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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)