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Managemant of otitis media
Middle ear cleft
PathogenesisEustachian tube
obstruction
Negative Middle ear pressure
Transudation
Transudation
Collection of fluid in Middle ear (SOM, MEE, ME)
OTITIS MEDIA
Aim of Management
• To re-establish ventilation of Middle ear cleft
Incidence
• 5.2% General population• 9.4% Low socio-economic group
children• 0.67% High socio-economic
group children
Predisposing factors
• In children– Short horizontal
ET– Adenoids– Cleft palate– Weak Palate
– Allergy– Immunodeficiency– Day care school– Bottle feeding– Down’s syndrome
Symptoms
• Acute pain• Excessive crying• Irritability• Fever• Discharging ear
Diagnosis
• Proper cleaning of the ear canal
• Otoscopy
• Naso-pharyngoscopy
Pathogens
• S. Pneumoniae• H. Influenzae• M. Catarrhalis• Gram –ve bacilli• Respiratory Syncitial Virus
Role of Viruses
• Release of inflammatory mediators• Colonization of bacteria• Suppressive effects on host’s
immunity
Drug resistance
• Resistant pathogens 20 – 25%
• Beta lactamase producing strains 40 – 50%
• Regional prevalence
Antibiotic of choice
• Should be given for 10 – 14 days– Amoxycillin 30 mg/kg– Amoxycillin – Clavulinic acid 30 mg/kg– Cefaclor 30 mg/kg– Other fourth generation cephalosporins– Quinolones– Trimethoprime - Sulphonamide
Local therapy
• Ear drops – Betnesol N,Ofloxacin, Ciprofloxacin
• Nasal drops• Inhalations• Local application 1% G V• Wick soaked in Hydrocortisone +
Antibiotic ointment• Antifungal drops
Surgery for Otitis Media
• Myringotomy
• Tympanostomy tube
• Adenoid removal :
C.S.O.M
• Tubotympanic
• Attico-antral
• Cholesteatoma
Surgery for CSOM
• Myringoplasty
• Tympanoplasty
• Ossiculoplasty
• Canal wall up/down Mastoidectomy
Prevention
• Vaccines• To keeps ear dry• Not to use ear buds• Prompt treatment of URTI• Adenoids removal• Tympanostomy tubes