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Otitis Media

ACUTE CHRONIC

Acute Viral Om

Acute Suppurative OM

Acute Necrotizing OM

Acute Allergic OM

Non-specific

Specific

Tuberculous OM

Syphilitic OM

Non-suppurative Suppurative

Tubo-tympanic

Attico-antral

OM with Effusion

Chronic Adhesive OM

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Chronic Suppurative

Otitis Media (CSOM)

Tubo-tympanic OM

Attico-antral OM

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Tubo-tympanic OM The aim is to control infection.

Eliminate ear discharge.

Later, correct the hearing loss by surgery.

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1. Aural toilet.

To remove all discharge and debris from the ear.

It can be done by : - dry mopping with absorbent

cotton buds

- suction clearance

under microscope

- irrigation

Ear must be dried after irrigation.

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2. Ear drops

Antibiotic ear drops (neomycin, polymyxin, chloromycetin

or gentamicin)

Combined with steroids.

Patient lies down with the diseased ear up, antibioticdrops are instilled and then intermittent pressure appliedon the tragus for antibiotic solution to reach the middleear.

3-4 times/day

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3. Systemic antibiotics

Useful in acute exacerbation of chronicallyinfected ear.

Otherwise, role of systemic antibiotics in the

treatment of CSOM is limited.

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4. Precautions

Keep water out of the ear during bathing,

swimming and hair wash.

Hard nose-blowing can also push theinfection from nasopharynx to middle ear

and should be avoided.

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5. Treatment of contributory causes

Infected tonsils, adenoids, maxillary antra,and nasal allergy.

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6. Surgical treatment

Aural polyp or granulations, if present, should beremoved before local treatment with antibiotics.

It will facilitate ear toilet and permit ear drops to

be used effectively.

An aural polyp should never be avulsedas it

may be arising from the stapes, facial nerve orhorizontal canal and thus lead to facial paralysisor labyrinthitis.

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7. Reconstructive surgery Myringoplasty with or without ossicular

reconstruction - to restore hearing.

Closure of perforation - prevent repeatedinfection from the external canal.

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Attico-antral OM1. Surgical Mainstay of treatment.

Remove the disease and render the ear safe. Preserve or reconstruct the hearing.

Two types of surgical procedures are done

to deal with cholesteatoma:

(a)Canal wall down procedures.

(b)Canal wall up procedures.

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(a)Canal wall down procedures.

Leave the mastoid cavity open into theexternal auditory canal so that the

diseased area is fully exteriorised.

Commonly performed operations are :

i) atticotomyii) modified radical mastoidectomy

iii) radical mastoidectomy

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(b)Canal wall up procedures.

Combined approach through the meatus andmastoid but retaining the posterior bonymeatal wall intact, thereby avoiding an open

mastoid cavity.

It gives dry ear and permits easy

reconstruction of hearing mechanism.

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Incidence of residual or recurrent cholesteatomain these cases is very high and therefore long-

term follow-up is essential.

In combined-approach or intact canal wallmastoidectomy, disease is removed bothpermeatally, and through cortical mastoidectomyand posterior tympanotomy approach.

(in which a window is created between the mastoid andmiddle ear, through the facial recess, to reach sinus

tympani)

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Difference between canal wall up and canal wall down

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2. Reconstructive surgery

Hearing can be restored by myringoplastyor tympanoplasty.

It can be done at the time of primarysurgery or as a second stage procedure.

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3. Conservative treatment

Limited role.

Repeated suction clearance and periodic checkups are essential.

It can also be tried out in elderly patients above65 and those who are unfit for generalanaesthesia or those refusing surgery.

Polyps and granulations can be cauterised bychemical agents like silver nitrate ortrichloroacetic acid.

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Otitis Media

ACUTE CHRONIC

Acute Viral Om

Acute Suppurative OM

Acute Necrotizing OM

Acute Allergic OM

Non-specific

Specific

Tuberculous OM

Syphilitic OM

Non-suppurative Suppurative

Tubo-tympanic

Attico-antral

OM with Effusion

Chronic Adhesive OM

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Chronic OM - Specific

Tuberculous OM Syphilitic OM

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Tuberculous OM

1. Systemic antitubercular therapy as beingcarried for primary disease. (EHRZ)

2. Local treatment in the form of aural toilet, and

control of secondary pyogenic infection.3. Mastoid surgery indicated for complications.Healing is delayed in tuberculous cases.Wound break-down and fistula formation are

common.Reconstructive surgery of middle ear is delayedtill antitubercular therapy has been completed.

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Syphilitic OM

Treatment consists of antisyphilitictherapy* with attention to aural toilet andcontrol of secondary infection.

Surgerymay be required for removal ofsequestra.

*Benzathine penicillin G 2.4 million units (IM) in a single dose.