1. OTITIS MEDIA Definition: inflammation of the middle ear
Very common in children but can occur in any age

2. Subtypes of OM Acute otitis media (AOM)
Otitis media with effusion (OME)
Chronic suppurative otitis media (CSOM)
Adhesive otitis media

3. Acute otitis media (AOM) develops suddely due to a (viral or bacterial) upper respiratory infection with blockage of the Eustachian tube.
The most common bacteria found in this case are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.

4. Otitis media with effusion (OME), also called serous or secretory otitis media (SOM) or GLUE ear.
it is simply a collection of fluid that occurs within the middle ear space due to the negative pressure produced by altered Eustachian tube function.
This can occur purely from a viral URI, with no pain or bacterial infection, or it can precede and follow acute bacterial otitis media.

5. Fluid in the middle ear sometimes causes conductive hearing impairment,. Over weeks and months, middle ear fluid can become very thick and glue-like (thus the name glue ear).

6. Chronic suppurative otitis media involves a perforation (hole) in the tympanic membrane and active bacterial infection within the middle ear space for several weeks or more.
There may be enough pus that it drains to the outside of the ear (otorrhea), or the purulence may be minimal enough to only be seen on examination using a binocular microscope.
This disease is much more common in persons with poor Eustachian tube function.
Hearing impairment often accompanies this disease.

7. Adhesive otitis media – if fluid is present within the ear for a protracted period, the tympanic membrane retracts and will adhesive to the middle ear, and adhesive otitis media may develop.

8. Causative organisms Streptococcus pneumoniae Haemophilus influenzae
Moraxella catarrhalis
Group A Streptococcus
Staph. aureus
Pseudomonas aeruginosa
RSV

9. RISK FACTORS Upper Respiratory Infections
Eustachian tube malformations
Allergies
Craniofacial abnormalities (cleft palate)
Smoking
Cholesteatoma

10. Pathophysioloy
This problem mainly deals with Eustachian tube dysfunction.
Otitis Media usually follows an URI in which there is edema of the eustacian tube, leading to blockage. Stasis of these middle ear secretions lead to infection and irritation
Other factors: allergic rhinitis, nasal polyps, adenoidal hypertrophy

11. Causative factors (mainly URI)
Edema in the Eustachian tube
Blockage in the Eustachian tube
Stasis of middle ear secretions
Irritation
Inflammation
Signs and symptoms

12. SIGNS & SYMPTOMS Otalgia – throbbing pain Otorrhea Headache Fever
Irritability
Loss of appetite
Vomiting
Hearing loss
Tinnitus
Vertigo

13. Diagnostic measures History collection Physical examination
Pneumatic otoscopy – gold standard mearsure
Tympanometry
Reflectometry
Mastoid x- rays

14. The classic description for Otitis Media is an erythematic, opaque, bulging tympanic membrane
Pneumatic Otoscopy: decreased tympanic membrane mobility
Spectral Gradient Acoustic Reflectometry: measures the condition of the middle ear by assessing the response of the TM to a sound stimulus. Equivalent to tympanometry for diagnosing middle ear effusions

15. Management
Antibiotics – assess for allergies and hypersensitivity reactions, inform not to miss any doses
Analgesics – do not drive after taking codeine, inform to take increase fluid
Antihistamines - chlorpheniramine
Decongestants - pseudoephedrine

16. Analgesics – acetaminophen, ibuprofen
Amoxicillin (drug of choice): mg/kg/day tid for days or,
Augmentin: 45 mg/kg/day bid for days
Auralgan: analgesic/adjunct for ear pain 2-4 drops tid

17. 2nd Line Treatment Regimen
Cefzil (cefprozil)
Pediazole ( erythromycin/sulfisoxazole)
Bactrim (trimethoprim/sulfamethoxazole
These medications are used as secondary agents if the primary antibiotic has failed after 10 days and the symptoms persists.

18. Surgical management Tympanocentesis & myringotomy
Tympanoplasty with mastoidectomy
Tympano – ossiculoplasty
Resection of the cholesteatoma

19. Tympanocentesis & myringotomy:
involves puncturing the tympanic membrane and aspirating middle ear fluid to relieve pressure. Only used if the primary and secondary line treatment fail.

20. COMPLICATIONS Hearing loss: conductive, sensorineural, mixed)
Acute mastoiditis
Chronic perforation of the TM
Tympanosclerosis
Cholesteatoma
Chronic suppurative OM
Facial nerve paralysis

21. Complications Intracranial complications Bacterial meningitis
Epidural abscess
Brain abscess
Hydrocephalus

22. Prevention
Most common in children so adequate breast feeding should be given
OM follows a respiratory tract infection, so treat the respiratory infections as soon as possible
Day care centers is considered as a source, so proper follow up should be maintained.
Health awareness programme in day care centers, schools can be helpful