OTITIS MEDIA OTITIS MEDIA  and its complications and its complications

prof. O.I.Yashanprof. O.I.YashanIt is estimated that 70% of children will have had one or more episodes of otitis media (OM) by their third birthday. This disease process knows no age boundaries but occurs mainly in children from the newborn period through approximately age 7 years, when the incidence begins to decrease. It occurs equally in males and females.

Ways of spreading of infection to the middle ear :Ways of spreading of infection to the middle ear : 1. Toubo genes - through an auditory tube (more frequent), in such cases acute rhinitis 1. Toubo genes - through an auditory tube (more frequent), in such cases acute rhinitis

took place before otitis.took place before otitis. 2. Haematoma genes – with the flow of blood (at a flu, scarlet, misle and others like that).2. Haematoma genes – with the flow of blood (at a flu, scarlet, misle and others like that). 3. Through the perforation due to a trauma of ear-drum.3. Through the perforation due to a trauma of ear-drum. Mainly, inflammation is limited by a mucus lining. Mainly, inflammation is limited by a mucus lining.

Middle ear effusion is the liquid resulting from OM. An effusion may be either serous (thin, watery), mucoid

(viscid, thick), or purulent (pus). The process may be acute (0 to 3 weeks in duration),

subacute (3 to 12 weeks in duration), or chronic (greater than 12 weeks in duration).

•Acute otitis mediaAcute otitis media – –represents the rapid onset ofan inflammatory process of the middle ear space associatedwith one or more symptoms or local or systemic signs.

AOM - acute inflammation of mucus lining of middle ear acute inflammation of mucus lining of middle ear cleft. AOM often appears as a complication of viral disease cleft. AOM often appears as a complication of viral disease (flu, AVI) is with subsequent stratification of bacterial (flu, AVI) is with subsequent stratification of bacterial infection (streptococcus, staphylococcus, pneumococcus, infection (streptococcus, staphylococcus, pneumococcus, Pseudomonas aerogenosa and others like that).Pseudomonas aerogenosa and others like that).

ClassificationClassificationAccording to clinico-morphologic proceed of acute According to clinico-morphologic proceed of acute middle otitis, catarrhal and purulent his forms are middle otitis, catarrhal and purulent his forms are

distinguisheddistinguished

ACUTE CATARRHAL OTITIS ACUTE CATARRHAL OTITIS MEDIAMEDIA

Acute catarrhal otitis media– easy form of acute otitis Acute catarrhal otitis media– easy form of acute otitis media, that develops mainly as a result of media, that develops mainly as a result of auditory tube auditory tube disfunctiondisfunction. .

Influential factorsInfluential factors: Pathological processes: in : Pathological processes: in nasopharynx (adenoids, tumours); nasopharynx (adenoids, tumours);

nose (acute and chronic rhinitis) and in paranasal cavities nose (acute and chronic rhinitis) and in paranasal cavities (acute and chronic sinusitis). (acute and chronic sinusitis).

They cause the violation of functions of auditory tube – They cause the violation of functions of auditory tube – ventilation, drainage and protective. As the tube’s mucus ventilation, drainage and protective. As the tube’s mucus lining is covered by a cilliar epithelium in continuation of lining is covered by a cilliar epithelium in continuation of mucus lining of nasopharynx, through the tube infection mucus lining of nasopharynx, through the tube infection gets in a tympanic cavity, causing its inflammation.gets in a tympanic cavity, causing its inflammation.

ClinicClinic Feeling of otologic Feeling of otologic

fullness.fullness. Moderate hearing loss.Moderate hearing loss. Tinnitus.Tinnitus. Insignificant excretions Insignificant excretions

from an ear (possible).from an ear (possible). Temperature reaction and Temperature reaction and

general state are normal general state are normal (mainly).(mainly).

OtoscopyOtoscopy The ear-drum is slightly bulged, The ear-drum is slightly bulged,

gray-pink color.gray-pink color. Air bubbles and prominent

vascularity.

The perforation is absent in most The perforation is absent in most cases, if it arises up, brief excretion cases, if it arises up, brief excretion from the ear appears. from the ear appears.

