Otitis Media

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Problems in the Eustachian Tube

-Upper respiratory infections
-Big adenoids
-Allergy
* Foods
* Environmental
* Smoke
* Other air quality issues
-Cleft palate
-Deviated septum
-Infants (angle of slope)

Flow Chart of Otitis Media

Acute otitis media
(w/o effusion)

-The first sign of otitis media
-Before effusion or discharge

Gross morphology
-Injection of the TM vessels
-No bulging

Clinical
-Acute onset of ear pain

Acute suppurative OM
(acute ear infection)
-Etiology

Etiology:
-The inflammatory edema from allergy or infection further interferes with ET drainage

Commonly associated organisms:
-Strep pneumoniae
-Staph aureus
-Hemophilus influenza
-Moraxella catarrhalis (Branhamella)
-Pseudomonas aeruginosa

Acute suppurative OM
(acute ear infection)
-S/Sxs

Morphology of Tympanic membrane
-Inflammation
-Bulging
-Loss/diffusion of light reflex
-Loss/diffusion of other landmarks

Others findings:
-Lymphadenopathy
-Fever
-Ear pain
-malaise

Acute suppurative OM
(acute ear infection)
-Clinical Course
-Complications

Should the TM rupture:
-Pain is immediately relieved
-Hearing is impaired
-A purulosanguinous d/c may shoot from the drum (may find on the pillow in the AM)

Clinical
-Allopathic treatment is Antibiotics or
"tubes" (tympanostomy tube)

Complications
-Rupture of TM
-Spread of infection to the
-mastoid process
-cochlea
-meninges

Healing of a TM Perforation

-Hyperemia of the margin of the perforation.
-Red-yellow-brown crust at the margin with a thin membrane covering the perforation
-Epithelial migration occurs from the center to the periphery
-The crust is released into the canal and eventually removed

Mastoiditis

Cholesteatoma

-An epidermoid cyst
-lined with keratinizing squamous or columnar epithelium (mucus producing)
-filled with amorphous debris and sometimes cholesterol

Etiology
-Congenital
-Acquired
* Perforation of TM
* Chronic retraction
* Chronic otitis media

These lesions by progressive enlargement may erode into:
-the ossicles
-the labyrinth
-the adjacent bone
-the surrounding soft tissue
* masses in the neck may be visible

Sequelae
This can grow into the ossicles or inner ear and cause deafness

-"Sometimes the cyst ruptures increasing the inflammatory reaction and inducing the formation of giant cells that enclose partially necrotic squames and other particulate debris"

Serous Otitis Media

-Serous fluid in the middle ear in the absence of infection

Etiology
-As in ASOM (usually bacteria or allergy)

Pathophysiology
-Normal serous fluid is trapped by a dysfunctional eustachian tube
-If the fluid becomes thick it is called "glue ear" or chronic catarrhal otitis media

Clinical
-Hearing loss
-Delayed/abnormal speech acquisition

Chronic Otitis Media

-A longstanding smoldering bacterial infection accompanied by a perisitant discharge through a perforation in the drum

Bullous Myringitis

Otosclerosis and Tympanosclerosis

-New bone/fibrous tissue forms in the ear affecting hearing

-Otosclerosis
* Autosomal dominant
* Begins in early decades of life
* Abnormal bone deposition around the oval window
* May lead to marked hearing loss

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