otitis media aguda unjfsc
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OTITIS MEDIA AGUDADR JOHN A. CERVANTES A.OTORRINOLARINGOLOGO
U.N.M.S.M.-U.N.J.F.S.C.
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La otitis media aguda OMA! es e"diag#$sti%o m&s '(e%ue#te des)u*s de"
(es'(iado %om+# , de "os %o#t(o"es desa"ud de" #io sa#o. U# /0 de #ios de 1 aos 2a#
e3)e(ime#tado a" me#os u# e)isodio ,u# 110 2a# su'(ido 1 o m&s ata4ues.
E" )i%o de i#%ide#%ia est& e#t(e "os 5-6 meses.
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Se de7#e OMA8 i#9ama%i$# de "a mu%osade" o:do medio; a%om)aada; ge#e(a"me#te;de "a )(ese#%ia de ":4uido e# di%2a %a<idad.
E" o:do medio es u#a %a<idad a*(ea e# "a4ue "a e3iste#%ia de %ua"4uie( ":4uidoe3udado; t(asudado; )us o sa#g(e! es
siem)(e )ato"$gi%a. Si 2a, si#tomato"og:a %":#i%a agudaat(i=ui="e a esta )(ese#%ia de ":4uido;2a="amos de otitis media aguda OMA!.
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Si #o 2a, si#tomato"og:a %":#i%a aguda;"a otitis media (e%i=e e" #om=(e de
otitis media se%(eto(a; %o# e'usi$#;e3udado o de((ame OME!. Sue"e se( u# e<e#to e<o"uti<o )ost-
i#'e%%i$# aguda , toda<:a e# "aa%tua"idad; "a ma,o(:a de es)e%ia"istasORL se (e7e(e# a esta situa%i$# %omo>otitis serosa?.
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Si este de((ame du(a m&s de 1 meses, es =i"ate(a"; (e%i=e e" #om=(e de
OTITIS MEDIA CON DERRAME CRÓNICA OMEC!. Si e" de((ame es s$"o u#i"ate(a"; de=e
du(a( m&s de 5 meses )a(a se(%ata"ogado de %($#i%o.
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Ha="amos de OTITIS MEDIAPERSISTENTE e# dos situa%io#es8
6. si#tomato"og:a aguda ota"gia ,@o7e=(e! m&s a""& de B 2o(as e# e" %u(sode u# t(atamie#to AT '(a%asote(a)*uti%o! o
B. #ue<o e)isodio agudo a#tes de u#mes de "a 7#a"ia%i$# de" mismo OMA(e%idi<a#te!.
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SIGNOS SINTOMAS
ESECFICOS Ota"gia E4ui<a"e#te a "a ota"gia e# "a%ta#tes
I((ita=i"idad T(a%%i$# de" )a=e""$# au(i%u"a( Hi)oa%usia de %o(ta e<o"u%i$# si# ta)$# de %e(ume# Su)u(a%i$# aguda )(o<e#ie#te de" o:do medio
INESECFICOS Fie=(e V$mitos Dia((ea
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FASES8
Hi)e(emi%a8 mem=(a#a tim)&#i%a2i)e(<as%u"a(iada u o)a%a.
T(asudado8 mem=(a#a tim)a#i%a di"atada
, %o# gas e# su i#te(io(. E3udati<a8 A=om=amie#to de "a
mem=(a#a tim)&#i%a. Su)u(ati<a8 Sa"ida de mate(ia" )u(u"e#to
a t(a<*s de u#a )e('o(a%i$# tim)&#i%a.
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ATOGENIA La i#'e%%i$# <:(i%a de "a (i#o'a(i#ge
'a<o(e%e "a a)a(i%i$# de "a dis'u#%i$#de "a t(om)a de Eusta4uio; 'e#$me#o4ue %om=i#a "a )(ese#%ia de )(esio#es#egati<as e# e" o:do medio %o# "adi7%u"tad e# e" d(e#aKe de "asse%(e%io#es 2a%ia "a (i#o'a(i#ge.
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Du(a#te e" desa((o""o %(a#eo'a%ia"; "a t(om)ade Eusta4uio su'(e di<e(sos %am=ios.
