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
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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)
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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.
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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
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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.
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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
