1. AOM & OME Bastaninejad Shahin, MD, ORL & HNS

2. Normal TM!

3. Definition Otitis media (OM) is the most common bacterial infection in children: –AOM = MEE + Sx and Px of acute inflammation (fever, pain, a red and bulging TM) –OME = MEE without signs of inflammation

4. Definition Known risk factors for OM: –Young age (first 2yrs) –Male gender –Bottle feeding –Sibling with OM –Crowded living condition (day care) –Smoking in home –Heredity and variety of associated conditions (CP, CF, Down,...) Birth weight is not a RF

5. Pathophysiology Pathophysio. Of AOM is related to the Eustachian tube function: 1.Protection failure (abnormally patent) 2.Clearance failure (tubal obstruction) 3.Under aeration (tubal obstruction) NewNew OLDOLD

6. AOM Common bacterial germs: –Strep. Pneumoniae –HI –Branhamella catarrhalis The protection problem is not the result of the adenoid size and it’s ensuing obstruction, it’s the result of abnormally patency of the tube

7. OME Here, tubal obstruction is the result of inflammatory process rather than the cause of it  FUNCTIONAL OBSTRUCTION MEE in OME contains some bacterial germs  available evidence links OME to the bacterial infection

8. Audiometric issues in OME Audiometry is a guide for surgery in older children (more than 2yr): –ABG>20dB Tympanometric patterns in OME: –Type A (+100 to-100)  5% –Type B (-300 )  80% –Type C (-150 to -200)  20-50%

9. AOM Complications Extra cranial (mastoiditis, neck inflammation) Intracranial (meningitis, brain abscess and...) The most common of them is: Mastoiditis Tx: IV Abx + Drainage of the pus and removal of infected bone

10. AOM Treatment 1.Antimicrobial therapy –No Abx!: only observation and analgesics (90% resolution specially in older childern) –Single IM Ceftriaxone –Oral Abx (5 days  10 days) 2.Adjunct medical therapy : only analgesics In less than 2yrs and day care setting

11. Continue (AOM) Tympanocentesis: –Premature newborns –Immunocompromised –Progressive Sx and Px while receiving an appropriate Abx –Intracranial infection –Research porposes

12. Continue (AOM) Myringotomy: –AOM with Facial nerve paralysis –With Meningitis –With other CNS problems –Unresponsive AOM –In Immunosuppressed –Severe pain is not an indication for this procedure MastoiditisFacial nerve paralysisintracranial otogenic infections In Mastoiditis, Facial nerve paralysis and intracranial otogenic infections, myringotomy + VT, provides long lasting drainage than a simple myringotomy...

13. Continue (AOM) Follow-Up: 3 rd day & 2 nd wk to 4 th wk Recurrent AOM:Recurrent AOM: –Abx. prophylaxis: Sulfasoxazole or Amoxicillin (20mg/kg) for 3-6 mo, another option is Co-trimoxazole –Surgery : Adenoidectomy + VT When pt had 4 bouts of AOM in 6mo or 6 bouts in one year

14. OME Treatment Below antimicrobial therapy, then observe for at least one month: –Sulfisoxazole + Erythromycin –Co-trimoxazole –Co-amoxiclav Surgical Txy: Surgical indications:

15. Continue (OME) Hearing loss + effusion for more than 4-6mo Time critrion (fall) Retracted pockets in contact with I or S ossicles, or a pocket with epithelial debris ABG > 20 dB

16. Continue (OME) Surgeries: –VT insertion –Adenoidectomy (independent to the size)