Recovery takes place already in a Recovery takes place already in a few days. It is needed to remember few days. It is needed to remember that complications can also develop that complications can also develop in patients without the perforation. in patients without the perforation. Therefore the they must be under Therefore the they must be under the medical observation until the medical observation until complete convalescence.complete convalescence.

DiagnosticsDiagnostics OtoscopyOtoscopy Veber’s testVeber’s test – lateralizatsiya sound in a sick ear, – lateralizatsiya sound in a sick ear, Rine’s Rine’s

testtest – negative, – negative, Shvabah’s test Shvabah’s test – is prolonged (pathology – is prolonged (pathology of conductive mechanism).of conductive mechanism).

Impossibility to blow the auditory tube during theImpossibility to blow the auditory tube during the Valsalva maneuverValsalva maneuver. .

Negative or poorly positive Negative or poorly positive Polittcer’s testPolittcer’s test..

Additional inspectionAdditional inspection methods methods General blood test : leukocytosis, change to the left, speed-General blood test : leukocytosis, change to the left, speed-

up SHOE;up SHOE; Bacteriological research of pus to find a sensitiveness to Bacteriological research of pus to find a sensitiveness to

the antibiotics (with the purpose of choice of adequate the antibiotics (with the purpose of choice of adequate antibiotic therapy – better locally). antibiotic therapy – better locally).

X-ray of mastoid process – fogging of middle ear cavities.X-ray of mastoid process – fogging of middle ear cavities.

Audiogramm Audiogramm – presence of air-– presence of air-bone gap (pathology of conductive bone gap (pathology of conductive

or mixed type).or mixed type). -10

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ComplicationsComplications Sensoneural hearing loss.Sensoneural hearing loss. Transition in purulent form with development Transition in purulent form with development

of the proper complications.of the proper complications.

Medical TreatmentMedical Treatment decongescent drops to the nose (treatment of inflammatory decongescent drops to the nose (treatment of inflammatory

processes in nose and pharynx)processes in nose and pharynx) smearing of pharynx, gargling, smearing of pharynx, gargling, physiotherapy on the nose, paranasal cavities and pharynx. physiotherapy on the nose, paranasal cavities and pharynx. In addition, warmly on the area of ear,– anodynes, In addition, warmly on the area of ear,– anodynes, alcoholic drops to the ear (3% alcoholic solution of salicylic alcoholic drops to the ear (3% alcoholic solution of salicylic

acid, 2% r-n of novoimanin, Chlorofilipt and others like that). acid, 2% r-n of novoimanin, Chlorofilipt and others like that). At the presence of excretions the careful clearing of external At the presence of excretions the careful clearing of external

auditory canal and subsequent ear drops. auditory canal and subsequent ear drops. Valsalva and Polittser maneuver for the improvement of Valsalva and Polittser maneuver for the improvement of

auditory tube’s function. auditory tube’s function. catheterization of auditory tube, and at suspicion of catheterization of auditory tube, and at suspicion of

complications – tympanostomya (introduction a little tube in complications – tympanostomya (introduction a little tube in the ear-drum), at development of complications – antro the ear-drum), at development of complications – antro mastoidotomiamastoidotomia

ProphylaxisProphylaxis

adenotomiya, adenotomiya, septoplasty, septoplasty, TreatmentTreatment of sinusitisof sinusitis

ACUTE SUPERATIVE OTITIS ACUTE SUPERATIVE OTITIS MEDIAMEDIA

Purulent inflammation of middle ear mucus lining: Purulent inflammation of middle ear mucus lining: auditory tube, tympanic cavity and mastoid process. auditory tube, tympanic cavity and mastoid process.

Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis.

ReasonsReasons upper respiratory infection precedes the ear involvement

and spreads up the eustachian tube. In most cases acute cold In most cases acute cold traumastraumas

PathomorphologyPathomorphology Mucus lining acutely, is thickened in 10-20 times, Mucus lining acutely, is thickened in 10-20 times,

the mucoid edema, smallcells infiltration, arterial the mucoid edema, smallcells infiltration, arterial hyperemia. hyperemia.

ExcretionExcretion, which can be serous, hemorrhagic, , which can be serous, hemorrhagic, purulent or mixed, purulent or mixed, accumulates in the tympanic accumulates in the tympanic cavity. cavity.

