1. Acute suppurative otitis media

2. 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

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

4. 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

5. 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

6. Treatment Systemic treatment Antibiotics to control infection
Decongestants
Supportive therapy

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

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

9. Acute mastoiditis

10. 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

11. 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

12. Chronic suppurative otitis media

13. 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

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

15. chronic simple otitis media

16. chronic otitis media with osteitis

17. Cholesteatoma

18. 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

19. 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

20. 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

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

22. 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

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

24. Treatment Surgery as soon as possible 1873 Simple mastoidectomy
Myringoplasty
Radical mastoidectomy
Modified radical Mastoidectomy
Now tympanoplasty with or without mastoidectomy

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

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

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

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

29. Extra-cranial complications

30. Extra-cranial complications
Mastoid abscess

31. Extra-cranial complications
Labyrinthitis

32. Extra-cranial complications
Facial palsy

33. Intracranial complications

34. Intracranial complications
Brain Abscess

35. Intracranial complications
hydrocephalus

36. Thanks！