Transcript Acute Otitis Media

OTITIS MEDIA
Dr.Isazadehfar
OTITIS MEDIA
Definition: Presence of a middle ear infection
 Acute Otitis Media: occurrence of bacterial
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infection within the middle ear cavity
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Otitis Media with Effusion: presence of
nonpurulent fluid within the middle ear cavity
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OM is the second most common clinical
problem in childhood after upper
respiratory infection
EPIDEMIOLOGY
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Peak incidence in the first two years of life (esp.
6-12 months)
Boys more affected girls
50% of children 1 yr of age will have at least 1
episode.
1/3 of children will have 3 or more infections by
age 3
90% of children will have at least one infection
by age 6
Occurs more frequently in the winter months
MICROBES AT FAULT!!!
Streptococcus pneumonia
 Homophiles influenza(non-typeable)
 Moraxella catarrhalis
 Group A Streptococcus
 Staph aureus
 Pseudomonas aeruginosa
 RSV assoc. with Acute Otitis Media
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Classification of Otitis Media
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Acute Otitis Media: presents with fever,
otalgia, and hearing loss
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Otitis Media with Effusion: evidence of
middle ear effusion on pneumatic otoscopy
 Recurrent Otitis Media: inability to clear
middle ear effusions
 Chronic Serous Otitis Media: presents as
‘fullness in the ear’, tinnitus, or another acute
disease
RISK FACTORS
Upper Respiratory Infections
 Allergies
 Craniofacial abnormalities (cleft palate)
 Down’s Syndrome
 Passive smoking
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PATHOGENESIS
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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
SIGNS & SYMPTOMS
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Neonates/Infants: change in behavior,
irritability, decreased appetite, vomiting
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Children(2-4): otalgia, fever, noises in ears,
cannot hear properly, changes in personality
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Children (>4): complain of ear pain, changes in
personality
On Physical exam…
The classic description → erythematic,
opaque, bulging tympanic membrane
with loss of anatomic landmarks
including a dull/absent light reflex
 Pneumatic Otoscopy → decreased
tympanic membrane mobility
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DIAGNOSIS
Pneumatic Otoscopy→ standard tool
 Impedance Tympanometry
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Spectral Gradient Acoustic Reflectometry
 Diagnostic 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)
INDICATIONS FOR TYMPANOCENTESIS
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Toxic appearing child
Failed treatment regimen with antibiotics
Suppurative complications
Immunosuppressed pt
Newborn infant in which the usual pathogens
may not be the case
DIFFERENTIAL DIAGNOSIS
Otitis externa
 Bullous myringitis
 Cerumen impaction
 Dental abscess
 Foreign body in ear canal
 Referred pain (parotid/tooth/lymphadenitis)
 Tonsilitis
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TREATMENT
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Amoxicillin: 20-40 mg/kg/day tid for 10-14 days
or,
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Augmentin: 45 mg/kg/day po bid for 10-14 days
(amoxicillin and clavulanate potassium)
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Auralgan: analgesic/adjunct for ear pain 2-4 drops
tid (antipyrine, benzocaine, and dehydrated glycerin)
nd
2
Line Treatment Regimen
Cefzil
 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.
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COMPLICATIONS
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Hearing loss: conductive, sensoneural, mixed)
Acute mastoiditis: before the advent of antibiotics
 Chronic perforation of the TM
 Tympanosclerosis
 Cholesteatoma(keratin cyst)
 Chronic suppurative OM
 Cholesterol granuloma: ‘Blue drum syndrome’
 Facial nerve paralysis
Complications cont…
Intracranial complications
 Bacterial meningitis
 Epidural abscess
 Subdural empyema
 Brain abscess
 Otitic hydrocephalus
 Lateral sinus thrombosis
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What Is Chronic otitis media?
Inflammation of the middle ear that lasts
for more than 6 weeks
 Usually preceded by Acute otitis media,
or viral URTI
 Common in the age 3-6
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Causes and predisposing factors:
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Late onset or inappropriate antibiotic treatment of
acute otitis media.
URTI, Allergic rhinitis
Lowered Resistance in malnutrition and anemia
In early onset type: Short period breastfeeding and
long time group child care
Eustachian tube deformity, adenoid hypertrophy
Septal deviation, cleft palate, sinusitis
Symptoms:
Conductive deafness
 Vertigo
 Tinnitus
 Ear discharge
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Etiologies
Pseudomonas aerugenosa
 Proteus
 E.coli
 H. influenza
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1. Serous ( Otitis media with effusion OME )
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Stages:
 1. URTI or acute otitis media –> Fluid collection in
middle ear and obstruction of Eustachian tube 
tympanic membrane retraction
 2. Fluid become pus and glue like  conductive
hearing impairment and pain  necrosis  tympanic
membrane perforation
 3. Could end up with mastoiditis ( if not stopped )
 Enlarged adenoid is most common cause in children
Management of serous Chronic otitis media
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Systemic decongestants
Nasal drops
Surgery ( myringotomy ) , if the above 2 failed
Myringotomy is tiny incision done in the ear drum to
relief pressure and drain pus
CHOLESTEATOM