As the auditory tube function is deteriorate and As the auditory tube function is deteriorate and excretion can not be eliminated through the tube in excretion can not be eliminated through the tube in the nasopharynx, pressure rises in tympanic cavity, the nasopharynx, pressure rises in tympanic cavity, that bulges the ear-drum outside. that bulges the ear-drum outside.

The micro thromboses appear in drum vessels, that The micro thromboses appear in drum vessels, that lead to necrosis of the thinnest areas of ear-drum. In lead to necrosis of the thinnest areas of ear-drum. In this place the perforation forms, through it the this place the perforation forms, through it the excretion is selected in external auditory canal. excretion is selected in external auditory canal.

Exudation diminishes gradually, excretions become Exudation diminishes gradually, excretions become not so abundant and acquire purulent, and then not so abundant and acquire purulent, and then mucus character. The auditory tube function mucus character. The auditory tube function gradually improves, excretions find the natural way gradually improves, excretions find the natural way to outflow - in nasopharynx, the perforation closes, to outflow - in nasopharynx, the perforation closes, the auditory function recovers. the auditory function recovers.

Clinic: Clinic: three stages of APOM three stages of APOM I stage – I stage – before perforativebefore perforative (1-3 days duration) – is characterized (1-3 days duration) – is characterized

by a diffuse inflammatory process in a middle ear without by a diffuse inflammatory process in a middle ear without restriction. Beginning of disease is acute, from appearance of the restriction. Beginning of disease is acute, from appearance of the expressed shooting, pulsating expressed shooting, pulsating painpain in the ear, which hides other in the ear, which hides other otologic symptoms: hearing loss, tinnitus, feeling of liquid in the ear otologic symptoms: hearing loss, tinnitus, feeling of liquid in the ear (ear fullness). (ear fullness).

There are expressed symptoms of general intoxication: high body There are expressed symptoms of general intoxication: high body temperature, chill and common indisposition. temperature, chill and common indisposition.

There can be the vestibular signs: dizziness, nausea, nystagmus, There can be the vestibular signs: dizziness, nausea, nystagmus, considerable hearing loss. considerable hearing loss.

A mastoid process is slightly painful. A mastoid process is slightly painful. The infection can be spread to the labyrinth and in the skull, causing The infection can be spread to the labyrinth and in the skull, causing

early complications with especially heavy motion.early complications with especially heavy motion.

Otoscopy of first APOM stageOtoscopy of first APOM stage The ear-drum is The ear-drum is redred (at (at

the beginning on the the beginning on the maleus handle, and then maleus handle, and then fully), fully), bulgedbulged, especially , especially in back quadrants (due to in back quadrants (due to accumulation of accumulation of excretion in the tympanic excretion in the tympanic cavity), cavity), thickenedthickened, , infiltrative;infiltrative; the cognitive the cognitive ear-drumear-drum pointspoints disappear;disappear; the line the line between ear-drum and between ear-drum and auditory canal auditory canal disappeardisappear

Influenza AOMInfluenza AOM Hemorrhagic

discharges Bullous myringitis with

hemorrhagic blebs on tympanic membrane and skin of EAC

Sensorineural hearing hearing loss. loss.

The ІІ stage – perforative The ІІ stage – perforative (4-7 days duration) (4-7 days duration)

Spontaneous perforation in ear-drum appears. Excretion Spontaneous perforation in ear-drum appears. Excretion outflows from a middle ear cleft; pain calms down quickly, outflows from a middle ear cleft; pain calms down quickly, the body temperature of goes down; general intoxication the body temperature of goes down; general intoxication decreases. decreases.

OtoscopyOtoscopy The external auditory canal is filled with excretions: at the The external auditory canal is filled with excretions: at the

beginning of illnesses with heamorhagic or serous, and then beginning of illnesses with heamorhagic or serous, and then - mucus or purulent. Appearance of excretions with an - mucus or purulent. Appearance of excretions with an unpleasant smell suspects necrosis of bone (necrotic unpleasant smell suspects necrosis of bone (necrotic inflammation of the ear), which more frequent arises up at inflammation of the ear), which more frequent arises up at scarlet fever, measles, agranulocitosis and others like that.scarlet fever, measles, agranulocitosis and others like that.

