Otitis media

Inflammation and /or infection of the middle ear cleft

SUPPURATIVE O.M.

NON SUPPURATIVE O.M.

SUPPURATIVE O.M.
ACUTE SUPPURATIVE O.M. CHRONIC SUPPURATIVE O.M.

ACUTE S.O.M.

Aetiology : common in children/ viral * extension from infected N/Px via sub mucosal lymphatic's OR via an infected exudates through E.T. ** through perforated tymp. memb. *** haematologenous route.

Bacteriology:

Wide range of microrganism. Strep . Pneumonia Hemolytic strept. Staph aureous H . influenza Branhamella catahralis Beta- lactamase producing organism

Pathology :

tubal occlusion Engorgement & oedema of the cleft`s lining. Exudation into the tympanic cavity ,/serous at beginning ----mucopurulent Bulging of the T.M. Pressure necrosis>>>rupture of the T.M. & otorrhoea Exudation may be found in the mastoid process causes osteitis (mastoiditis)& erosion of the cortex >>>subperiosteal abscess


Clinical features:
Before perforation; (acute tubal occlusion) _ fullness in the ear. _ deafness. _ discomfort. _ bubbling sound in the ear _ autophonia _ red t.m. _ bulging.

After perforation Relief of pain. otorrhoea

Retention of pus in the mastoid(mastoiditis)
pain in the mastoid region Oedema over the mastoid processIncrease constitutional features/ fever,pain ,malaise….etc

Treatment :

rest & sedation Analgesia Local heat swab for C/S (discharge) Systemic antibiotics Local treatment AB. +/- steroid Nasal decongestant drops Cortical mastoidectomy

Chronic otitis media

Tubotympanic Attico antral

1-Tubotympanic

Aetiology: *- residue of acute s.o.m. **- re infection

Pathology of tubotympanic c.s.o.m.

Perforation Oedematous mucosa of the tympanic Cavity Occasionally gr. T. or polyp Metaplasia of sq. epith. >>> sec. col. Epith. Same changes in the mastoid air cells>>chronic mastoiditis (mastoid reservoir)

Clinical features

Discharge ; often scanty mucoid, but becomes copious & purulent during exacerbation / U.R.T.I. Conductive deafness Radiological findings reveals , sclerosis of the mastoid air cells

Treatment:

Swab for C/SAural toiletSystemic& local AB.Removal of the polyp & gr. t. if presentElimination of the adjacent foci of infection/ts.,sinusitis…etcMastoid exploration Myringoplasty for dry perforation

2- attico-antral

Dangerous disease Ass. Cholesteatoma (epidermoid cyst containing keratin with cholestrol crystals)

Pathology:

Disease is limited at attic region (pars flaccida) or extruteded into ext.canal. Extension into the tymp. Cavity +/- ossicular chain disruption. Expansion into the mastoid bone >>absorption of the bone(auto mastoidectomy) Gr. T. & polyp Invasion of the labyrinth >> fistula & SNHL. Invasion of the meninges >>meningitis Pressure on the facial n.>> palsy

Clinical features :

Deafness Malodourous otorrhoea Perforation // attic or mariginal Cholesteotoma may be visible Signs of complications may be found ; fever, headache ,earache, vertigo, facial palsy . Radiological findings shows bone destruction in the advance stage

Treatment:

Conservative R; * if no complications or small cholesteatoma via repeated suction clearance & regular follow up Surgical R; - complications - fail of cons. R, * atticotomy * mastoidectomy * tympanoplasty (removal of the disease & reconstruction of the ossicular chain)


complications
Subperiosteal abscess Facial n. palsy Labyrinthitis Meningitis Thrombophlebitis of the sigmoid sinus Brain abscess septicaemia