Acute suppurative otitis media

 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.
nihar.gupta99@gmail.com 2

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

 Streptococcus pneumoniae (30%)
 Haemophilus influenzae (20%)
 Moraxella catarrhalis (12%)
 Others: Streptococcus pyogenes,
Staphylococcus aureus and
Pseudomonas aerugenosa
 No growth in 18-20% cases
 Viruses: RSV, influenza, rhino & adeno
virus

 It is the most common route.
 CHILDREN ARE MORE SUCCEPTIBLE:
1. Eustachian tube in infants
and young children is shorter, wider,
more horizontal and less stiff.
2. Large adenoids can interfere with the
opening of the tube
3. Immune system is not fully developed

 A small tube connecting the middle ear
to the nasopharynx
 FUNCTIONS
1. Regulate and equalize pressure of
middle ear
2. Prevent fluid from accumulating in the
middle ear
3. Protect from the nasopharyngeal
infection

•In children ET is at an angle of 10° while in adults it is at an
angle of 45°.
•ISTHMUS is a narrowing in the ET, at the junction of the
cartilaginous and bony part.
•It is only present in adults.nihar.gupta99@gmail.com 9

 Associated with TM perforation
 Eg. TM trauma, insertion of tympanostomy
tubes, tympanometry, myringotomy
 This is an uncommon route

 The disease runs through the following
stages:
1. Stage of tubal occlusion
2. Stage of pre-suppuration
3. Stage of suppuration
4. Stage of resolution or
complication

Mucosa: Hyperemia, Swelling
Eustachian tube is occluded
Intratympanic pressure ↓
Air ↓ fluid ↑
Tympanic membrane retracts

TM RETRACTS
Tinnitus
Ear
fullness
Earache
Hearing
loss

 TM retracted
1. Foreshortened
handle of malleus
2. No cone of light
3. Prominent lateral
process of malleus
 Conductive
deafness in tuning
fork test

Bacteria invade tympanic
cavity
Hyperemia
Inflammatory exudate
Congested TM

 EARACHE
 Deafness
 Tinnitus
 High fever
(children)
 Cartwheel
appearance of
TM

Pus increases
TM is compressed, ischemic
TM is tense and bulges
TM necrosis

 EXCRUCIATING
PAIN
 Deafness
 Fever 102-103°F
(Children)
 Vomiting
 Convulsions
 X ray mastoid:
clouding of air
cells due to
exudate.

 Follows TM
perforation
 Earache relieved at
once
 General
condition(temp,
wbc count)
improves

 Intratemporal(within
the confines of
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

 Control infection
 Local therapy
 Treat related disease

 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)

 BEFORE PERFORATION
 Relieve earache & control inflammation:
1. Decongestant nasal drops(ephedrine,
oxymetazoline, xylometazoline)
2. Oral nasal decongestant
(pseudoephedrine)
3. Analgesic & antipyretic(paracetamol)

 Myringotomy is a surgical procedure in
which a tiny incision is created in
the eardrum to relieve pressure caused
by excessive buildup of fluid, or to
drain pus from the middle ear.
 A tympanostomy tube is inserted into the
eardrum to keep the middle ear aerated
for a prolonged time and to prevent
reaccumulation of fluid.

 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

 AFTER PERFORATION
1. Clear external acoustic canal-Ear toilet
2. Control infection
3. Repair TM

 Chronic rhinitis
 Chronic sinusitis
 Chronic tonsillitis
 Adenoid vegetation

 MEATAL FURUNCLE
1. No hearing loss
2. TM is normal
 ACUTE MYRINGITIS
1. Severe earache
2. Hearing loss is slight
3. TM: hyperemia and bulla forms
4. After influenza or zoster infection

Acute suppurative otitis media

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