csom ppt

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