2 DefinitionInflammation of the middle ear.May also involve inflammation of mastoid, petrous apex, and peri-labyrinthine air cells
3 ClassificationAcute OM - rapid onset of signs & symptoms, < 3 wk courseSub-acute OM - 3 wks to 3 monthsChronic OM - 3 months or longer
4 Acute Suppurative Otitis Media (ASOM) EtiologyAge: Common among children due to shorter Eustachian tube
5 Adenoiditis, Tonsillitis, Rhinitis, Sinusitis, Pharyngitis & infections secondary to cleft palate Trauma to the TMHead injuryBarotrauma
6 PathologyCatarrhal stage: is characterized by occlusion of Eustachian tube and congestion of middle ear.Stage of exudation: Exudate collects in the middle ear and ear drum is pushed laterally. Initially the exudate is mucoid, later it becomes purulent.
7 Pathology3. Stage of suppuration: Pus in the middle ear collects under tension, stretches the drum & perforates it by pressure necrosis & the exudate starts escaping into external auditory canal 4. Stage of healing: The infection starts resolving from any of the stages mentioned & usually clears up completely without leaving any sequelae.
8 Pathology5. Stage of complications: Infection may spread to the mastoid antrum. Initially it causes Catarrhal mastoiditis [congestion of the mastoid mucosa], stage of Coalescent mastoiditis & later empyeme of the mastoid
9 Clinical manifestations: ASOM 1. Catarrhal stage (stage of congestion)Fullness or heaviness in the earSevere ear pain at nightDeafnessTinnitus (ringing or buzzing in the ear)Autophony (spoken words of patient echo in his ears)TM (ear drum) gets retractedCart wheel appearance of ear drumAbsence of light reflex
11 2. Stage of exudationAll symptoms becomes more severe.
12 3. Stage of suppuration Perforation of Ear drum Otorrhoea with mucoid purulent dischargePulsatile discharge (ear discharge with each arterial dilation) [Lighthouse sign]
13 4. Stage of healingHealing starts in this stage
14 5. Stage of complicationSpread of infection to mastoid
15 Diagnosis Tuning fork test and audiometry Radiography Bacteriological examination of the ear dischargePneumatic otoscopy is gold standard
16 Treatment - AOM Systemic Local Antibiotics: Tetracycline, erythromycin, ampicillin or penicillin for 6 daysSystemic decongestants: Phenylephrine HClLocalGlycerine carbolic ear drops or warm olive oil reduces pain before perforation of TM.Antibiotic drops : Chloramphenicol, spirit boric drops is used after perforation of TM.
17 Surgery Myringotomy: The TM is incised to drain the middle ear cavity. Myringo-puncture: Puncturing the ear drum with a long thick injection needle & aspirating the middle ear contents.
18 Chronic Otitis MediaIt is the chronic infection of middle ear cleft mucosa.Chronic Suppurative Otitis Media (CSOM): accompanied by continuous or intermittent otorrhoeaChronic Non-Suppurative Otitis Media: No otorrhoeaChronic Specific Otitis Media: Tb OM or syphilitic OM
19 CSOMBenign or tubotympanic type with central perforation of the ear drum: The disease is limited to the TM & the Eustachian tube. No complications occur as a rule.Dangerous or Attico-antral type with attic and marginal perforation: It is characterised by the presence of destructive cholesteatoma, which may spread beyond the ear cleft causing life threatening complications
21 Etiology:CSOM AOM which fails to heal. Acute necrotic OM Traumatic large perforationCongenital cholesteatoma
22 Benign or tubotympanic type PathologyBenign or tubotympanic typeEtiological factors Necrosis of ear drum portion which has poor blood supply Necrosis of ossicular chain Sclerosis of mastoid bone Polyp formation
23 Dangerous / Attico-antral type Cholesteatoma formation Polyps and granulation Perforation and retraction of ear drum Partial or complete damage of Ossicles
26 Clinical stages Benign perforation Dangerous perforation Active stage : discharge is actively flowingQuiescent stage : ear remains dry for up to 6 monthsInactive stage : Ear remains dry for > 6 monthsDangerous perforationActive stageInactive stage
27 DiagnosisExamination of nose and pharynx to find any septic focus or an obstruction around the Eustachian tubeHearing test [voice test, tuning fork test, audiometry]: Conductive deafness up to 60 db hearing lossRadiology of the mastoid
28 Diagnosis Testing the patency of Eustachian tube: Using ear dropsUsing Valsalva maneuverOtomicroscopy: perforation, cholesteatoma, polyps
29 Management of Benign Perforation Adenoidectomy, tonsillectomy; treatment of sinusitis & DNS to remove the septic focciAntibiotic ear dropsChemical cautery using 50% trichloro acetic acidTT injectionTympanoplasty: Reconstruction of middle ear and ossicular chain after removing the active diseaseMyringoplasty : repair of defect in TM
30 Management of dangerous perforation Suction and cleaning of cholesteatomaExcision of polyps and granulomasMastoidectomyAtticotomy & atticoantrostomytympanoplasty