Acute Otitis Media & Otitis Media with Effusion (OME) PDF

ACUTE SUPURATIVE OTITIS MEDIA Asst prof dr.Falih Al-Anbaky Acute Spprative Otitis Media Introduction: Definition:- Acute Inflammation of the mucoperiosteal lining of the middle ear cleft (Eustachian tube, tympanic cavity, mastoid antrum and mastoid air cell. --More common in infant and children...

ACUTE SUPURATIVE OTITIS MEDIA Asst prof dr.Falih Al-Anbaky Acute Spprative Otitis Media Introduction: Definition:- Acute Inflammation of the mucoperiosteal lining of the middle ear cleft (Eustachian tube, tympanic cavity, mastoid antrum and mastoid air cell. --More common in infant and children of lower socio-economic. --Mostly follow viral URTI. Route of infection: Via ET the MC ( lumen or sub epithelial lymphatics). ET in children immature (short wide straight). Breast feeding swimming diving can predispose. Via external ear : Traumatic perforation. Blood borne :uncommon ASOM Predisposing factors Recurrent attacks of common cold,URTI,measles,diphtheria, whooping cough. Recurrent tonsilitis and adenoiditis. Acute and chronic rhinitis &sinusitis. Allergic rhinitis. Tumours of nasopharynx. Packing of nose. Cleft palate. *ASOM Bacteriology: Mostly it is viral infection. ▪ Infant &children: Streptococcus pneumoniae MC Haemophilus influenzae Moraxella catarralis Less common: S pyogens ,S aureus Pseudomonas ASOM Pathology and clinical features Stage of tubal occlusion: - Negative M E pressure (Retraction of TM with some effusion{transudation} in ME. -Deafnes & earache without fever. -- TM retracted, H. of Malleus foreshortened,prominent lateral process of M,loss of light reflex. --TFTest: conductive deafnes. ASOM Stage of pre-suppuration: -Pyogenic organism invade ME. -Inflammatory exudate formed. - TM become congested hyperemic. -Marked earache (throbbing). -High degree of fever&child become restless. - Cart wheel appearance of TM. -TFTs show conductive deafnes ASOM Stageof suppuration: -Formation of pus in ME& mastoid cells. - TM start bulging to the point of rupture. -Excrutiating earache ,deafnes increase. - High grade fever. -Vomiting& convulsion may occur (in infant, children). -TM appear red &bulging with loss of land marks. - Yellow spot( point of eminent rupture) on TM may be seen. - Xray mastoid show clouding of air cells. ASOM Stage of perforatio and resolutios : -TM may ruptures with release of pus & subsidence of symptoms. -EAC may contain blood stained discharge or mucopurulent. Asmall perforation is seen in antero-inferior quadrent. ASOM Stage of complications: -If virulence of organism is high or resistance of patient is poor or inadequate treatment: Extra cranial :- -Acute mastoiditis, subperiosteal abscess,facial paralysis,labyrinthitis,petrositis. Intracranial:- extradural abscess , meningitis, brain abscess or lateral sinus thrombosis. ASOM Investigation Most cases diagnosed clinically. Some time do cbc, Discharge swab for c\s. Mastoid xry not always ASOM Treatment: Most cases of AOM of viral origin will resolve spontaneously with in 24- 72 hrs ,Acording to guide line no need for antibiotis only symptomatic. If persist ,detoriarate,or suppurative, so;- -Antibiotics:Ampecillin,amoxycillin,co-amoxyclav,cefixim ,erythromycin,cotrimoxazole. -Decongestant nasal drop. -Oral decongestant -Dry local heat. -Analgesics & antipyretics. -Ear toilet (discharge). -Myringotomy: if ▪ Bulging of TM persist with more pain or fever. ▪ Incomplete resolution despite antibiotics. ▪ Persistent effusion beyond 3 months.  Asom AB therapy Review after 48-72hrs Earache& fever goog response persist or increase another AB for 10 dys or continue on same for 10 dys myringotomy &c\s & specific AB Complete resolution complete resolution Persistent fluid but earache &fever abate periodic check 12 wks complete resolution persistent effusion treat as OME OTITIS MEDIA WITH EFFUSION OME *Introduction *Otitis media with effusion (OME) is a condition that most commonly affects children,but could occur at any age. OME is caused by the build-up of a viscous* Non purulent inflammatory fluid within the * middle ear, resulting in a conductive hearing impairment OME Serous Otitis Media Secretory Otitis Media Mucoid Otitis Media Glue ear Accumulation of non purulent fluid in the middle ear cleft. Commonly seen in school age children OME Aetiology: Two mechanism of fluid collection: ❖ Malfunction of ET. (in children it immature short wide straight).and any diseases that causing ET obstruction. ❖Increased secretory activity of ME mucosa due to chronic inflammatory changes. OME Etiology ❖Malfunctioning of ET - Adenoid hyperplasia - Chronic rhino-sinusitis - Chronic tonsillitis - Any mass or tumor in nasopharynx (adults) -Cleft palate, palatal paralysis -Craniofacial disorder e.g Down syndrome -Allergy (atopy) ME mucosa act as a shock organ -Mucocilliary disorders -Unresolved AOM (inadequate treatment) -URTI Viral infection:Adeno &Rhino viruses OME Symptoms: It may be unilateral or bilateral ▪ CHL most common feature around 40 dB loss. ▪ Sensation of fullnes or pressure in ears. ▪ In young children this may be noticed as difficulty with attention at school or poor(delayed &defective) speech and language development. ▪ Mild earache OME Signs: on examination depend on onset: Early: -TM is dull, opaque with loss of light reflex -Fluid level (hair line) and air bubbles may be seen. -TM may be retracted (distraction of cone of light reflex, fore shorten HOM,prominent lateral process. Late: -TM may be grey(early) ,yellow, yellow brown or bluish in color due to fluid & according to onset. -TM may show pulging due to fluid,vessels congested. -Mobility of TM is restricted (by seigle pneumatic speculum or valsalva). OME Investigation TFT (512hz) CHL [Rinne –ve Weber lateralized to affected ear. Pure Tone Audiometry show AB gap. Tympanometry(impedance audiometry type B). Mstoid plane x-ray :Clouding or hazzenes of air cells. OME TREATMENT: ▪ Medical Tr for acute cases (serous OM) -Decongestant local &oral. -Antihistamin and steroid. -Antibiotic not given routinelly it is non bacterial fluid unless there is URTI. -Middle ear aeration :Valsalva,ET catheterization,chewing gum Recent guide line these measure of treatment of no good benefit. OME ▪ Surgical treatment -Myringotomy: if it persist for more than 3 month (interfere with speech and school performance):-- -Myringotomy &aspiration for serous OM -Myringotomy and Gromet (ventilatione tube or tympanostomy tube) insertion in case of chronic or glue fluid founded remain for 6-12 month and expel out. --Cortical mastoidectomy to remove loculated thick fluid or cholesterol granuloma.in cases of recurence,persistant. --Treatment of causative factor (Tonsillectomy ,Adenoidectomy for older children. OME Sequelae of chronic OME Atrophy and atelectasis of TM , due to dissolution of fibrous layer. Ossicular necrosis(long processof incus) Tympanosclerosis:hyalinised collagen with chalky deposit on TM. Retraction pocket and cholesteatoma Cholesterol granuloma Adhesive otitis OM. THANK YOU *