Questions and Best Answers

Courses


Tag

         Otitis media is inflammation of mucous membrane of middle ear cleft.

AETIOPATHOGENESIS:

      It usually occurs in infants & children following viral infection of upper respiratory tract. The disease is going through the following steps-

  1. STAGE OF TUBAL OCCLUSION:

       

               Oedema & hyperaemia of nasopharyngeal end of eustachian tube.

                                                                ↓

                                                      Blocks the tube.

                                                                ↓

                     Leads to absorption of air & negative intratympanic pressure.

                                                                ↓

               Retraction of tympanic membrane with some degree of effusion in middle ear.

 

  1. STAGE OF PRE-SUPPURATION:

 

                                                 Prolonged tubal occlusion

                                                                      ↓

                                      Pyogenic organism invade tympanic cavity.

                                                                      ↓

                                                     Hyperaemia of its lining

                                                                      ↓

                                          Inflammatory exudate in the middle ear.

 

  1. STAGE OF SUPPURATION:

                           Formation of pus in middle ear & sometimes in the mastoid air cells.

                                                                          ↓

                                                      Increase tension on the TM

                                                                          ↓

                          Pressure necrosis in the Pars tensa leading to small central perforation

                                                                          ↓

                                Ear starts draining (first serosanguinous & later mucopurulent)

  1. STAGE OF RESOLUTRION:

 

It is due to – 1. Most resistance over takes the virulence of organism. 2. Proper antibiotic therapy.

                                    Dimmunition of cessation of ear discharge.

                                                                  ↓

                                               Subsidence of symptoms

                                                                  ↓

                                   Inflammatory process begins to resolve.

  1. STAGE OF COMPLICATION:

Untreated cases can lead to intracranial & extra cranial complication by- 1) Erosion of bone, 2) Hyperaemic decalcification or thrombo-embolic phenomena.

 

CLINICAL FEATURES:

  1. STAGE 1: Deafness- Mild conductive.

                  Earache- Mild to moderate.

  1. STAGE 2: Marked earache.

                  Deafness.

                  Tinnitus.

                  High fever.

  1. STAGE 3: Deafness, Fever (102-103◦ F), Vomiting, Convulsion, Pain is less- discharge.
  2. STAGE 4: Earache relieved, fever comes down.
  3. STAGE 5: Acute mastoiditis, Subperiosteal abscess, Facial paralysis, Labyrinthitis, Extra-dural abscess, Meningitis, Brain abscess.

MANAGEMENT:

     1. STAGE 1:

  • Antibiotics- Ampicillin & amoxycillin. If allergic, Cefaclor, Cotrimoxazole, Erythromycin.
  • Decongestant- Pseudoephedrine (oral).
  • Nasal drops- Ephedrine, Oxymetazoline, Xylometazoline.
  • Methanol or tincture benzoin steam inhalation.

     2. STAGE 2:

  • Antibiotics.
  • Analgesic & antipyretics- paracetamol.
  • Myringotomy.

     3. STAGE 3:

  • Aural Toilet- dry mopped with Sterile cotton buds.
  • Antibiotic ear drops. 

     4. STAGE 4:

  • Depends on the type of complication.

 

 

;