EAR - Acute Suppurative Otitis Media

What is acute suppurative otitis media?

Acute suppurative otitis media is an acute infection affecting the mucosal lining of the middle ear and the mastoid air system.

Acute suppurative otitis media often follows an upper respiratory tract infection. It is usually seen in childhood.

What are the common routes of infection for acute suppurative otitis media?

The commonest routes of infection in cases of acute suppurative otitis media are as follows:

1) Via eustachian tube: This tube is shorter and wider in children. Infection easily passes into the middle ear via this tube after a bout of tonsillitis, sinusitis or even swimming in unhygienic water
2) Through the tympanic membrane
3) Blood borne route is extremely rare
4) Allergy: Allergic oedema of the eustachian tube is said to cause occasional acute otitis media.

What are the pathological stages of acute suppurative otitis media?

Following are the stages through which a case of acute suppurative otitis media progresses:

1) Stage of Hyperaemia: There is hyperaemia of the middle ear and eustachian tube mucosa. The blood vessels over the tympanic membrane appear dilated
2) Exudation stage: Serous exudate with polymorphonuclear leucocytes fills the middle ear space. The ear drum is congested and bulging. The middle ear mucosa hypertrophies with metaplasia of simple cuboidal epithelium to mucin producing cells
3) Suppurative stage: The tympanic membrane bulges and ruptures spontaneously through a small perforation in the pars tensa. Ear discharge is usually present
4) Stage of Coalescent mastoiditis: The air in the mastoid air cells gets absorbed. Mastoid air cells coalesce into larger cavities full of exudate increasing the ear discharge
5) Stage of Resolution: Due to effect of medicines the tympanic membrane starts healing. Hearing gradually improves

What are the possible complaincations of acute suppurative otitis media?

When the infection spreads beyond the middle ear cleft, it may lead to a stage of complications. Possible complications include:

• Mastoiditis
• Subperiosteal abscess
• Facial paralysis
• Labyrinthitis petrositis
• Extradural abscess
• Meningitis or brain abscess

What is the treatment for acute suppurative otitis media?

Medical treatment of acute suppurative otitis media:

Local

Systemic

 

1) Ear toilet                             

2) Antibiotics, steroid ear drops

3) Antihistaminics                   

4) Nasal decongestants                       

1) Antibiotics

2) Nasal decongestants

3) Analgesics

 

Surgical treatment of acute suppurative otitis media:

Myringotomy, if severe earache with bulging ear drum



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