden presssure change in the middle ear like scuba
diving or airplane descent), eustachian tube
dysfunction from respi infection or allergy

Serous Otitis Media: Symptoms

Fullness in the ear or sensation of congestion
Popping and crackling noises as the eustachian
tube attempts to open
Air bubbles are visualized
Conductive hearing loss

Serous Otitis Media:

Management
Need not be treated medically unless infection occurs
(AOM)
Myringotomy
Corticosteroids in small doses
Valsava maneuver may be cautiously performed

Chronic Otitis Media

Result of repeated AOM causing irreversible tissue
pathology and persistent perforation of the tympanic
membrane
Damage the tympanic membrane, destroy the ossicles,
and involve the mastoid

Chronic Otitis Media:

Symptoms
Symptoms may be minimal
Persistent or intermittent, foul-smelling otorrhea
Perforation of tympanic membrane
Pain is usually not experienced, except in cases of
acute mastoiditis
Cholesteatoma
Conductive hearing loss

Chronic Otitis Media: Management

Careful suctioning of the ear
Instillation of antibiotic drops to treat purulent
discharge
Systemic antibiotics are usually not prescribed except
in cases of acute infection
Surgery: Tympanoplasty
Ossiculoplasty
Mastoidectomy

Surgical Management
Myringotomy
-surgical opening of the eardrum
Mastoidectomy
-to remove cholesteatoma, gain access to diseased
structures and create a dry healthy ear
Ossiculoplasty
-surgical reconstruction of the middle ear bones