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    DR - Haider Salih Ibrahim: Pyogenic Organisms. Middle Ear Cleft

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    Nashat Saadi
    The document discusses acute suppurative otitis media, including its definition, etiology, risk factors, bacteriology, pathology, clinical features, diagnosis, and treatment. It is an inflammation of the middle ear caused by bacterial infection, most commonly affecting young children. Key symptoms and stages of the disease are outlined.

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    DR - Haider Salih Ibrahim: Pyogenic Organisms. Middle Ear Cleft

    Uploaded by

    Nashat Saadi
    11 views6 pages
    The document discusses acute suppurative otitis media, including its definition, etiology, risk factors, bacteriology, pathology, clinical features, diagnosis, and treatment. It is an inflammation of the middle ear caused by bacterial infection, most commonly affecting young children. Key symptoms and stages of the disease are outlined.

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    The document discusses acute suppurative otitis media, including its definition, etiology, risk factors, bacteriology, pathology, clinical features, diagnosis, and treatment. It is an inflammation of the middle ear caused by bacterial infection, most commonly affecting young children. Key symptoms and stages of the disease are outlined.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    11 views6 pages

    DR - Haider Salih Ibrahim: Pyogenic Organisms. Middle Ear Cleft

    Uploaded by

    Nashat Saadi
    The document discusses acute suppurative otitis media, including its definition, etiology, risk factors, bacteriology, pathology, clinical features, diagnosis, and treatment. It is an inflammation of the middle ear caused by bacterial infection, most commonly affecting young children. Key symptoms and stages of the disease are outlined.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    of 6

    Dr.

    Haider Salih Ibrahim

    Acute Suppurative Otitis Media:


     It is an acute (<3 weeks)
    inflammation of middle ear
    by pyogenic organisms.
     middle ear implies middle
    ear cleft, i.e.
     eustachian tube
     middle ear
     attic,
     aditus antrum
     mastoid air cells

     The highest incidence of otitis media occurs between the ages of 6 and
    12 months and decreases with age

     Aetiology
     follows viral infection of upper respiratory tract but soon the pyogenic
    organisms invade the middle ear.
     second most common disease in infants and children especially in children of
    lower socio-economic group (upper respiratory infection is the most
    common)

     Routes of Infection
     1. Via eustachian tube
    o most common route.
    o Eustachian tube in infants and young children is shorter, wider and
    more horizontal
    o Breast or bottle feeding
     2. Via external ear
    o Traumatic perforations of tympanic membrane due to any cause open a
    route to middle ear infection.
     3. Blood-borne
    o This is an uncommon route

    1
     Risk Factors

     host risk factors


    1. Age (highest incidence of AOM is between 6 and 11 months of age)
    2. Gender (Male)
    3. Adenoids , tonsil , Chronic rhinitis and sinusitis (reservoir of infection &
    mechanical ET obstruction)
    4. ET dysfunction (short, horizontal, compliant)
    5. Cleft palate

     Environmental risk factors


    1. URTIs ( most common)
    2. Daycare attendance (2.6x)
    3. Season (Fall/Winter)
    4. siblings
    5. Parental history of OM
    6. Passive smoking
    7. Low S/E status (overcrowding, poor sanitation)
    8. Lack of breastfeeding
    9. Night-time bottle (horizontal position)

    2
     Bacteriology
     Most common organisms in infants and young children are
     Streptococcus pneumoniae (30%) (Gram-positive, alpha-hemolytic)
     Haemophilus influenzae (20%) (Gram-negative aerobic,coccobacilli)
     Moraxella catarrhalis (12%) (Gram-negative, aerobic)

     Pathology and Clinical Features


     The disease runs through the following stages:
     1. Stage of tubal occlusion
     Oedema and hyperaemia of nasopharyngeal end of eustachian tube
    blocks the tube, leading to absorption of air and negative intratympanic
    pressure.

     2. Stage of pre-suppuration
     If tubal occlusion is prolonged
     pyogenic organisms invade tympanic cavity causing hyperaemia of its
    lining.
     Inflammatory exudate appears in the middle ear.
     Tympanic membrane becomes congested.

    3
     3. Stage of suppuration
     This is marked by formation of pus in the middle ear and to some extent
    in mastoid air cells.
     Tympanic membrane starts bulging to the point of rupture.

     4. Stage of resolution
     The tympanic membrane ruptures with release of pus and subsidence of
    symptoms.
     Inflammatory process begins to resolve.

     Complication
     If virulence of organism is high or resistance of patient poor, resolution
    may not take place and disease spreads beyond the confines of middle ear.
     It may lead to:-
    Intratemporal complications of Intracranial complications of
    AOM AOM

    o Chronic suppurative OM o Meningitis


    o Tympanic membrane perforation o Epidural/subdural/cerebral
    o Cholesteatoma abscesses
    o Tympanosclerosis o Focal encephalitis
    o Mastoiditis with or without o Lateral/sigmoid sinus thrombosis
    Abscess (Postauricular, Bezold’s, o Otitic hydrocephalus
    Zygomatic, Parapharyngeal,
    Retropharyngeal)
    o Petrositis
    o Labyrinthitis – Serous or
    Suppurative
    o Facial palsy
    o CHL or SNHL

    4
     Diagnosis :-
     clinical and physical exam “ears, a proper head and neck
    examination is
    invaluable, because it may identify condition that may
    predispose “
     audiogram (CHL <30 dB) and tympanometry

     Treatment
    1. Antibacterial therapy

     amoxicillin-clavulanate (augmentin) Recommended for of
    7-10 days
     if allergic to these penicillins can be given
    Cephalosporins such as cefdinir,
    cefuroxime, cefpodoxime, and ceftriaxone
     Antibacterial therapy must be continued,
    till tympanic membrane regains normal
    appearance and hearing returns to
    normal.
    2. Decongestant nasal drops
     should be used to relieve eustachian tube
    oedema and promote ventilation of middle ear.

    5
    3. Oral nasal decongestants.
    4. Analgesics and antipyretics
     Paracetamol helps to relieve pain and bring down
    temperature.
     Avoid the use of aspirin in children because of the risk of
    Reye’s syndrome.
    5. Ear toilet

    6. Dry local heat


     It helps to relieve pain.
    7. Myringotomy
     It is incising the drum to evacuate pus

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