Otitis Media

Otitis Media

Otitis Media

It is an infection of the middle ear.

Classification:

1- Acute otitis media (suppurative or purulent ).

2- Chronic otitis media ( also called secretory, serious and nonsuppurative ).

The inflammatory process of the middle ear with effusion collection as a result of auditory canal blockage. bacterial or viral agents cause purulent exudate to collect in the space of the middle ear behind the eardrum.

Aetiology:

1- Suppurative otitis media:

a) Bacteriologic: Hemophilus influenza, beta-hemolytic streptococci or pneumococci.

b) Secondary: common cold, measles or scarlet fever.

2- Nonsuppurative otitis media:

a) Allergy.

b) Auditory canal dysfunction ( obstruction or abnormal patency ).

Predisposing factors:

1- the auditory canal in children is shorter, wider and more horizontal, thus making the middle ear more accessible to the invasion of microorganism.

2- anatomic immaturity of tubal muscles and cartilage in children under two years of age.

3- certain craniofacial congenital defects e.g. cleft palate and down syndrome.

Incidence:

- Suppurative: in children under 5 years of age mostly below 2 years.

- Nonsuppurative: school-age children.

- Increase in winter and early spring.

Clinical Manifestations:

1- History of common cold for several dates.

2- Fever.

3- Older child: pain in the affected ear, headache, vomiting and impaired hearing.

4- Infant: may rub ear, anorexia, turn head from side to side and/ or diarrhoea.

5- Decreased hearing.

Complication:

1- Chronic otitis media.

2- Mastoditis.

3- Septicemia.

4- Meningitis.

5- Deafness.

Diagnostic evaluation:

-  Pneumatic otoscope: bulging, red eardrum, rupture drum may be obscured by secretions.

- Culture and sensitivity: for secretion of the ruptured eardrum or by myringotomy.

Treatment:

Identify the aetiology.

Antibiotic according to culture and sensitivity.

Analgesic and antipyretic ( ear drops to relieve pain ).

Antihistaminic and decongestant.

Follow up hearing tests.

Surgical:

A) Myringotomy: opening in the tympanic membrane to allow drainage and relief pressure.

B ) Tympanostomy ventilating tube: the small plastic tube is inserted in the middle ear through the myringotomy incision.

C ) Tympanocentesis: aspiration of middle ear fluids.


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