A common cause of pain in children with complications like discharging ear.

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ACUTE
OTITIS
MEDIABRIG
ANWAR UL HAQ
00923018513303

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9.  E:PRESENTATIONSAnimationsEARHearin
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10.  Acute suppurative otitis media is defined
as suppurative infection involving the
mucosa of the middle ear cleft.
 By convention it is termed acute if the
infection is less than 3 weeks in duration.
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11. MIDDLE EAR CLEFT
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12. It occurs more easily:
 In children and infant
 In winter and spring
 After upper respiratory infection
Measles, diphtheria, tonsillitis,
chronic infection of sinuses and nasal
allergy are other predisposing factors
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13. CAUSATIVE ORGANISM
 Streptococcus pneumoniae (30%)
 Haemophilus influenzae (20%)
 Moraxella catarrhalis (12%)
 Others:
 Streptococcus pyogenes
 Staphylococcus aureus
 Pseudomonas aerugenosa
 No growth in 18-20% cases
 Viruses: RSV, Influenza, Rhino & Adeno
Virus
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15. EUSTACHIAN TUBE WAY
 It is the most common route
 CHILDREN ARE MORE SUCCEPTIBLE:
1. ET in infants & young children
1. Shorter
2. Wider
3. More horizontal
4. Less stiff
2. Large adenoids
1. interfere with the opening of the tube
3. Immune system
1. not fully developed
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16. EUSTACHIAN TUBE
 A small tube connecting
 Middle ear to the nasopharynx
 Functions
 Regulate and equalize
 Pressure of middle ear
 Prevent fluid
 Accumulating in the middle ear
 Protect from
 Nasopharyngeal infection 16

17. •Children ET 10°
•Adults ET 45°
•ISTHMUS(narrowing of ET)
•junction of the cartilaginous and bony part.
•It is only present in adults. nihar.gupta99@gmail.com 17
Shorter
Wider
More horizontal
Less stiff

18. EXTERNAL ACCOUSTIC
MEATUS WAY
 Associated withTM perforation
 Infection
 Tm trauma
 Tympanostomy tubes,
 Tympanometry,
 Myringotomy
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 Uncommon route

19. EXTERNAL ACCOUSTIC MEATUS
 Associated withTM perforation
 Infection
 TM trauma
 Tympanostomy tubes
 Tympanotomy
 Myringotomy
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20. 1. Stage of tubal occlusion
2. Stage of pre-suppuration
3. Stage of suppuration
4. Stage of
 Resolution
 Complication
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21. STAGE OF TUBAL OCCLUSION
Mucosa: Hyperemia, Swelling
Eustachian tube is occluded
Intratympanic pressure ↓
Air ↓ fluid ↑
Tympanic membrane retracts
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22. SYMPTOMS
TM RETRACTS
Tinnitus
Ear
fullness
Earache
Hearing
loss
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23. CLINICAL SIGNS
 TM retracted
1. short handle of
malleus
2. No cone of light
3. Prominent lateral
process of malleus
 Conductive deafness in
tuning fork test
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24. STAGE OF PRE-SUPPURATION
Bacteria invade tympanic
cavity
Hyperemia
Inflammatory exudate
CongestedTM
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25. C/F
 EARACHE
 Deafness
 Tinnitus
 High fever
(children)
 Cartwheel
appearance of
TM
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26. STAGE OF SUPPURATION
Pus increases
TM is compressed, ischemic
TM is tense and bulges
TM necrosis
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27. C/F  EXCRUCIATING PAIN
 Deafness
 Fever 102-103°F
(Children)
 Vomiting
 Convulsions
 X ray mastoid:
clouding of air cells
due to exudate.
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28. STAGE OF RESOLUTION
 Earache
 relieved
 General condition
 Temp decreases
 WBC Count Improves
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29. STAGE OF COMPLICATION
 Intratemporal
 (within temporal bone)
1. Acute mastoiditis
2. Facial paralysis
3. Labyrinthitis
4. Petrositis
 Intracranial:
1. Extradural abscess
2. Subdural abscess
3. Meningitis
4. Brain abscess
5. Lateral sinus
thrombophlebitis
6. Otic hydrocephalous
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31.  Control infection
 Local therapy
 Treat related disease
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32. CONTROL INFECTION: ANTIBIOTICS
 Arrest & reverse inflammation
 Prevent suppuration and perforation
 Relieve symptoms,
 Hasten resolution
 Reduce risk of complications
 AMPICILLIN
(50 mg/kg/day in 4 divided doses)
 AMOXICILLIN
(40 mg/kg/day in 3 divided doses)
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33. LOCAL THERAPY
 BEFORE PERFORATION
 Relieve earache
 control inflammation
 Prevent perforation(spontaneous)
1. Decongestant nasal drops(ephedrine,
oxymetazoline, xylometazoline)
2. Oral nasal decongestant
(pseudoephedrine)
3. Analgesic & antipyretic(paracetamol)
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34. MYRINGOTOMY
 Myringotomy
 Tiny incision eardrum
Relieve pressure
Drain pus from the middle ear.
 A tympanostomy tube
 Keep the middle ear aerated
 Prevent re accumulation of fluid.
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36. MYRINGOTOMY
 INDICATIONS :
1. Symptoms are not relieved by antibiotics
2. TM bulges significantly
3. TM perforation is too small
4. Incomplete resolution
5. Persistent effusion beyond 12 weeks
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37. LOCAL THERAPY
 AFTER PERFORATION
1. Clear external acoustic canal toilet
2. Control infection
3. Repair TM
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38. TREAT RELATED DISEASE
 Chronic rhinitis
 Chronic sinusitis
 Chronic tonsillitis
 Adenoid vegetation
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39. DIFFERENTIAL DIAGNOSIS
MEATAL FURUNCLE
1. No hearing loss
2. TM is normal
ACUTE MYRINGITIS
1. Severe earache
2. Hearing loss is slight
1. TM: hyperemia and bulla forms
2. After influenza or zoster infection
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