ASOM from Dhingra

1. Acute Suppurative Otitis Media
Acute inflammation of middle ear by
pyogenic organisms

2. Aetiology
Infants and children of lower
socioeconomic group
Follows viral infection of upper respiratory
tract

3. Routes of Infection
Via eustachian tube
Via external ear
Blood borne

4. Predisposing Factors
Recurrent
attacks of
common cold,
upper respiratory
tract infections,
exanthematous
fevers
Infections of
tonsils or
adenoids
Chronic rhinitis
and sinusitis
Nasal allergy
Tumours of
nasopharynx,
packing of nose,
epistaxis
Cleft palate

5. Bacteriology
Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis
Streptococcus pyogenes
Staphylococcus aureus
Pseudomonas aeruginosa

6. Pathology and Clinical
Features
Stage Pathology Symptoms Signs
Tubal
Occlusion
• Oedema &
hyperaemia
of
nasopharyng
eal end of
tube
• Retraction of
TM
• Deafness
• Earache
• TM retracted
• Handle of
maleus more
horizontal
• Lateral
process of
maleus
prominent
• Loss of light
reflex
• Conductive
deafness

7. Stage Pathology Symptoms Signs
Presuppuration • Pyogenic
organsims
invade
tympanic
cavity
• Hyperaemia
of lining
• Inflammatory
exudate in
middle ear
• TM congested
• Earache
o Throbbing
o Disturbs sleep
• Adults –
deafness &
tinnitus
• Children –
Fever
• Congestion of
pars tensa
• Cartwheel
appearance
of TM
• Conductive
deafness
Suppuration • Pus in middle
ear
• TM bulges out
• Severe
earache
• Deafness
increases
• Fever
o Vomiting
o Convulsions
• TM
o Red
o Bulging
o Loss of
landmarks
• Tenderness
over mastoid
antrum

8. Stage Pathology Symtoms Signs
Resolution • TM ruptures
• Release of
pus
• Subsidence
of symptoms
• Earache
relieved
• Fever
subsides
• EAC may
contain
blood-tinged
discharge
• Later
becomes
mucopurule
nt
Complication • Virulence of
organism is
high
• Resistance
of host is
poor
• Acute mastoiditis
• Labyrinthitis
• Subperiosteal abscess
• Facial paralysis
• Petrositis
• Extradural abscess
• Meningitis
• Brain abscess
• Lateral sinus thrombophlebitis

9. Treatment
Antibacterial therapy
Ampicillin 50mg/kg/day in 4 divided doses
Amoxicillin 40mg/kg/day in 3 divided
doses
Decongestant nasal drops
Ephedrine (1% in adults & 0.5% in children)
Oxymetazoline
Xylometazoline
Oral nasal decongestants
Pseudoephedrine 30mg twice daily

10.  Analgesics & antipyretics
 Paracetamol
 Ear toilet
 Dry-mopping
 Dry local heat
 Relieves pain
 Myringotomy
 Drum is bulging; acute pain
 Incomplete resolution despite antibiotics; persistent conductive
deafness
 Persistent effusion beyond 12 weeks

11. Acute Necrotising Otitis Media
 Variety of ASOM seen in children suffering from
exanthematous fevers
 Caused by B-haemolyticus streptococci
 Rapid destruction of entire tympanic membrane
 Profuse otorrhea
 Healing followed by fibrosis or secondary acquired
cholesteatoma

12. Treatment
Antibacterial therapy for a least 7-10
days
Cortical mastoidectomy
Medical treatment fails to control
Condition gets complicated by
acute mastoiditis

13. Thank you