1. Dr. Lamia AlMaghrabi Consultant ENT King Saud Medical City
OTITIS MEDIA (OM)
Dr. Lamia AlMaghrabi
Consultant ENT
King Saud Medical City

2. Otitis media
Otitis media: is inflammation of the middle ear, or a middle ear infection.

3. Otitis Media
It is the most common disease of childhood, next to viral URTI.
It is acute bacterial infection in 80% (1-6 years)
The most frequent disease treated with antibiotics.
Infectious &non inf. OM result in significant morbidity.

4. Otitis Media 1-Acute Otitis Media
Acute bacterial infection with purulent exudate in ME.
Characterized by : rapid sign and symptoms.

5. Otitis Media Incdence:
1-7 years of age with peak incidence in 1 year-old.
Finland study ( 75 % of children under 10 y.at least 1 /OM)
6- 11 month-old 75.5% one attack OM.
30% of children below 5 y. had multiple OM.
4 time higher in winter than in summer.

6. Normal Ear Drum

7. Pathogenesis Adenoid hypertrophy immature ET Tube Nasopharyngeal Ca
Ciliary dysfunction
Cleft palate
<
a-tensor tympani muscle
b- levator palati muscle
c- tensor palati muscle
d- Salpingopharyngeus muscle

8. Pathogenesis
Middle ear contamination

10. OTITIS MEDIA Presentation: Acute onset of otalgia ( T ). Fever
Sleeplessness
Irritability
Pulling of the ear by the child
Some degree of hearing loss
Ear discharge.
Tinnitus.
Ear fullness.
Dizziness.

11. OTITIS MEDIA
Streptococcus pneumonia Hemophilus influenzae Morexilla catarrhalis Streptococcus pyogenes (Grp. A) Staphylococcus aureus Others Mixed infections No growth
25% 25% 20% 2%
1% 20% 5% Remainder

12. OTITIS MEDIA
Treatment

13. OTITIS MEDIA
Proper ; antibiotic / dose / compliance / duration
1st line:
Amoxicillin 500 mg p.o. tid x 7-10 days ( beta lactam resistant bacteria )
2nd line:
Augmentin 875 mg p.o. bid x 7-10 days
Ceftin 500 mg p.o. bic x 7-10 days
Penicillin allergic patients
Septra DS i p.o bid x 7-10 days
ii. Erythromycin

14. 2- OTITIS MEDIA WITH EFFUSION
Most common disease treated by pediatricians
Myringotmy &tube insertion is the most common surgery in children.

15. OTITIS MEDIA WITH EFFUSION
Chronic , asymptomatic.
20 to 35% no history of AOM.
Fluid in the ME could be:
serous
mucoid (glue ear)
mucopurulent

16. Serous Otitis Media

17. OTITIS MEDIA WITH EFFUSION
Etiology

18. OTITIS MEDIA

19. OTITIS MEDIA WITH EFFUSION

21. OTITIS MEDIA WITH EFFUSION
Diagnosis
AUDIOMETRY
PLAY AUDIOMETRY
TYMPANOMETRY

22. OTITIS MEDIA WITH EFFUSION Treatment
Adeno – Tonsellectomy&Myringotomy tube insertion (T&A &TUBES)

23. Complication Brain abscess Extradural abscess Meningitis
Sub dural abscess
labrynthitis
Lateral sinus thrombosis
Acute mastoiditis
Petrositis
Facial N paralysis

24. Complication
Extracranial
Acute mastoiditis
Labrynthitis
Facial paralysis
Intracranial
Meningitis
Brain abscess

25. Acute mastoiditis

26. Labrynthitis

27. Facial nerve paralysis

28. Meningitis

29. Brain abscess

30. Post op mastiod cavity

31. Tympanosclerosis

32. Retraction of The Eardrum

33. Retraction Pocket Formation

34. 2ndry cholesteatoma

35. Tympanic membrane perforation
Tympanoplasty

36. TYMPANOPLASTY

37. Chronic Otitis Media Persistant disease, Severe destruction
It is characterized by:
Deafness
Ear discharge
T.m. perforation

38. TYPES OF C.S.O.M.
Tubo tympanic s.o.m. Safe
Attico antral Unsafe

39. Chronic Otitis Media Causes: 1 Late treatment of acute otitis media.
2 Inadequate or inappropriate antibiotic therapy.
3 Upper airway sepsis.
4 Lowered resistance, e.g. malnutrition, anaemia,immunological
impairment.
5 Particularly virulent infection, e.g. measles.

40. ATTICO ANTRAL C.S.O.M. Cholesteatoma Keratinizing Squamous Epithelium.
A small sac
May involve whole middle ear cleft

41. TUBO TYMPANIC C.S.O.M
Deafness
Discharge
Central perforation

42. TUBO TYMPANIC C.S.O.M Patency of Eustachian tube
Nidus of infection in U.R.T.I.
Immune status of patient
Aerobic and Anaerobic

43. TYPES OF TUBO TYMPANIC C.S.O.M.
Active Tubo Tympanic C.S.O.M.
Inactive Tubo Tympanic C.S.O.M.

44. Audiological assessment
Voice test
Tuning fork test Rinne, Webers , A.B.C.
Pure tone audiogram

46. RADIOLOGICAL ASSESSMENT
CT-scan temporal bone

48. treatment Aural toilet Antibiotics Cotton buds Suction and cleaning
Topical antibiotics
Systemic antibiotics

49. Surgical treatment Precipitating disease Adenoid DNS Nasal polyps
Aural polypectomy
Functional reconstruction tympanoplasty

50. THANK YOU