DISORDERS OF MIDDLE EAR

DR. SUDEEP K.C.

Acute suppurative otitis Media

•Acute inflammation of middle ear by pyogenic organisms.

•Etiology:• Infants and child of lower socioeconomic group . • • Routes of infection: Via Eustachian tube(Most common route)Via External earBlood borne

PREDISPOSING FACTORS:

Recurrent attacks of common cold , URTI, measles , Diptheria, whooping cough.Infections of tonsils and adenoids.Chronic rhinitis and sinusitisNasal allergyTumours of nasopharynx , packing of nose

Bacteriology:

Streptococcus pneumoniae – 30%Haemophilus influenza-20% Moraxella catarrhalis -12%Other organisms : streptococus pyogenes, staph. aureus , pseudomonas aeruginosa.

Pathology and clinical features:

1)Stage of tubal occlusion: Oedema and hyperemia of nasopharyngeal end of Eustachian tube blocks the tube negative intra tympanic pressureretraction of TM.

Symptoms:

Deafness and ear ache , no fever.

Signs:

TM is retracted with shortening of handle of malleus and loss of the light reflex.

2)STAGE OF PRE-SUPPURATION: prolonged tubal occlusioninvasion of tympanic cavity by pyogenic organism causing hyperaemia of its lininginflamatory exduate appearTM congested.

Symptoms: Marked ear ache that disturbs sleep.Deafness and tinnitus.High fever.

Signs: Congestion of pars tensa , cart wheel apperance of TM, finally it get uniformly red.

3)STAGE OF SUPPURATION:This is marked by formation of pus in middle ear and mastoid air cells.TM starts bulging to a point of rupture.

Symptoms: Excruciating Ear ache.Increasing Deafness.High fever with vomiting and even convulsion.

Signs:Tm is red and bulging with loss of landmarks .Handle of malleus is engulfed by swollen and protuding TM.yellow spot is seen where rupture is imminent.x-ray mastoid show clouding of air cells.

4)STAGE OF RESOLUTION:

TM ruptures with release of pus and subsidence of symptoms . Inflammatory process begins to resolve.

Symptoms:With evacuation of pus Earache is relieved , fever comes down .

Signs:External auditory canalcontain blood tinged or mucopurulent discharge.Perforation on TM .

5)STAGE OF COMPLICATION:

If the virulence of organism is high or resistance of patient is poor , resolution may not take place and disease spreads beyond middle ear.

TREATMENT:

1)Antibacterial Therapy: It is indicated in all cases with fever and severe ear ache.It should be continued at least for 10 days.

2)Decongestant nasal drops: Ephedrine , oxy or xylo metazoline.

3)Oral nasal decongestant : Pseudoephedrine 30 mg twice daily .or combination of decongestant with anti histamin.

4)Analgesics and antipyretics:

5)Ear toilet:

6)Dry local heat:

7)Myringotomy : It is incising drum to evacuate pus .

Indications:

a)Drum is bulging and there is acute pain.

b)Incomplete resolution despite antibiotics when drum remain full with persistent conductive deafness.

c)Persistent effusion beyond 12 weeks

OTITIS MEDIA WITH EFFUSION(GLUE EAR) This is an

insidious condition characterized by accumulation of non purulent effusion in middle ear cleft.

Pathogenesis:

1)Malfunctioning of Eustachian tube:

2)Increased secretory activity of middle ear mucosa:

ETIOLOGY:

1)Malfunctioning of Eustachian tube : The causes are Adenoid hyperplasia.Chronic sinusitis and rhinitisChronic tonsillitisTumours of nasopharynx 2)Allergy 3)Unresolved otitis media 4)Viral infections

CLINICAL FEATURES:

Symptoms : The disease affects 5-8 yrs of age.Hearing lossDelayed and defective speechMild ear ache

Otoscopic findings:

TM is often dull and opaque with loss of light reflex .a) It may appear yellow , grey or bluish colour . B)Thin leash of blood vessel is seen along handle of malleus and periphery of TM . C)Retraction of TM with Air fluid level .Mobility of TM get restricted .

Treatment:

A)Medical DecongestantsAnti allergic MeasuresAntibioticsMiddle ear aeration

B)Surgical: Myringotomy and aspiration of fluidGrommet insertionTympanotomy or cortical matoidectomySurgical treatment of causative factor

THE END