By : wala’ mosa Presented to: Dr. Ayham Abu Lila

Ear infections Otitis externa acute chronic malignant Otitis media Acute chronic With effusion LabyrinthitisMastoiditis

Acute Otitis media Rapid onset of sign & symptom of inflammation in the middle ear

Clinical manifestation 90% of case have URI symptoms before develop AOMSymptoms Otalgia (98.2%) Fever (52.8%) Hearing loss, Pressure in ear (46%) Rhinorrhea (58.3%) Vomit & diarrhea

Eustachian tube dysfunction can’t drain fluid from the middle ear fluid build up within the normally air-filled middle ear Bacteria or viruses that have entered the middle ear through the eustachian tube can also get trapped in this way. These germs can breed in the trapped fluid leading to an ear infection.

Etiology Eustachian tube dysfunction Mechanical –Intrinsic : Inflammation of mucous membrane of eustachian tube –Extrinsic : Obstructing mass Adenoid tissue, Nasopharyngeal Tumor Functional

Etiology Functional –Found in younger children. –Cartilage part is less stiff than in adult. So it easily to collapse. –More horizontal angle.

otitis media Chronic ear infection –persists or keeps coming back, and causes long-term or permanent damage to the ear. Otitis media with effusion –is fluid in the middle ear space –Almost every acute ear infection is followed by days or weeks of OME. –it can cause the eardrum to perforate. –So the pain and pressure suddenly stops and pus drains from the ear.

Doctors diagnose ear infection by otocsope Healthy eardrum appears pinkish-gray Infected eardrum looks red and swollen. Pneumatic otoscope is used to detect fluid in the middle ear.

Clinical manifestation Bulging tympanic Normal tympanic

When too fluid build up in the middle ear, it can put pressure on the eardrum until it ruptures. Pain disappear Although ruptured eardrum sounds frightening, it usually heal itself in a couple of weeks.

Ear Tubes If these infections are not responsive to antibiotics then a tympanostomy (tube insertion) may be recommended which removes fluid behind the ear drum and reverses hearing loss.

Comlication of otitis media Mastoiditis Meningitis Facial paralysis Brain abscess

Vazquez E et al. Radiographics 2003;23: ©2003 by Radiological Society of North America subperiosteal abscess (A), epidural abscess (B) subdural empyema (C) brain abscess (D) meningitis (E) lateral sinus thrombosis (F) carotid artery involvement (G) apical petrositis (H) Complication of Otitis media

(otitis externa)Swimmer's ear

Acute or chronic Otitis externa: –is inflammation, irritation, or infection of the outer ear and ear canal. bacteria Enterobacter aerogenes, Proteus mirabilis, Klebsiella pneumoniae, Staphylococcus epidermidis, Streptococci. fungi –Candida and Aspergillus. Viruses –herpesvirus hominis and varicella-zoster virus

occurs most often in elderly patients with diabetes who have a recurrent history of non-resolving otitis externa. inflammation and damage of the bones and cartilage at the base of the skull. Pseudomonas aeruginosa is the predominant organism that causes this life-threatening infection. Malignant otitis externa (Osteomyelitis of the skull),

Edema, ear pain erythema cascade into cellulitis, chrondritis, osteomyelitis of the temporal bone, cranial neuropathies meningitis, or a brain abscess.

Labyrinthitis Inflammation of the inner ear. cause sudden vertigo, tinnitus. Causes: is not clear –Auto-immune –Viral –Bacterial (it may start after a middle ear infection.) –Tumor may also cause hearing loss

Mastoiditis Infection of mastoid process, portion of temporal bone of the skull that is behind the ear which contains open, air-containing spaces It is usually caused by untreated acute otitis media

Bacteria that cause mastoiditis –pneumococcus (in children under age 6), – Hemophilus influenzae, – beta-hemolytic streptococci, staphylococci, –and gram-negative organisms. if not treated promptly –lead to meningitis, facial paralysis, and brain abscess, in addition to hearing loss and bone destruction.

–Abscess in sternocleidomastoid muscle where pus from mastoiditis –Rare complication of acute otitis media Bezold’s abscess