AOM & OMEAOM & OMEAOM & OMEAOM & OME

Bastaninejad Shahin, MD, ORL & Bastaninejad Shahin, MD, ORL & HNSHNS

Normal TM!

Definition

• Otitis media (OM) is the most common bacterial infection in children:– AOM = MEE + Sx and Px of acute

inflammation (fever, pain, a red and bulging TM)

– OME = MEE without signs of inflammation

Definition• Known risk factors for OM:

– Young age (first 2yrs)– Male gender– Bottle feeding– Sibling with OM– Crowded living condition (day care)– Smoking in home– Heredity and variety of associated conditions

(CP, CF, Down, ...)

Birth weight is not a RFBirth weight is not a RF

Pathophysiology

• Pathophysio. Of AOM is related to the Eustachian tube function:1. Protection failure (abnormally

patent)2. Clearance failure (tubal obstruction)3. Under aeration (tubal obstruction)

New

OLD

AOM• Common bacterial germs:

– Strep. Pneumoniae– HI– Branhamella catarrhalis

• The protection problem is not the result of the adenoid size and it’s ensuing obstruction, it’s the result of abnormally patency of the tube

OME

• Here, tubal obstruction is the result of inflammatory process rather than the cause of it FUNCTIONAL OBSTRUCTION

• MEE in OME contains some bacterial germs available evidence links OME to the bacterial infection

Audiometric issues in OME

• Audiometry is a guide for surgery in older children (more than 2yr):– ABG>20dB

• Tympanometric patterns in OME:– Type A (+100 to-100) 5%– Type B (-300 ) 80%– Type C (-150 to -200) 20-50%

AOM Complications

• Extra cranial (mastoiditis, neck inflammation)

• Intracranial (meningitis, brain abscess and...)

• The most common of them is: Mastoiditis

Tx: IV Abx + Drainage of the pus and removal of infected bone

AOM Treatment1. Antimicrobial therapy

– No Abx!: only observation and analgesics (90% resolution specially in older childern)

– Single IM Ceftriaxone– Oral Abx (5 days 10 days)

2. Adjunct medical therapy : only analgesics

In less than 2yrs and day care setting

Continue (AOM)

• Tympanocentesis:– Premature newborns– Immunocompromised– Progressive Sx and Px while

receiving an appropriate Abx– Intracranial infection– Research porposes

Continue (AOM)

• Myringotomy:– AOM with Facial nerve paralysis– With Meningitis– With other CNS problems– Unresponsive AOM– In Immunosuppressed– Severe pain is Severe pain is notnot an indication for this an indication for this

procedureprocedure

In MastoiditisMastoiditis, Facial nerve paralysisFacial nerve paralysis and intracranial intracranial otogenic infectionsotogenic infections , myringotomy + VT, provides long lasting drainage than a simple myringotomy...

Continue (AOM)

• Follow-Up: 3rd day & 2nd wk to 4th wk

• Recurrent AOM:Recurrent AOM:– Abx. prophylaxis: Sulfasoxazole or

Amoxicillin (20mg/kg) for 3-6 mo, another option is Co-trimoxazole

– Surgery : Adenoidectomy + VT

When pt had 4 bouts of AOM in 6mo or 6 When pt had 4 bouts of AOM in 6mo or 6 bouts in one yearbouts in one year

OME Treatment

• Below antimicrobial therapy, then observe for at least one month: – Sulfisoxazole + Erythromycin– Co-trimoxazole– Co-amoxiclav

• Surgical Txy:

Surgical indications:

Continue (OME)

• Hearing loss + effusion for more than 4-6mo

• Time critrion (fall)• Retracted pockets in contact with I

or S ossicles, or a pocket with epithelial debris

ABG > 20 dB

Continue (OME)

• Surgeries:– VT insertion– Adenoidectomy (independent to the size)