ASOM

ASOM

ASOM

Acute suppurative otitis media is a common infection affecting d mucosa of d middle ear cleft and may cause severe pain.

AETIOLOGY:
1) Age: occurs in all ages, common in children
2) sex: affects both equally
3) geograpical distribution: all over d world





3) Portals for entry of infection
   i) Eustachian tube: in majority of cases inf. reaches from eust. tube due to following causes
     a) anatomical obsruction
     b) infections like adenoids, tonsillitis, rhinitis etc
     c) hygeine: forcible blowin of d nose
     d) swimming: water entering nose may spread inf to d middle ear
     e) Iatrogenic: after postnasal packing and badly performd adenoidectomy
     f) use of feeding bottle:
   ii) External ear: trauma to d ear drum
   iii) Head injury
   iv) Blood borne inffctions

5) Predisposing factors
i) reduced vitality
ii) atmospheric pressure changes max occure while flying or driving

CAURATIVE ORGANISM:
 usually streptococcus haemolyticus, s. aueus, H. influenyae

PATHOLOGY:
5 Stages
i) Catarrhal stage: charactorised by occlusion of eustachian tube and congestion
ii) Stage of exudation:
collects in d middle ear, initially it ir mucoid later becomes purulent
iii) Stage of suppuration:
pus collects under pressure, stretches drum nd perforates it ane exudate starts escaping in ext. auditary canal
iv) Stage of healing:
depending upon virulence of organism, resistance offered, and d antibiotics administered infection resolves from any stage
v) stage of complication:
infection may spread to mastoid antrum, initially causes catarrhal mastoiditis. In next stage granulation and oedema blocks d aditus to antrum, pus collects undr mastoid undr tension leadin to breakdown of air cell septa and air cells in mastoid coalesce. This is calld empyema of mastoid

CLINICAL FEATURER
1) Catarrhal stage
symptoms:
i) fullness: pt complains heaviness in ear
ii) pain: pain  becomes more severe at night due to venous congestion
iii) deafness: always present and increases progressively
iv) tinnitus:
v) autophony: words echo in pt's ear
vi) constitutional sypmtoms: due to toxins
Signs:
i) retraction of drum
ii) congestion of drum: cartwheel appearance coz of dilated bld vessels. Later it bcomes cmpltly red
ii) light reflex: lost due to oedema

2) Stage of Exudation
    -all symptoms become more severe.
    -The drum now starts bulging and becomes convex.
    -drum may perforate at a point

3) Stage of Suppuration
i) pain and constitutional symptoms lesren
ii) otorrhoea, may b blood stained, mucoid to purulent
iii) perforation: usually ind ant-inferior quadrant with pulsatilf disbharge

4) Stage of Healing
  may begin from any stage

5) Stage of Complications
 infection may spread to mastoid or other neighbouring structures

INVESTIGATIONS
i) Tert of Healing
  - tunning fork test
  - audiometry
ii) Radiography
  - mastoid radiograph
iii) Bacteriological examination
  - of discharge to detect causatiue organism

TREATMENT
A) SYSTEMIC
1) antibiotics such as tetracycline, erytromycin, ampicilline at least for 6 days
2) Decongestants
- nasal decongestant drops
- systemic decongestants like phenylephrine hydrochloride
3) analgesics to relieve pain

B) LOCAL
1) Ear drops before perforation:
    i) glycerin carbolic ear drops reduce d pain
    ii) warm oil reduces pain bx fomentation
2) ear drops after perforation
    i) antibiotic ear drops
    ii) ciprofloxacin and norfloxacin ear drops
    iii) spirit boric drops
3) Aural Toilet
    water shud b prevented frm entering into d ear

C) SURGICAL
1) Myringotomy: ear drum is incised to drain middle ear discharge
  its indications are
i) Stage of exudation
ii) Impending intracranial complications
iii) ASOM with small perforation
iii) secretory otitis media
iv) Haemotympanum
v) unresolved acute otitis media

2) Myringopuncture
    puncturin the ear drum with a long thick needle and aspirating the middle ear content

SEQUELAE:
i) Healing: may b complete with thin scar on drum.
ii) Perforation
iii) Deafness may persist because of eustachian tube inadequacy