Transcript Acute otitis media

OTITIS MEDIA
and its complications
prof. O.I.Yashan
It is estimated that 70% of children will have had
one or more episodes of otitis media (OM) by their
third birthday. This disease process knows no age
boundaries but occurs mainly in children from the
newborn period through approximately age 7
years, when the incidence begins to decrease. It
occurs equally in males and females.
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Ways of spreading of infection to the middle ear :
1. Toubo genes - through an auditory tube (more frequent), in such
cases acute rhinitis took place before otitis.
2. Haematoma genes – with the flow of blood (at a flu, scarlet, misle
and others like that).
3. Through the perforation due to a trauma of ear-drum.
Mainly, inflammation is limited by a mucus lining.
Middle ear effusion is the liquid resulting from OM.
An effusion may be either serous (thin, watery),
mucoid (viscid, thick), or purulent (pus).
The process may be acute (0 to 3 weeks in duration),
subacute (3 to 12 weeks in duration), or chronic
(greater than 12 weeks in duration).
•Acute otitis media –represents the rapid onset of
an inflammatory process of the middle ear space
associated
with one or more symptoms or local or systemic signs.
AOM - acute inflammation of mucus lining of middle ear
cleft. AOM often appears as a complication of viral disease
(flu, AVI) is with subsequent stratification of bacterial
infection (streptococcus, staphylococcus, pneumococcus,
Pseudomonas aerogenosa and others like that).
Classification
According to clinico-morphologic proceed of acute
middle otitis, catarrhal and purulent his forms are
distinguished
ACUTE CATARRHAL OTITIS
MEDIA
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Acute catarrhal otitis media– easy form of acute otitis
media, that develops mainly as a result of auditory tube
disfunction.
Influential factors: Pathological processes: in
nasopharynx (adenoids, tumours);
nose (acute and chronic rhinitis) and in paranasal cavities
(acute and chronic sinusitis).
They cause the violation of functions of auditory tube –
ventilation, drainage and protective. As the tube’s mucus
lining is covered by a cilliar epithelium in continuation of
mucus lining of nasopharynx, through the tube infection
gets in a tympanic cavity, causing its inflammation.
Clinic
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Feeling of otologic
fullness.
Moderate hearing loss.
Tinnitus.
Insignificant excretions
from an ear (possible).
Temperature reaction and
general state are normal
(mainly).
Otoscopy
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The ear-drum is slightly bulged,
gray-pink color.
Air bubbles and prominent
vascularity.
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The perforation is absent in most
cases, if it arises up, brief excretion
from the ear appears.
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Recovery takes place already in a
few days. It is needed to remember
that complications can also develop
in patients without the perforation.
Therefore the they must be under
the medical observation until
complete convalescence.
Diagnostics
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Otoscopy
Veber’s test – lateralizatsiya sound in a sick ear, Rine’s
test – negative, Shvabah’s test – is prolonged (pathology
of conductive mechanism).
Impossibility to blow the auditory tube during the Valsalva
maneuver.
Negative or poorly positive Polittcer’s test.
Additional inspection methods
General blood test : leukocytosis, change to the left, speedup SHOE;
Bacteriological research of pus to find a sensitiveness to
the antibiotics (with the purpose of choice of adequate
antibiotic therapy – better locally).
X-ray of mastoid process – fogging of middle ear cavities.
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Audiogramm – presence of airbone gap (pathology of conductive
or mixed type).
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Complications
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Sensoneural hearing loss.
Transition in purulent form with development of
the proper complications.
Medical Treatment
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decongescent drops to the nose (treatment of inflammatory
processes in nose and pharynx)
smearing of pharynx, gargling,
physiotherapy on the nose, paranasal cavities and pharynx.
In addition, warmly on the area of ear,– anodynes,
alcoholic drops to the ear (3% alcoholic solution of salicylic
acid, 2% r-n of novoimanin, Chlorofilipt and others like that).
At the presence of excretions the careful clearing of external
auditory canal and subsequent ear drops.
Valsalva and Polittser maneuver for the improvement of
auditory tube’s function.
catheterization of auditory tube, and at suspicion of
complications – tympanostomya (introduction a little tube in
the ear-drum), at development of complications – antro
mastoidotomia
Prophylaxis
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adenotomiya,
septoplasty,
Treatment of sinusitis
ACUTE SUPERATIVE OTITIS
MEDIA
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Purulent inflammation of middle ear mucus lining:
auditory tube, tympanic cavity and mastoid process.
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Streptococcus pneumoniae,
Haemophilus influenzae,
Moraxella catarrhalis.
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Reasons
upper respiratory infection precedes the ear involvement
and spreads up the eustachian tube.
In most cases acute cold
traumas
Pathomorphology
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Mucus lining acutely, is thickened in 10-20 times,
the mucoid edema, smallcells infiltration, arterial
hyperemia.