E# e" "a%ta#te *sta es 2o(io#ta" %o# u#aa#gu"a%i$# de 6/ g(ados e# (e"a%i$# %o# e")"a#o 2o(io#ta"; misma 4ue <a aume#ta#do2asta se( de g(ados e# "a edad adu"ta.
La "o#gitud <a desde 6 mm e# "a%ta#tes2asta 16-1 mm e# adu"tos; se di<ide e# u#a)o(%i$# $sea , u#a %a(ti"agi#osa; "a 4ue7sio"$gi%ame#te )e(ma#e%e %e((adaa=(i*#dose %o# deg"u%i$#; =osteo; esto(#udo, ma#io=(a de Va"sa"<a )(esi$# )ositi<a!.
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OTOSCOIA
De gran valor predictivo de OMA: A=om=amie#to tim)&#i%o
Su)u(a%i$# de %o(ta e<o"u%i$#)(o<e#ie#te de" o:do medioDe gran valor predictivo de OME:
T:m)a#o ama(i""e#to T:m)a#o au"ado Hi)e(emia aso%iada a matide.
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IMAGENOLOGIA
TC de uti"idad e# "a e<a"ua%i$# de "as%om)"i%a%io#es de "as otitis medias%($#i%as; e# "os %o#t(o"es )oste(a)*uti%os de
)a%ie#tes 4ue #o e<o"u%io#a#'a<o(a="eme#te e# "os tiem)os 2a=itua"es; ,e# "as a"te(a%io#es de" o:do i#te(#o; "as%ua"es )uede# %om)(omete( a suse"eme#tos #e(<iosos o a "as est(u%tu(as$seas %$%"ea; <est:=u"o; %o#du%tossemi%i(%u"a(es; et%.!.
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OMA
CaKa tim)&#i%a i4uie(da )a(%ia"me#te o%u)ada )o(de#sidad de )a(tes ="a#das si# e(osi$# $sea #i de "a%ade#a osi%u"a(. O:do i#te(#o; mastoides; CAE , CAI si#
a"te(a%io#es.
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O%u)a%i$# %om)"eta )o( de#sidad de )a(tes ="a#das de" o:do mediode 'o(ma =i"ate(a"; si# e(osi$# de "a %ade#a de 2uese%i""os. Adem&se3iste o%u)a%i$# de" aditus ad a#t(um; a#t(o , %e"di""as mastoideassi# e(osi$# $sea t(a=e%u"a( #i de "as )a(edes; e# (e"a%i$# %o#OTOMASTOIDITIS ILATERAL; a!. E" i#te(io( de "a mastoides de(e%2ase o=se(<a %o# i#te#sidad de sea" =aKa-i#te(media e# T6; =!.
a b
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OMA mastoiditis i4uie(das %o# 'o(ma%i$# de em)iema
mastoideo , e(osi$# de "a )a(ed "ate(a" mastoidea; a!. OMA M. Coa"es%e#te =i"ate(a" %o# aume#to de )a(tes ="a#dasde(e%2o de=ido a %e"u"itis )e(iau(i%u"a(; =!.
a b
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RM Es e" m*todo de e"e%%i$# a#te "a sos)e%2a%":#i%a de %om)(omiso de "as est(u%tu(as de"%o#du%to auditi<o i#te(#o , "os &#gu"os
)o#to%e(e=e"osos; %omo es e" %aso de "os#eu(i#omas de" #e(<io a%+sti%o s%2a#omasde" VIII )a(!; me#os '(e%ue#teme#te de "osme#i#giomas; , mu, (a(ame#te de "os
tumo(es g"$mi%os de" go"'o de "a <e#a ,ugu"a(aguKe(o (asgado )oste(io(!.
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COMLICACIONES
Las %om)"i%a%io#es g(a<es e# "a 'aseaguda )et(ositis; "a=e(i#titis; )a(&"isis
'a%ia"; me#i#gitis; a=s%eso %e(e=(a"...!)(&%ti%ame#te 2a# desa)a(e%ido desde"a uti"ia%i$# ge#e(a" de AT e# "a OMA.
