OTITIS MEDIA

 Definition: inflammation of the middle ear

 Very common in children but can occur in any age
Subtypes of OM
 Acute otitis media (AOM)
 Otitis media with effusion (OME)
 Chronic suppurative otitis media
(CSOM)
 Adhesive otitis media
 Acute otitis media (AOM) develops
suddely due to a (viral or bacterial) upper
respiratory infection with blockage of
the Eustachian tube.
 The most common bacteria found in this
case are Streptococcus
pneumoniae, Haemophilus influenzae,
and Moraxella catarrhalis.
 Otitis media with effusion (OME), also
called serous or secretory otitis media
(SOM) or GLUE ear.
 it is simply a collection of fluid that occurs
within the middle ear space due to the
negative pressure produced by altered
Eustachian tube function.
 This can occur purely from a viral URI, with
no pain or bacterial infection, or it can
precede and follow acute bacterial otitis
media.
 Fluid in the middle ear sometimes
causes conductive hearing impairment,.
Over weeks and months, middle ear
fluid can become very thick and glue-
like (thus the name glue ear).
 Chronic suppurative otitis media involves a
perforation (hole) in the tympanic membrane and
active bacterial infection within the middle ear
space for several weeks or more.
 There may be enough pus that it drains to the
outside of the ear (otorrhea), or the purulence
may be minimal enough to only be seen on
examination using a binocular microscope.
 This disease is much more common in persons
with poor Eustachian tube function.
 Hearing impairment often accompanies this
disease.
 Adhesive otitis media – if fluid is
present within the ear for a protracted
period, the tympanic membrane retracts
and will adhesive to the middle ear, and
adhesive otitis media may develop.
Causative organisms
 Streptococcus pneumoniae
 Haemophilus influenzae
 Moraxella catarrhalis
 Group A Streptococcus
 Staph. aureus
 Pseudomonas aeruginosa
 RSV
 RISK FACTORS
 Upper Respiratory Infections
 Eustachian tube malformations
 Allergies
 Craniofacial abnormalities (cleft palate)
 Smoking
 Cholesteatoma
Pathophysioloy
 This problem mainly deals with Eustachian
tube dysfunction.
 Otitis Media usually follows an URI in which
there is edema of the eustacian tube, leading
to blockage. Stasis of these middle ear
secretions lead to infection and irritation
 Other factors: allergic rhinitis, nasal polyps,
adenoidal hypertrophy
 Causative factors (mainly URI)
 Edema in the Eustachian tube
 Blockage in the Eustachian tube
 Stasis of middle ear secretions
 Irritation

 Inflammation

 Signs and symptoms

 SIGNS & SYMPTOMS
 Otalgia – throbbing pain
 Otorrhea
 Headache
 Fever
 Irritability
 Loss of appetite
 Vomiting
 Hearing loss
 Tinnitus
 Vertigo
Diagnostic measures
 History collection
 Physical examination
 Pneumatic otoscopy – gold standard
mearsure
 Tympanometry
 Reflectometry
 Mastoid x- rays
 The classic description for Otitis Media is an
erythematic, opaque, bulging tympanic
membrane
 Pneumatic Otoscopy: decreased tympanic
membrane mobility
 SpectralGradient Acoustic
Reflectometry: measures the condition of
the middle ear by assessing the response of
the TM to a sound stimulus. Equivalent to
tympanometry for diagnosing middle ear
effusions
Management
 Antibiotics– assess for allergies and
hypersensitivity reactions, inform not to
miss any doses
 Analgesics – do not drive after taking
codeine, inform to take increase fluid
 Antihistamines - chlorpheniramine
 Decongestants - pseudoephedrine
 Analgesics – acetaminophen, ibuprofen

 Amoxicillin (drug of choice): 20-40

mg/kg/day tid for 10-14 days or,
 Augmentin: 45 mg/kg/day bid for 10-14
days
 Auralgan: analgesic/adjunct for ear pain
2-4 drops tid
2nd Line Treatment Regimen
 Cefzil (cefprozil)
 Pediazole ( erythromycin/sulfisoxazole)
 Bactrim (trimethoprim/sulfamethoxazole
 These medications are used as
secondary agents if the primary
antibiotic has failed after 10 days and
the symptoms persists.
Surgical management
 Tympanocentesis & myringotomy
 Tympanoplasty with mastoidectomy
 Tympano – ossiculoplasty
 Resection of the cholesteatoma
 Tympanocentesis & myringotomy:
 involves puncturing the tympanic membrane
and aspirating middle ear fluid to relieve
pressure. Only used if the primary and
secondary line treatment fail.
 COMPLICATIONS
 Hearing loss: conductive, sensorineural, mixed)
 Acute mastoiditis
 Chronic perforation of the TM
 Tympanosclerosis
 Cholesteatoma
 Chronic suppurative OM
 Facial nerve paralysis
Complications
 Intracranial
complications
 Bacterial meningitis
 Epidural abscess
 Brain abscess
 Hydrocephalus
Prevention
 Most common in children so adequate
breast feeding should be given
 OM follows a respiratory tract infection,
so treat the respiratory infections as
soon as possible
 Day care centers is considered as a
source, so proper follow up should be
maintained.
 Health awareness programme in day
care centers, schools can be helpful