Excretion, which can be serous, hemorrhagic,
purulent or mixed, accumulates in the tympanic
cavity.
As the auditory tube function is deteriorate and
excretion can not be eliminated through the tube in
the nasopharynx, pressure rises in tympanic cavity,
that bulges the ear-drum outside.
The micro thromboses appear in drum vessels, that
lead to necrosis of the thinnest areas of ear-drum. In
this place the perforation forms, through it the
excretion is selected in external auditory canal.
Exudation diminishes gradually, excretions become
not so abundant and acquire purulent, and then
mucus character. The auditory tube function
gradually improves, excretions find the natural way
to outflow - in nasopharynx, the perforation closes,
the auditory function recovers.
Clinic: three stages of APOM
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I stage – before perforative (1-3 days duration) – is characterized
by a diffuse inflammatory process in a middle ear without
restriction. Beginning of disease is acute, from appearance of the
expressed shooting, pulsating pain in the ear, which hides other
otologic symptoms: hearing loss, tinnitus, feeling of liquid in the ear
(ear fullness).
There are expressed symptoms of general intoxication: high body
temperature, chill and common indisposition.
There can be the vestibular signs: dizziness, nausea, nystagmus,
considerable hearing loss.
A mastoid process is slightly painful.
The infection can be spread to the labyrinth and in the skull, causing
early complications with especially heavy motion.
Otoscopy of first APOM stage
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The ear-drum is red (at
the beginning on the
maleus handle, and then
fully), bulged, especially
in back quadrants (due to
accumulation of
excretion in the tympanic
cavity), thickened,
infiltrative; the cognitive
ear-drum points
disappear; the line
between ear-drum and
auditory canal disappear
Influenza AOM
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Hemorrhagic discharges
Bullous myringitis with
hemorrhagic blebs on
tympanic membrane and
skin of EAC
Sensorineural hearing loss.
The ІІ stage – perforative
(4-7 days duration)
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Spontaneous perforation in ear-drum appears. Excretion
outflows from a middle ear cleft; pain calms down quickly,
the body temperature of goes down; general intoxication
decreases.
Otoscopy
The external auditory canal is filled with excretions: at the
beginning of illnesses with heamorhagic or serous, and then
- mucus or purulent. Appearance of excretions with an
unpleasant smell suspects necrosis of bone (necrotic
inflammation of the ear), which more frequent arises up at
scarlet fever, measles, agranulocitosis and others like that.
Otoscopiya of the second APOM stage
Ear
Drum is red,
thickened, infiltrated.
Positive symptom of
„pulsating drop” through the small
perforate opening,
located mainly in the
back-lower quadrant of
ear-drum, in time by
cardiac abbreviation the
exudates get out.
The third stage – convalescence
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(reverse development or reparative, lasts to the
end of third week).
The quantity of excretions diminishes, they
become thicker, flow out without periodic shoves.
The hearing gets better, a tinnitus disappears.
Otoscopy
The ear-drum was insignificantly swollen and
pink during a maleus handle, the small
perforation is closed by a thin scar.
Diagnostics
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Veber’s Test– sound lateralization in a sick ear, Rine’s test–
negative, Shvabah’s test – is prolonged (defeat of conductive
mechanism).
Audiogramm – presence of air-bone gap (worsening of hearing
by conductive or mixed type).
Impossibility to do the Valsalva maneuver.
Negative or poorly positive Polittser’s test.
Additional inspection methods
General blood test: leycotsitosis, change to the left;
Bacteriological research of pus on a sensitiveness to the
antibiotics (with the purpose of choice of adequate antibiotic
therapy - it is better locally).
X-ray of mastoid process – the fogging of middle ear cavities.
Consequences
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1. The most frequent is complete convalescence, the
criteria of which is normalization of the common state,
normal otoscopy picture of ear-drum and complete hear
recovering.
2. Firm hearing loss as a result of scar formation in a
tympanic cavity (without the perforation).
3. Permanent perforation of the ear-drum (transition in a
chronic otitis media).
If convalescence does not come to the end of 3th week,
there is the danger of appearance of complications, the
signs of which are: worsening of the common state, the
repeated rise of body temperature, strengthening of pain
in the ear which already began to calm down, increase of
quantity of excretions, absence of improvement of
hearing loss, appearance of pain in the mastoid process.
Complications
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Mastoiditis,
Labyrinthitis,
Sensoneural hearing loss (cochleitis),
Facial nerve palsy,
Otogenic sepsis,
Intracranial complications.
Chronic mesotympanitis
•Central drum perforation;
•Permanent or periodical discharges
without bad smell.
Chronic epitympanitis with
cholesteatoma
Audiogram
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Air-bone gap (conductive hearing loss)
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Ряд2 Кісткова
провідність
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CT or MRI scan
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