,Welcome,Acute suppurative Otitis Media First Affiliated Hospital of Chongqing Medical University Yu Lin,Acute suppurative otitis media (ASOM) is inflammation of the middle ear cleft due to bacterial infection. It is also referred to as acute otitis media .,ASOM is most common in children between the ages of 3 to 7 years. Such infants have a short, wide, more horizonally placed eustachian tube than adults, allowing contamination from the regurgitation of feed. Poor sanitation, over-crowding and malnutrition are all risk factors in children. Risk factors in all age groups include recurrent or chronic rhinosinusitis, chest disease and eustachian tube dysfunction .,ASOM is a bacterial disease caused by pus forming organisms. Pathogenic bacteria have been isolated from the nasopharynx in up to 97% of children with ASOM. The bacterial infection may be a primary infection, or secondary following a viral acute non-suppurative otitis media.,Bacteria enter the middle ear cleft via the eustachian tube, a tympanic membrane perforation or are blood-borne. Common organisms include: Beta haemolytic streptococcus (40%) Haemophilus influenzae (30%) Moraxella catarrhalis (10%),Bacteriology,organisms mucous membrane inflammation suppurative stage catarrhal stage infection resolves rupture of tympanic infection resolves chronicity,Pathology,invade,causing,Sources of infection in otitis media the Eustachian tube is the chief route a. upper respiratory tract infection frequently a complication of viral infection common cold, acute rhinitis ,acute tonsillitisacute adenoiditisb. acute infectionmeasles, scarlet fever or influenza,c. swimming and diving d. anatomical factors the Eustachian tube is shorter , wider and more horizontal in child the external auditory meatus traumatic perforation of tympanic membrane,General symptoms fever, elevation of pulse rate, malaise Children suffer from general toxaemia and local symptoms are not evident. Temperature may be as high as 39,the child is crying and pulling at the ear or burrowing it into the pillow.,Symptom and sign,Local symptoms otalgia sharp, lancinating characterdue to accumulation of pus and pressure necrosis of the tympanic membrane . If tympanic membrane ruptures, the pain goes away.,symptom,hearing loss conductive type , tinnitusa conductive hearing loss which progresses otorrhea occurs after episodes of pain, and is due to perforation of the tympanic membrane and release of pus .,symptom,Examination on otoscopic examination the earliest stage, the injection of the vessles around malleus. The drum changes to bright red , bulges, all the landmark vanished. at last, perforation.,tenderness of bone usually in the bonebehind the ear hearing test conductive deafness blood examination a high leucocyte count,Examination,Acute otitis media is usually diagnosed via visualization of the tympanic membrane in combination with the appropriate clinical history.,otoscope,General management antibiotics haemolytic streptococcus sensitive to penicillin full doses ,a full 10-day course,Local management a. before perforation eardrops 3% carbolic acid in glycerin myringotomy indication : persistence of pain or fever more 24 to 48 hours b. after perforation aural toilet and eardrops 3% hydrogen peroxide solution 0.25% chloromycetin solution 0.3% ofloxacin solution 3% lincomycin solution,treatment,Treatment of causative factorindication after myringotomy, not recover Predisposing conditions to ASOM should be treated after resolution. adenoidectomy tonsillectomy rhinitis sinusitis,treatment,not treated in time or inefficiently treated, go on to chronicity. Perforated, somewhat difficulty the cause is not removed, a tendency recur.,Thanks For Your Attention !,