acute otitis media

Acute Otitis Media (AOM)

AOM is called acute suppurative otitis media or purulent otitis media.

Acute otitis media is acute inflammation and infection of middle ear mucosa. 

Causes 

Pyrogenic bacteria

Bacteria enter into middle ear via eustachian tube. The major symptoms of acute media otitis accumulation of fluid in the middle ear. 

Upper respiratory infection

Bacterial infection; Pneumococcus, Haemophilus influenzae, Moraxella.

Viral infection; Rhinovirus, Respiratory syncytial virus (RSV) 

Prematurity and low birth weight

Vitamin A, Zinc and iron deficiency

Altered immunity History of seasonl allergy

Pathophysiology

Due to upper respiratory tract nfection, inflammation of nasopharynx and eustachian tube.

Inflammatory reaction phagocytosis, inflammatory exudate occurs.

Cause obstruction in eustachian tubes.

Result pulls interstitial fluid into tube and creates serous effusion.

Serous effusion provide media for rapid growth of microbes.

Stages of Acute Otitis Media

1. Stage l

Tympanic congestion

Bacteria invade tympanic cavity, hyperaemia and edema occurs. 

Pain and sensation of fullness in ear occurs. Tympanic membrane congested.

2. Stage ll

Exudation

Inflammatory process cause accumulation of exudate in tympanic cavity. 

Tympanic membrane bulging. Pain in ear with hearing loss.

3. Stage lll

Suppuration

Formation of pus in middle ear. Changes in pressure cause perforation of tympanic membrane.

Mucosa of mide ear congested and thicken, hearing loss.

4. Stage lV

Convalescent or Recovery or Resolution 

Recovery process begins. 

5. Stage V

Complication

Continuous infection with proper treatment may cause decalcification of wall of mastoid air cell results in large cavity and leads bony erosion.

Clinical Manifestations

Rapid onset and short duration.

1. Sever otalgia

2. Conductive deafness (hearing loss)

3. Ringing or buzzing of ear (tinnitus)

4. Sense of fullness of ear

5. Rubbing the ear

6. Mastoid tenderness

7. Headache

9. Discharge from ear

10. Difficulty in hearing and speaking

Diagnostic Evaluation

1. Culture

Tympanocentesis; for collect specimen

2. CT scan, MRI scan

3. Audiometry

4. Insufflation

5. Tympanometry

6. Acoustic Reflexometry

To identify presence of absence of middle ear effusion (MEE).

Management

1. Antibiotics

Amoxicillin-clavulanate

2. For Pain and Fever

Analgesic; Acetaminophen,  Antipyrine and benzocaine otic drops

Antipyretic; Acetaminophen

Surgical Management

1. Tympanocentesis

Aspirate content from middle ear

2. Myringotomy

Close the perforation (hole) in tympanic membrane.