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COMLICACIONES TEMILESDE LA OTITIS MEDIA AGUDA
Todos "os )a%ie#tes )(ese#ta#%om)"i%a%io#es e#t(e 1 , 6 d:as
des)u*s de" diag#osti%o de otitis mediaaguda. Las disti#tas 'o(mas de)(ese#ta%i$# 'ue(o#8 oto((ea)e(siste#te; 7e=(e; 'o%a"idad
#eu(o"$gi%a; masa )(eau(i%u"a(; ,)a(&"isis 'a%ia".
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MENINGITIS
Com)"i%a%i$# mas '(e%ue#te. Diag#osti%o )o( LCR. Ne%esidad de estudios de image# )a(a
des%a(ta( e'e%to de masa sig#i7%ati<o de)osi="e a=s%eso i#t(a%(a#ea".
TC8 Fu#dame#ta" %o(tes 7#os de a"ta (eso"u%i$#)a(a <e( dis(u)%i$# de %o(ti%a" $sea mastoidea.
No 2a""agos es)e%:7%os )o( image#. E# estudios TC , RM %o# %o#t(aste )uede
o=se(<a(se (ea"%e me#:#geo.
.
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MENINGITIS NEUMOCOCICA
o%u)a%i$# de %e"das mastoideas, o:do medio i4uie(do . u(=uKaa*(ea i#t(a%(a#ea" ad,a%e#te.
dis(u)%i$# de "a %o(ti%a" mastoidea.
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ACIENTE B
IMAGEN 1
IMAGEN 2
IMAGEN 3
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ASCESO INTRACERERAL
Segu#da %om)"i%a%i$# i#t(a%(a#ea" e#'(e%ue#%ia e# "a Otitis Media.
O%u((e )o( %o#tigidad di(e%ta %o# "adis(u)%i$# %o(ti%a" , %o#ta%to %o# "a%oa"es%e#%ia mastoidea.
Image#8
- Co"e%%i$# ":4uida %o# (ea"%e e# a#i""o. -Es (e%ome#da="e (ea"ia( estudiosa#giog(&7%os TC o RM )a(a des%a(ta(t(om=osis de se#os du(a"es aso%iada.
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A=s%eso tem)o(o)a(ieta"
O%u)a%i$# de o:do medioi4uie(do , %oa"es%e#%ia de%e"das mastoideas.
Masa 2i)ode#satem)o(o)a(ieta" i4uie(da%o# im)o(ta#te edema
<asog*#i%o .
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A=s%eso %e(e=(a" tem)o(o)a(ieta" de(e%2o.
RM T6; %o"e%%i$#2i)oi#te#satem)o(o)a(ieta"
%$(ti%o-su=%o(ti%a"
TB; %o"e%%i$#2i)e(i#te#sa %o#
mode(ado edema<asog*#i%o.
T6PI %o#%o#t(aste)a(amag#*ti%o;
(ea"%e e# a#i""o de"a %o"e%%i$#.
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TROMOSIS DE SENOSDURALES.
Se#os t(a#s<e(sos , sigmoideos "osmas '(e%ue#teme#te a'e%tados.
No(ma"me#te se%u#da(ios a a=s%eso
e)idu(a". Se )(odu%e de=ido a #e%(osis )o()(esi$# e# "a )a(ed de" se#o;ad2e(e#%ia )"a4ueta(ia , )(o)aga%i$#
de" t(om=o mu(a" (esu"ta#te. Com)"i%a%i$# )o%o '(e%ue#te
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6; se#o t(a#s<e(so Ladode(e%2o!. B; <e#a %e(e=(a"i#te(#a. 1; Se#o sagita"su)e(io(. ; Se#o sigmoideoLado i4uie(do!.
6; se#o t(a#s<e(so. B; Se#osagita" su)e(io(. 1; Se#osigmoideo. ; =u"=o de "a
,ugu"a(
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TC a3ia" %o# <e#ta#a de 2ueso e#4ue se a)(e%ia otomastoiditis%oa"es%e#te.
TC a3ia" %o# <e#ta#a de
)a(tes ="a#das e# 4ue sea)(e%ia =u(=uKa a*(eai#t(a%(a#ea" e3t(aa3ia" ,em)iema i)si"ate(a".
