Acute Supperative Otitis Media (ASOM)


Acute suppurative otitis media is a common infection affecting the mucosa of the middle ear cleft and may cause severe pain.





AETIOLOGY:
1) Age: occurs in all ages, common in children.
2) Sex: affects both equally.
3) Geograpical distribution: all over the world.





3) Portals for entry of infection
i) Eustachian tube: in majority of cases inf. reaches from eustachian tube due to following causes:-
a) Anatomical obsruction.
b) Infections like adenoids, tonsillitis, rhinitis etc.
c) Hygeine: forcible blowin of the nose.
d) Swimming: water entering nose may spread infection to the middle ear.
e) Iatrogenic: after postnasal packing and badly performd adenoidectomy.
f) Use of feeding bottle:
ii) External ear: trauma to the ear drum.
iii) Head injury.
iv) Blood borne infections.





5) Predisposing factors
i) Reduced vitality.
ii) Atmospheric pressure changes max occure while flying or driving.





CAURATIVE ORGANISM:
Usually streptococcus haemolyticus, S.aureus, H. influenyae





PATHOLOGY:
5 Stages
i) Catarrhal stage: Characterised by occlusion of eustachian tube and congestion.
ii) Stage of exudation: Collects in the middle ear, initially it ir mucoid later becomes purulent.
iii) Stage of suppuration: Pus collects under pressure, stretches drum nd perforates it ane exudate starts escaping in ext. auditary canal.
iv) Stage of healing: Depending upon virulence of organism, resistance offered, and the antibiotics administered infection resolves from any stage.
v) Stage of complication: Infection may spread to mastoid antrum, initially causes catarrhal mastoiditis. In next stage granulation and oedema blocks d aditus to antrum, pus collects undr mastoid undr tension leading to breakdown of air cell septa and air cells in mastoid coalesce. This is called empyema of mastoid.





CLINICAL FEATURES
1) Catarrhal stage
Symptoms:
i) Fullness: Pt complains heaviness in ear.
ii) Pain: Pain becomes more severe at night due to venous congestion.
iii) Deafness: Always present and increases progressively.
iv) Tinnitus.
v) Autophony: Words echo in pt’s ear.
vi) Constitutional sypmtoms: due to toxins.
Signs:
i) Retraction of drum.
ii) Congestion of drum: cartwheel appearance coz of dilated bld vessels. Later it bcomes cmpltly red.
ii) Light reflex: lost due to oedema.





2) Stage of Exudation
-All symptoms become more severe.
-The drum now starts bulging and becomes convex.
-Drum may perforate at a point.





3) Stage of Suppuration
i) Pain and constitutional symptoms lesren.
ii) Otorrhoea, may b blood stained, mucoid to purulent.
iii) Perforation: usually ind ant-inferior quadrant with pulsatilf disbharge.





4) Stage of Healing
May begin from any stage.





5) Stage of Complications
Infection may spread to mastoid or other neighbouring structures.





INVESTIGATIONS
i) Test of Hearing





  • Tunning fork test.
  • Audiometry
    ii) Radiography
  • Mastoid radiograph
    iii) Bacteriological examination of discharge to detect causative organism.




TREATMENT
A) SYSTEMIC
1) Antibiotics such as Tetracycline, Erytromycin, Ampicillin at least for 6 days.
2) Decongestants





  • Nasal decongestant drops.
  • Systemic decongestants like phenylephrine hydrochloride.
    3) Analgesics to relieve pain.




B) LOCAL
1) Ear drops before perforation:
i) Glycerin carbolic ear drops reduce the pain.
ii) Warm oil reduces pain by fomentation.
2) Ear drops after perforation.
i) Antibiotic ear drops.
ii) Ciprofloxacin and norfloxacin ear drops.
iii) Spirit boric drops.
3) Aural Toilet.
Water should be prevented from entering into the ear.





C) SURGICAL
1) Myringotomy: ear drum is incised to drain middle ear discharge
Its indications are:-
i) Stage of exudation.
ii) Impending intracranial complications.
iii) ASOM with small perforation.
iii) Secretory otitis media.
iv) Haemotympanum.
v) Unresolved acute otitis media.





2) Myringopuncture
Puncturing the ear drum with a long thick needle and aspirating the middle ear content.





SEQUELAE:
i) Healing: may b complete with thin scar on drum.
ii) Perforation.
iii) Deafness may persist because of eustachian tube inadequacy.