Otitis Media (Infecton In Middle Ear )

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OTITIS MEDIA

It is a bacterial or Infection in the  middle ear’ usually secondary to a upper respiratory tract infection (URTI).Although acute otitis media can occur at  any age’ it is most common in young children’ particularly from age 3 mo to 3 yr. Microorganisms  may migrate from the nasopharynx  to the  middle ear  by  moving over the surface of the  Eustachian tube’s mucous membrane or by  propagating  in the  lamina propria  of the mucous membrane  as a spreading cellulitis or thrombophlebitis.

CAUSES

In Newboms

• Gran-negative enteric bacilli’Escherichia coli’ Staphylococcus aureus.

After the neonatal period

• E. coli rarely causes acute otitis media

• In older infants and children 14 yr. Streptococcus pneumoniae’Haemophilus influezae’grap A β-hemolytic streptpococci’Moraxella(Branhamella) catarrhalis’ and S. aureus .
• Viral otitis media is usually complicated by secondary invasion by one of these bacteria.

In those<yr ‘S pneumonia; group

• Β-hemolytic streptococci’  S  aureus’H. inflenzae.

RISK FACTORS

• Day care
• Formula feeding
• Passive smoking
• Male

• Family history of middle ear disease

• Acute otitis media in  first year of life is a risk factor  for recurrent acute otitis  media

SIGNS AND SYMPTOMS

• Severe earache
• Hearing loss
• Fever (up to 40.50° C[105.0°F])
• Nausea and vomiting
• Diarrhea
• Bulged erythematous  tympanic membrane
• Serosanguineous
• Purulent otorrhea

DIAGNOSIS

Differential Diagnosis

• Referred pain from the jaw or teeth

Investigations

• Tympanometry
• Acoustic reflectometry
• Hearing testing
• Tympanocentesis
• Nasopharyngeal cultures

TREATMENT

Goal

• To relieve symptoms
• Hasten resolution of the infection
• Reduce the chance of labyrinthine and intracraninal infectious
• Reduce the complications and residual damage to the hearing  mechanism in the middle ear.

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ANTIBIOTIC THERAPY

• 1^st line agents:moxicillin’ co-trimoxazole’erythromycin
• 2^nd line  agents: Amoxicillin/clavulanate’cefdinir’ cefpodoxime’cefuroxime axetil’clarithromycin.
• 3^rd line agents: Ceftiaxone’clindamycin’levofloxacin.

Surgical Treatment

Myringotomy should be considered if the trmpanic membrane is bulged or if pain’ fever’ vomiting’and diarrhea are severe or persistent.

COMPLICATIONS

o Acute mastoiditis

o Petrositis

o Hearing loss

o Labyrinthitis

o Cholesteatoma

o Fcial paralysis

o Conductive and sensorineural hearing loss

o Epidural abscess

o Atrophy and scarring of eardrum’ chronic perforation and otorrhea

o Meningitis’ brain abscess’ lateral sinus thrombosis’ subdural empyema’ and otitic hydrocepPROGNOSIS

Symptoms of otitis media usually improve in 48-72hrs’otitis media with effusion following acute otitis resolved  in 90%by  3 months. Otitis media with effusion have lesser percentage of complications.