IN THE NAME OF

GOD

Acute otitis media

Dr. Syed Ali Naqi
Assistant Professor
Deptt ENT,IMDC.

Definition:

Inflammation of the middle

ear cleft.

Types of otitis media

1.

Suppurative
ASOM
CSOM

2. Non Suppurative
(Secretory Otitis media)

3. Specific
Tuberculosis
Syphilitic

Duration
Acute

up to 3 weeks

Sub acute 3weeks- 3months

Chronic

3 months onwards

Types of Acute Otitis Media

1. Acute Suppurative otitis media
2. Acute non-Suppurative otitis
media

Acute Suppurative otitis media

Infection of mucoperiosteal lining middle ear cleft/
pyogenic organism hyperemic engorgement exudation
of pus potentially serious in nature.

Incidence:
4% population
Disease of childhood, adult rare
Peak incidence under 2 years of age
Male, day care school, non breast fed, winter

Aetiology
Predisposing factors :

Children (2 YRS) more prone due to

Short, wider , horizontal

& In efficient Eustachian tube
Adenoids
Recumbent position during feeding
Poor general resistance
Poor scocio economic group,
unhygienic , over crowding & poor living

Routes of infection
Eustachian tube :
(Most common route)
Infection
Nasopharyngeal conditions
Aspiration
Jumping

Routes of infection (conti)

External Ear
Contaminated traumatic rupture of tympanic
membrane
Pre existing perforation of tympanic membrane
Swimming
Bathing

Blood born
Rarely
From distant septic focus
Bacteremia/septicemia
Medial wall of inner ear (remote cause)
Meningitis
Labyrinthitis

Causative organisms
Primary invaders

viruses
Common cold
Adenovirus
Influenza virus
Resp. syncytial virus
Common micro-organisms
Streptococcus pneumonia
Haemophilius influenza
Staph aureus
Beta hemolytic streptococcus
Moraxella catarhallis

Pathology
Cyclic inflammatory changes
1. Eustachian tube obstruction
(Catarrhal stage)
2. Stage of exudation/transudation
(Pre Suppurative stage)
3. Suppurative stage
4. Perforation of tympanic membrane
5. Stage of resolution & complications

Clinical features
Inflammation begins in Eustachian
tube and spreads backwards
producing a cyclic inflammatory
changes which makes it convent to
describe clinical features in stages.

1) Stage of tubal occlusion/Catarrhal

stage
Sense of blockage
Decreased hearing
Own voice sounds unusually loud in affected
ear
Slight pain

Retraction of tympanic membrane

Light reflux disappears

Fluid level/bubbles may appear but mostly not
visible due to progressive loss of transluncy due
to progressive disease

2) Stage of Pre-suppuration
Invasion by pyogenic organisms
Increasing earache & deafness

Pain intense throbbing & prevents sleep

Tinnitus may be present
Progressive hyperemia of ear drum
Temperature rises

3) Stage of suppuration
A) Before perforation

Tympanic membrane angry red looking and

buldging.
Handle of malleus invisible & so the other
land marks

Yellow spot of necrosis

Tenderness over mastoid

antrum

Suppurative stage
B)

After perforation

Spontaneous rupture of TM
Escape of blood stained purulent discharge
Spontaneous relief of pain
Pus discharge slows & ceases with in 2 days
Perforation heals, & land marks re appear
Perforation usually appears at antero inferior
quadrant of TM

4) Stage of resolution
At any stage
Adequate treatment

High resistance of patient & low virulance of organisms

Complete restoration of function/partial recovery of
function

Stage of Complications
Inadequate treatment
High virulence of organisms

Poor resistance of host

Generally occur 2nd week but may occur

earlier

Investigations

Audiometry
Pus swab for C/S
Radiology

Treatment
Treatment depends on the stage of infection
- Medical
- Surgical

Stage of tubal obst.

Tubal opening
. Local decongestants nasal drops/spray
. Analgesic

Treatment(Conti)
Pre Suppurative
Local decongestants
Analgesic
Antibiotics
Adult
Penicillin
1st line
Children
Amoxicillin
Neonate
Ampicillin

2nd

Combination
line
Erythromycin
Sulphonamide
Cefaclor

Treatment
Stage of suppuration
Before perforation
Medical
Surgical
Medical :

Antibiotics
Analgesics
Local decongestants
Rest

Treatment (cont.)
Surgical
Myringotomy indications

Severe pain persistency 12-24 hours inspite

of adequate
antibiotics
2. Convex red bulging ear drum 24-36 hour
adequate
antibiotics treatment
3. Delayed resolution despite antibiotics for 3
weeks
4. Small perforation with in adequate drainage
& impeding
intracranial complications
1.

Treatment (cont.)
Suppurative
Treatment after perforation
1. Pus swab C/S
2. Aural toilet
3. Antibiotic ear drops
4. Antibiotics
5. Local decongestants

Complications
Very uncommon
Mainly inpatients with recurrent
otitis media
Mastoiditis
Sigmoid sinus thrombosis
Meningitis
Facial palsy
SNHL
Abscess

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If You have any
questions Most
welcome
If No ,,,,,Then Allah
Hafiz.