Acute Suppurative Otitis Media

Acute Suppurative Otitis Media

It is a pyogenic organism-induced acute middle ear inflammation. Middle ear cleft; area in the middle ear (Eustachian tube, middle ear, attic, aditus, antrum and mastoid air cells).

Risk factors

• Infection of tonsils and adenoids
• Chronic rhinitis and sinusitis
• Nasal allergy
• Tumors of nasopharynx
• Cleft palate
• Low socioeconomic status
• Slum area
• Crowded group
• Swimming in dirty water
• Age (Infant and Children)

Pathology and presentation

During the course of a disease, the following pathological changes are observed;

1. Stage of tubal occlusion

Negative intratympanic pressure causes the tympanic membrane to retract with some degree of effusion in the middle ear, while infection and inflammation of the Eustachian tube restrict the tube itself, causing air to be absorbed. symptoms/signs of the aforementioned illness; Conductive deafness is revealed via turning fork and earache (not marked) tests.

2. Stage of pre-suppuration

Pyogenic organisms penetrate the tympanic cavity if the tubal blockage is left untreated, leading to inflammatory exudates in the middle ear. This stage is characterized by a severe earache, sleep disturbances, a high fever, restlessness, deafness, and tinnitus.

3. Stage of suppuration

pus buildup in the middle ear and its extension into the mastoid air cells. This stage shows itself in:

• An earache becomes excruciating.
• Fever of 102-1030F may be associated with vomiting and even convulsion
• Red and bulging tympanic membrane and loss of landmarks.
• Tenderness over the mastoid antrum
• Deafness is increased

4. Stage of resolution

Pulse is released as a result of the rupture of the tympanic membrane. The symptoms have now diminished, and the inflammatory process is starting to lessen. Blood-tinged discharge may still be present in the external auditory canal (mucopurulent)

5. Stage of complication

If the infection is left untreated and the organism's virulence is high, it can spread outside the middle ear. Acute mastoiditis, meningitis, extradural abscesses, facial paralysis, brain abscesses, and other conditions are possible outcomes.

Diagnosis

• History taking
• Physical examination findings (presence of conductive deafness)0
• Audiogram
• Pus culture and sensitivity test
• X-ray of mastoid bone
• CT Scan
• On otoscopic examination: shows rough, red, bulging tympanic membrane with absence of light reflex

Treatment

• Antibiotic therapy: common drugs are
  • Ampicillin 50 mg/kg/day four times a day
  • Amoxicillin 40 mg/kg/day three times a day
  • Cefaclor 20 mg/kg two times a day
  • Erythromicin30-50 mg/kg four times a day
  • The use of antibiotics must be continued for at least 10 days, or until the appearance of the tympanic membrane and the restoration of normal hearing.

• Decongestant nasal drops
  • Ephedrine nose drops 0.5% or oxymetazoline ( Nasivion drops).
• Analgesic and antipyretics for pain and fever
• Ear toilet
  • If there is ear discharge, insert a wick wet with antibiotic and a dry mopped with sterile cotton.
• Dry local heat
  • to avert suffering and discomfort
• Surgical treatment
  • Myringotomy ( incision of the drum to remove pus) ( incision of the drum to evacuate pus). When antibiotics are unable to completely treat the illness and there is a persistent effusion that lasts longer than 12 weeks, it is advised.