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A#gioRM <e#osa e# "a 4ue se e<ide#%ia
t(om=osis de se#o t(a#s<e(so i4uie(do.
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ASCESOS
EQTRACRANEALES
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LOCALIACIN
-A=s%eso su=)e(i$sti%o mastoideo(et(oau(i%u"a(!8 E" m&s '(e%ue#te.
-A=s%eso de eo"d8 e#t(e e"
m+s%u"o este(#o%"eidomastoideo , e"dig&st(i%o.
-A=s%eso su=)e(i$sti%o igom&ti%o.
-A=s%eso de Mou(et8 e#t(e e"dig&st(i%o , "a <e#a ,ugu"a(. -A=s%eso )(eau(i%u"a(. -Ot(as "o%a"ia%io#es di<e(sas.
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HALLAGOS RADIOLGICOS 8CT
TC si# %o#t(aste8 - o)a%i7%a%i$# %o# o si# #i<e"es
2id(oae(eos de "as %e"das mastoideas%o# e(osi$# %o(ti%a" , t(a=e%u"a(<a(ia="e.
- Co"e%%i$# "i4uida ad,a%e#te omasa de )a(tes ="a#das
TC %o# %o#t(aste8 -Rea"%e )e(i'*(i%o de "a %o"e%%i$#.
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HALLAGOS RADIOLGICOS8 RM
T6PI8 %o"e%%i$# 2i)oi#te#sa su=)e(i$sti%a ,e# %e"das mastoideas.
TBPI8 %o"e%%i$# 2i)e(i#te#sa su=)e(i$sti%a ,
e# %e"das mastoideas. T6 %o# %o#t(aste8-Rea"%e )e(i'*(i%o de "a %o"e%%i$#.
-Estudio e# "os 1 )"a#os de"
es)a%io.
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A=s%eso de eo"d
A=s%eso )(eau(i%u"a(
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A=s%eso )(eau(i%u"a(.
dis(u)%i$# de "a%o(ti%a"mastoidea
de(e%2a.
o%u)a%i$# de "as %e"das mastoideas de(e%2as.
%o"e%%i$# )(eau(i%u"a(de(e%2a %om)ati="e
%o# a=s%eso
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ARLISIS FACIAL
Com)"i%a%i$# mu, )o%o '(e%ue#te. A'e%ta %o# m&s '(e%ue#%ia "os
segme#tos tim)&#i%o , mastoideo. Se )(odu%e e# )a%ie#tes %o#
de2is%e#%ia de" a%uedu%to de Fa"o)io. No(ma"me#te se (esue"<e %o# e"
t(atamie#to de "a i#'e%%i$#.
No e3iste# 2a""agos (adio"$gi%oses)e%:7%os.
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ACIENTE
IMAGEN 68 O%u)a%i$# de o:domedio de(e%2o , mastoides%o# #i<e"es 2id(oae(eos.
DIAGNSTICO8 Otomastoiditis%oa"es%e#te de(e%2a %o#
)a(&"isis 'a%ia" se%u#da(ia.
IMAGEN1
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mastoide%tomia
6A MASTOIDECTOMA CERRADA. TCa3ia"; (ese%%i$# de %e"das mastoideasM!; )a(ed )oste(io( de" %o#du%toauditi<o e3te(#o CAE! %o#se(<ada. %o(o#a"
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BA MASTOIDECTOMA RADICALMODIFICADA. TC a3ia"; %a<idad demastoide%tom:a a=ie(ta !; se )(ese(<a "a%ade#a osi%u"a(; i#%"uida "asu)(aest(u%tu(a de" est(i=o 9e%2a #eg(a!.
%o(o#a"
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1A Mastoide%tom:a (adi%a". TC a3ia";%a<idad de mastoide%tom:a a=ie(ta !;
ause#%ia de %ade#a osi%u"a(.
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A Mastoide%tom:a (adi%a" , tim)a#o)"astia ti)o III. TC a3ia"; mastoide%tom:aa=ie(ta; tim)a#o)"astia e# di(e%ta (e"a%i$# %o# "a %a=ea de" est(i=o 9e%2a ="a#%a!;ause#%ia de" ,u#4ue , de" ma(ti""o.
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g(a%ias
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