Otitis Media Ppt

Pharyngotonsillitis
AOM
Epiglottitis
LTB
Dr.Karthik D
MD Paediatrics
ACUTE OTITIS MEDIA
• Acute inflammation of the muco periosteal layer
of the middle ear cleft
• Inflammation typically occur in <6 weeks
• 60%-70% of children have >1 episode

before 1st birthday
• Early onset <6 months is associated

with recurrent AOM and chronic OME
ROUTES OF INFECTION
• 1. Via Eustachian Tube - most common -inf. travels via
lumen of tube peritubal Iymphatic’s
• 2. Via External Ear traumatic perforation of tympanic

membrane
• Blood borne – uncommon

Predisposing factors
• Recurrent common cold, URTI, exanthematous fevers (like
measles, diphtheria, whooping cough)
• Infection of tonsils & adenoids Chronic rhinitis & sinusitis
Nasal allergy
• Tumours of nasopharynx
• Cleft palate
Eustachian tube
• In children ET is at an angle of 10° while in adults it is at an
angle of 45°.
• Isthmus is a narrowing in the ET, at the junction of the

cartilaginous and bony part.
• It is only present in adults.

Organisms
• Streptococcus pneumonia (30%)
• Haemophilus influenzae (20%)
• Moraxella catarrhalis (12%)
• Others: Streptococcus pyogenes,
• Staphylococcus aureus and Pseudomonas
• Fungal less common — aspergillus & candida
• Bacterial otitis media from super infection of viral also
possible
Pathophysiology
Stage of tubal oclusion
Mucosa : Hyperemia,swelling
Eustatchian tube: occluded
Intratympanic pressure : increased
Fluid : increases ; TM – retracts
‘ Symptoms : Deafness Ear ache
Signs : Retraction of the TM. Loss of cone of light.

Tuning Fork Test - conductive deafness
Stage of pre suppuration
Bacteria invade tympanic cavity
Symptoms :
Marked Hyperemia
ear-ache(throbbing nature)
Deafness & tinnitus High degree fever & restlessness
Signs :
Inflammatory
Congested pars exudate
tensa, Cart Wheel appearance of T.M
Tuning fork test - conductive loss
Congested Tympanic membrane

Stage of suppuration
Pus increases
Symptoms - EXCRUCIATING PAIN, Deafness, Fever 102- 103°F,
Vomiting, Convulsions
TM- compressed, ischemic
Signs - T.M appears red & bulging, Tenderness over mastoid antrum
TM-tense ,bulges - necrosis

X-ray mastoid - clouding of air cells
Stage of resolution
• Pathology - T.M ruptures, releases pus, symptoms subside
& resolution starts
• Mild infection/Early antibiotics resolution with no rupture of

TM
• Symptoms - Ear-ache relieved, Fever comes down
• Signs - EAC contain blood tinged discharge or

mucopurulent, Small perforation of T.M
Complications
Highly virulent organisms/ low immunity disease spreads
beyond middle ear resulting in
• Acute mastoiditis
• Sub periosteal abscess
• Facial paralysis
• Petrositis
• Meningitis
• Brain abscess
MEDICAL MANAGEMENT
• Systemic Antibiotics
• Nasal decongestants – Systemic/topical
• H1 anti-histamines
• Analgesics , antipyretics
• Aural toilet for ear discharge
• Hot fomentation for ear ache
• Review after 48 hours
AFTER 48 hrs
• Earache + fever persists: change to higher antibiotic.
• If T.M. is bulging perform myringotomy. Send ear discharge for

C/S.
• Earache + fever subside: continue same treatment for 10-14

days
• Review after 3 months

No effusion: no further treatment
Effusion persists: treat as Otitis Media with Effusion
Presence of abscess or coalescent mastoiditis: do
cortical mastoidectomy
MYRINGOTOMY
INDICATIONS :
• Symptoms are not relieved by antibiotics
• TM bulges significantly
• TM perforation is too small
• Incomplete resolution
• Persistent effusion beyond 12 weeks
• The tonsils participate in systemic immune
surveillance.
• In addition, Local tonsillar defenses include a lining of

antigen-processing squamous epithetium that involves
B- and T-cell responses.
• Acute infection of the pharynx , palatine tonsils or both

• Tonsillopharyngitis is usually viral - most often caused by the common cold
viruses (adenovirus, rhinovirus, influenza, coronavirus, and respiratory
syncytial virus),
• But occasionally by Epstein-Barr virus, herpes simplex virus, cytomegalovirus, or
HIV
• In about 30% of patients, the cause is bacterial.
• Group A B-hemolytic streptococcus (GABHS) is most common (Streptococcal
Infections) but Staphylococcus aureus, Streptococcus pneumoniae,
mycoplasma pneumoniae and Chlamydia pneumonia are sometimes
involved
• Rare causes includepertussis, Fusobacterium, diphtheria,syphilis; and
gonorrhea
• GABFIS occurs most commonly between ages 5 and 15 and is uncommon
before age 3.
• Pain with swallowing is the hallmark and is often referred to the ears.
• Very young children who are not able to complain of sore throat often
refuse to eat.
• High fever, malaise, headache, and GI upset are common, as are
halitosis and a muffled voice.
• A scarlatiniform or nonspecific rash may also be present.
• The tonsils are swollen and red and often have purulent exudates.
• Tender cervical tymphadenopathy may be present.
• Fever, adenopathy, palatal petechiae, and exudates are
somewhat more common with GABFIS than with viral
tonsillopharyngitis, but there is much overlap.
• GABHS usually resolves within 7 days. Untreated GAMS

may lead to Local suppurative complications (eg,
peritonsillar abscess or cettutitis) and sometimes to
rheumatic fever or glomerulonephritis
Epiglottitis vs LTB

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Pharyngotonsillitis

• Inflammation typically occur in <6 weeks

• 60%-70% of children have >1 episode

• Early onset <6 months is associated

• 2. Via External Ear traumatic perforation of tympanic

• Blood borne – uncommon

• Isthmus is a narrowing in the ET, at the junction of the

• It is only present in adults.

Eustatchian tube: occluded

Intratympanic pressure : increased

Fluid : increases ; TM – retracts

‘ Symptoms : Deafness Ear ache

Signs : Retraction of the TM. Loss of cone of light.

Congested Tympanic membrane

TM-tense ,bulges - necrosis

• Mild infection/Early antibiotics resolution with no rupture of

• Symptoms - Ear-ache relieved, Fever comes down

• Signs - EAC contain blood tinged discharge or

• Nasal decongestants – Systemic/topical

• If T.M. is bulging perform myringotomy. Send ear discharge for

• Earache + fever subside: continue same treatment for 10-14

• Review after 3 months

• Symptoms are not relieved by antibiotics

• TM perforation is too small

• In addition, Local tonsillar defenses include a lining of

• Acute infection of the pharynx , palatine tonsils or both

• GABHS usually resolves within 7 days. Untreated GAMS

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