Acute suppurative otitis media

Please download to get full document.

View again

of 24
All materials on our website are shared by users. If you have any questions about copyright issues, please report us to resolve them. We are always happy to assist you.
Similar Documents
Information Report

Health & Medicine


Views: 0 | Pages: 24

Extension: PDF | Download: 0

1. Acute Suppurative Otitis Media Bijay shah kanu 4th year PAHS 09 sept 2019 2. ASOM ã Acute inflammation of middle ear by pyogenic organism ã Midle ear= ear cleft=…
  • 1. Acute Suppurative Otitis Media Bijay shah kanu 4th year PAHS 09 sept 2019
  • 2. ASOM • Acute inflammation of middle ear by pyogenic organism • Midle ear= ear cleft= eustachian tube, middle ear, attic, aditus, antrum and mastoid air cells • More common in infants and children of lower socioeconomic class • Follows viral URTI
  • 3. Routes of infection • Via Eustachian tube • Via external ear in case of perforation • Blood borne: uncommon route
  • 4. Predisposing factors Any thing that interferes with normal functioning of Eustachian tube • Recurrent attacks of common cold, URTI, measles, diphtheria, whooping cough • Infection of tonsil and adenoids • Chronic rhinitis and sinusitis • Nasal allergy • Tumors of nasopharynx • Packing of nose and nasopharynx for epistaxis • Cleft palate
  • 5. Causative organism Most common organism in infants and young children are • Streptococcus pneumoniae -30% • Hemophilus influenzae -20% • Moraxella catarrhalis -12% • Strep. pyogens, Staph. aureus, P. aurugenosa are also involved • No growth in about 18-20% of cases
  • 6. Stages and clinical features 1. Tubal occlusion 2. Pre-suppuration 3. Suppuration 4. Resolution 5. Complication
  • 7. 1. Stage of Tubal occlusion • Edema and hyperemia of nasopharynx and eustachian tube blockage • Absorption of air and negative intratympanic pressure • Retraction of tympanic membrane with some degree of effusion
  • 8. Symptoms: • Deafness and earache (not so marked) • No fever Signs: • Retracted tympanic membrane • Horizontal handle of malleus • Predominance of lateral process of mallelus and loss of Light reflex • Conductive deafness
  • 9. 2. Stage of Pre-suppuration • Increased pyogenic activity in tympanic cavity • Hyperemia of its lining and inflammatory exudated • Congested tympanic membrane
  • 10. Contd… Symptoms: • Earache, throbbing type that disturbs the sleep • Deafness and tinnitus may be present • Child may have high fever and is restless Signs: • Congestion of pars tensa • Cart-wheel appearance • Blood vessels appears along the handle of malleus and at the periphery of TM • Uniformly red tympanic membranes in later stage • Conductive hearing loss
  • 11. 3. Stage of Suppuration • Formation of pus in middle ear and in mastoid air cells • Tympanic membrane starts bulging at point of rupture
  • 12. Symptoms: • Excruciating earache and increasing deafness • High fever, vomiting and convulsion (in children) Signs: • Red and bulges TM with loss of landmarks • Tenderness over mastoid antrum • X-ray of mastoid : clouding of air cells –exudate
  • 13. 4. Stage of resolution • Rupture of TM with release of pus and relief symptoms • Inflammatory process begins to resolve • If early treatment started or if infection is mild, resolution starts even without rupture of TM
  • 14. Symptoms: •Earache relieved and fever subsides Signs: • Blood tinged discharge in EAC which later becomes mucopurulent • Usually a small perforation in anteroinferior quadrant of pars tensa • Hyperemia of TM begins to subside with return to normal color and landmarks
  • 15. 5. Stage of Complication • Depends on • Virulence of organism is high or resistance of the patient ,resolution may not take place and disease spread beyond the confines of middle ear • May lead to mastoiditis, petrositis, extradural abscess, meningitis, brain abscess, lateral thrombophebitis
  • 16. Investigations • C/S of discharge • X-ray of ear/ mastoid • Audiometry
  • 17. Management Antibiotic therapy • Indicated in all cases with fever and severe earache • Ampicillin 50mg/kg/day in 4 divided dose • Amoxicillin 40mg/kg/day in 3 divided dose • Should be given till tympanic membrane regain normal appearance and hearing is normal (minimum 10 days)
  • 18. Antibiotics dose
  • 19. • Decongestant nasal drop : ephedrine 1% in adult and 0.5% in children )or oxymetazoline or xylometazoline – used to relieve Eustachian tube edema and promote ventilation • Oral nasal decongestant :pseudo ephedrine (Sudafed)30 mg twice daily or a combinations of decongestant and antihistaminic (triominic) – may achieve the same result without resort to nasal drops which are difficult to administer in children
  • 20. • Analgesics and antipyretics :to relieve pain and bring temperature down • Ear toilet : discharge in ear – dry mopped with sterile cotton buds and w wick moistened with antibiotics may be inserted • Dry local heat : to relieve pain
  • 21. Myringotomy • Incision of ear drum to evacuate the pus • Indications: • Bulged drum with acute pain • Incomplete resolution despite antibiotics when drum remains full with persistent conductive deafness • Persistent effusion beyond 12 weeks • All cases of ASOM should be followed till drum returns to its normal appearance and conductive deafness disappears
  • 22. References • PL Dhingra, et al. Diseases of ear, nose and throat & head and neck surgery, 6th edition
  • 23. Thank You
  • Recommended
    View more...
    We Need Your Support
    Thank you for visiting our website and your interest in our free products and services. We are nonprofit website to share and download documents. To the running of this website, we need your help to support us.

    Thanks to everyone for your continued support.

    No, Thanks

    We need your sign to support Project to invent "SMART AND CONTROLLABLE REFLECTIVE BALLOONS" to cover the Sun and Save Our Earth.

    More details...

    Sign Now!

    We are very appreciated for your Prompt Action!