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  1. Essentially self- limiting disease
    1. Gm- ve enteric pathogens in infants eg. E. Coli
    2. Usually in infants and children
    3. More in lower socio-eco group
Recent Pattern
Strept pneumonia  -  27%
H. influenza   -   27%
Streptococcal  -  10%
Moraxella  -   8%
Other’s  -  28%
  1. Organism:
    1. Streptococcus pneumonia (most common)
    2. H. Influenzae
    3. Moraxella catarrhalis
    4. Staphylococcus aureus sometimes
    5. Streptococcus pyogenes
    6. E. coli
  2. Routes of infection:
    1. Via Eust. Tube
    2. Via wet Ear
    3. Blood Born
  3. Stage of ASOM:
    1. Stage of Occlusion:
      Symptoms; Deafness, Earache, No fever
    2. Stage of Pre- suppuration
      1. Symptoms:
        1. Deafness (high sound)
        2. Earache
        3. High Fever
    3. Stage of suppuration:
      1. Symptoms;
        1. Excruciating pain
        2. Tympanic Membrane bulges and ruptures
        3. Fever
    4. Stage of resolution;
      Symptoms:  a- Earache relieved
    5. Stage of Complications:
      1. 85% of the tympanic membrane rupture occur in the antero- inferior quadrant
      2. Closure of the perforation in 90% of cases occur in 1 month
  4. Association of ASOM with
    1. Rec. URTI – Chr. Sinusitis
    2. Tonsillitis/adenoiditis
    3. Cleft palate
  5. Treatment: Involves treating the source i.e. nasopharynx and middle ear.
    1. Antibiotics: penicillin group/ erythromycin
    2. Analgesics
    3. Aural toileting
      1. Myringotomy:
        1. Tympanic membrane bulge and there is acute pain
        2. Incomplete resolution with antibiotics and patient complains of persistent deafness
        3. Persistent effusion till > 12 wks
        4. Tympani center is proposed by some instead of myringotomy in delayed resolution in immunocompromised. (70% have effusion till 12 wks 10% have persistent effusion)
      2. Decongestant nasal
      3. Oral antihistamine-decongestant

P.S.

  1. Facial paralysis in A.S.O.M is rare
  2. Otogenic intracranial complications in children arise more often due to acute rather than chronic suppurative otitis media.
  3. Complications:

Intratemporal                            

Intracranial

1.  Facial paralysis               

Extradural abscess

2.  Labyrinthine infections      

Subdural abscess

3.  Mastoiditis                       

Lateral sinus thrombophlebitis

4.  Petrositis                             

Otitic hydrocephalus

 

MCQ. Most common organisms in acute otitis media are Streptococcus pneumoniae, H. influenzae and Moraxella catarrhalis in decreasing order.





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