Acute suppurative otitis media

Overview Middle ear mucosa in acute suppurative inflammation. Common for ENT. Pathogens Streptococcus pneumoniae 肺炎链球菌 Haemophilus influenzae 流感嗜血杆菌 Hemolytic Streptococcus 溶血性链球菌 Staphylococcus 葡萄球菌

Etiology Acute upper respiratory tract infection Acute rhinitis Acute nasopharyngitis Acute tonsillitis Acute infectious diseases Scarlet fever Measles Whooping cough

Etiology Infants due to eustachian tube short and flat Infection by Eustachian tube Infants due to eustachian tube short and flat Infection by the external auditory canal Infection by blood

Symptoms Systemic symptoms: Earache Hearing loss and tinnitus Otorrhea Chills, fever Loss of appetite Relieve after tympanic membrane perforation Earache Hearing loss and tinnitus Otorrhea conductive deafness

Treatment Systemic treatment Antibiotics to control infection Decongestants Supportive therapy

Treatment Topical treatment Phenol glycerol Ear Drops Myringotomy Before perforation of tympanic membrane

Treatment Cleaning pus with 3%hydrogen peroxide Antibiotic eardrops Remove nasal, pharyngeal diseases adenoidal hypertrophy chronic sinusitis tonsillitis After perforation of tympanic membrane

Acute mastoiditis

Etiology Complication of acute suppurative otitis media Pathogens :drug resistant or Insensitive to commonly used antibiotics Simultaneously with other diseases: scarlet fever,measles,etc Poor drainage anatomical structure of mastoid air cell

Symptom Earache continuously exists after the perforation of tympanic membrane ,or with serious headache Ear discharging increase instead No hearing improve after the perforation of tympanic membrane or more serious hearing loss Systemic symptom become more serious Differential diagnosis: Furuncle external auditory canal

Chronic suppurative otitis media

Pathogenesis After acute suppurative otitis media Acute necrotizing otitis media Simultaneously with other diseases: scarlet fever;measles,etc Eustachian tube dysfunction Chronic nasal and pharyngeal diseases Pathogens Staphylococcus aureus 金黄色葡萄球菌 Pseudomonas aeruginosa 肺炎链球菌

Categories chronic simple otitis media chronic otitis media with osteitis chronic otitis media with cholesteatoma

chronic simple otitis media

chronic otitis media with osteitis

Cholesteatoma

Symptoms Ear discharging Intermittently Mucus secretions Mild conductive deafness Perforation of tympanic membrane, Middle ear mucosa smooth or mild congestive, Ossicular mostly intact X-ray or CT No bone destruction pneumatic type or diploetic type mastoid process

Symptoms Large perforation in tense part of tympanic membrane or Marginal perforation, there are granulation or polyps in tympanum X-ray or CT Mostly diploetic type mastoid process Soft tissue shadow in tympanum, tympanic antrum entrance and mastoid process

Symptoms Ear discharging continuously Produce foul-smelling pus which is characteristic of anaerobic streptococci Mild or serious conductive deafness, Mixed hearing loss Occasionally in advanced stage

Treatment Remove upper respiratory diseases chronic sinusitis tonsillitis Topical treatment medicine/surgery according to different types

Treatment Antibiotics ear drops Clear pus in external auditory canal and tympanum completely before ear drops Aminoglycoside otic solution forbidden Avoid powder Avoid colored ear drops Corrodent forbidden

Treatment Pus unobstructed drainage same as the simple but regular follow-up Poor drainage /suspected complications mastoid operation

Treatment Surgery as soon as possible 1873 Simple mastoidectomy 1878 Myringoplasty 1891 Radical mastoidectomy 1910 Modified radical Mastoidectomy Now tympanoplasty with or without mastoidectomy

Complications Classification Extra-cranial complications Intra-cranial complications Chronic otitis media with cholesteatoma

Extra-cranial complications Acute mastoiditis and mastoid abscesses (most common complication). Petrositis. Labyrinthitis. Facial paralysis. Osteomyelitis of the temporal bone

Extra-cranial complications External otitis Cervical lymphadenitis Retropharyngeal abscesses Parapharyngeal abscesses

Intracranial complications Extradural abscess (commonest intracranial complication) Subdural abscess Meningitis Brain abscess Temporal lobe abscess Cerebellar abscess Lateral sinus thrombosis Otitic hydrocephalus

Extra-cranial complications

Extra-cranial complications Mastoid abscess

Extra-cranial complications Labyrinthitis

Extra-cranial complications Facial palsy

Intracranial complications

Intracranial complications Brain Abscess

Intracranial complications hydrocephalus

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