Otoscopiya of the second APOM stageOtoscopiya of the second APOM stage Ear Drum is red, thickened, infiltrated. Positive symptom of „pulsating drop” - through the small perforate opening, located mainly in the back-lower quadrant of ear-drum, in time by cardiac abbreviation the exudates get out.

The third stage – convalescence The third stage – convalescence reverse development or reparative, lasts to the end reverse development or reparative, lasts to the end

of third week. of third week. The quantity of excretions diminishes, they The quantity of excretions diminishes, they

become thicker, flow out without periodic shoves. become thicker, flow out without periodic shoves. The hearing gets better, a tinnitus disappears. The hearing gets better, a tinnitus disappears.

Otoscopy Otoscopy The ear-drum was insignificantly swollen and The ear-drum was insignificantly swollen and

pink during a maleus handle, the small perforation pink during a maleus handle, the small perforation is closed by a thin scar. is closed by a thin scar.

DiagnosticsDiagnostics Veber’s TestVeber’s Test– sound lateralization in a sick ear, – sound lateralization in a sick ear, Rine’s testRine’s test– –

negative, negative, Shvabah’s test Shvabah’s test – is prolonged (defeat of conductive – is prolonged (defeat of conductive mechanism).mechanism).

Audiogramm Audiogramm – presence of air-bone gap (worsening of hearing – presence of air-bone gap (worsening of hearing by conductive or mixed type).by conductive or mixed type).

Impossibility to do the Impossibility to do the Valsalva maneuverValsalva maneuver. . Negative or poorly positive Negative or poorly positive Polittser’s testPolittser’s test.. Additional inspection methods Additional inspection methods General blood test: leycotsitosis, change to the left;General blood test: leycotsitosis, change to the left; Bacteriological research of pus on a sensitiveness to the Bacteriological research of pus on a sensitiveness to the

antibiotics (with the purpose of choice of adequate antibiotic antibiotics (with the purpose of choice of adequate antibiotic therapy - it is better locally). therapy - it is better locally).

X-ray of mastoid process – the fogging of middle ear cavities.X-ray of mastoid process – the fogging of middle ear cavities.

AudiogramAudiogram Air-bone gap (conductive hearing loss)Air-bone gap (conductive hearing loss) Mix hearing lossMix hearing loss

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ConsequencesConsequences 1. The most frequent is complete 1. The most frequent is complete convalescenceconvalescence, the , the

criteria of which is normalization of the common state, criteria of which is normalization of the common state, normal otoscopy picture of ear-drum and complete hear normal otoscopy picture of ear-drum and complete hear recovering. recovering.

2. Firm hearing loss as a result of scar 2. Firm hearing loss as a result of scar formation in a formation in a tympanic cavitytympanic cavity (without the perforation). (without the perforation).

3. Permanent perforation of the ear-drum (3. Permanent perforation of the ear-drum (transition in a transition in a chronic otitis mediachronic otitis media).).

If convalescence does not come to the end of 3th week, If convalescence does not come to the end of 3th week, there is the danger of appearance of complications, the there is the danger of appearance of complications, the signs of which are: worsening of the common state, the signs of which are: worsening of the common state, the repeated rise of body temperature, strengthening of pain repeated rise of body temperature, strengthening of pain in the ear which already began to calm down, increase of in the ear which already began to calm down, increase of quantity of excretions, absence of improvement of quantity of excretions, absence of improvement of hearing loss, appearance of pain in the mastoid process. hearing loss, appearance of pain in the mastoid process.

ComplicationsComplications Mastoiditis, Mastoiditis, Labyrinthitis, Labyrinthitis, Sensoneural hearing loss (cochleitis), Sensoneural hearing loss (cochleitis), Facial nerve palsy, Facial nerve palsy, Otogenic sepsis, Otogenic sepsis, Intracranial complications.Intracranial complications.

TreatmentTreatment

ChronicChronic mesotympanitismesotympanitis•Central drum perforationCentral drum perforation; ;

•Permanent or periodical discharges Permanent or periodical discharges without bad smellwithout bad smell..

Chronic epitympanitis Chronic epitympanitis with cholesteatomawith cholesteatoma

CT or MRI scanCT or MRI scan Coronary projectionCoronary projection