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Diagnosis Treatment
Multisystem evaluation Stabilize life threatening injuries
Imaging (CT/MRI) Observation
Audiologic evaluation Antibiotic coverage
ENoG (facial paralysis) Systemic steroids
Surgery to address TM perforation,
conductive hearing loss, facial
paralysis, persistent CSF leak
MIDDLE EAR
Etiology Treatment
Cotton applicators, Prevention of secondary
sticks, pins infection
Blast injury
Topical antibiotic drops
Barotrauma
Dry ear precautions
Diagnosis
Observation
Otoscopic exam
spontaneous healing in 78 to
Audiologic evaluation 94%
Imaging if necessary Surgery: Tympanoplasty,
Ossicular chain reconstruction
MIDDLE EAR
Stages of AOM
1. Erythema
2. Exudation
3. Suppuration
4. Coalescence and
mastoiditis
5. Complication or
Resolution
MIDDLE EAR
1. Erythema
Redness of TM due to middle ear
inflammation caused by direct extension of
pathogen from URTI
Otalgia
2. Exudation
Red/erythematous, bulging TM
Eustachian tube dysfunction
Myringotomy if too painful, not relieved by
analgesics and decongestants
MIDDLE EAR
3. Suppuration
TM perforation
Ear discharge, mucoid/serous
Not painful
Tx: Toilet, Wicking, Otic drops
5. Resolution or Complication
Resolution URTI resolves, TM perforation
heals; can occur at any stage
Treatment
Pain control
Oral antibiotics
Amoxicillin 40-50mkday
Erythromycin/Azithromycin
Diagnosis
Otoscopic exam
Audiologic evaluation
Imaging (high resolution CT)
Treatment
Create a safe, dry ear
Topical antibiotics
Surgery: Tympanoplasty or
Tympanomastoidectomy
MIDDLE EAR
Diagnosis
PE: whitish, foul-smelling debris
Audiometric evaluation
Imaging (HRCT)
Treatment
Surgery: complete removal of debris and
matrix, prevention of recurrence, hearing
rehabilitation
MIDDLE EAR
Extracranial Extracranial
Intracranial
Extratemporal Intratemporal
• Subperiosteal • Facial nerve injury • Meningitis
abscess • Labyrinthine fistula • Brain abscess
• Bezold abscess • Petrous apicitis • Lateral sinus
• Citelli abscess thrombosis
• Epidural abscess
• Otitic
hydrocephalus
complications of otitis media
complications of otitis media
complications of otitis media
complications of otitis media
complications of otitis media
complications of otitis media
complications of otitis media
complications of otitis media
complications of otitis media
complications of otitis media
complications of otitis media
complications of otitis media
complications of otitis media
complications of otitis media
complications of otitis media
complications of otitis media
complications of otitis media
Eradication of disease
Prevention on further deterioration of hearing
Prevention of disabling and fatal complications
Restoration of hearing
ENT – Head and Neck surgeon
Operating room and table
Otologic instruments
Operating microscope
Surgical drill system
Suction-irrigation system
Indications:
Acute otitis media, not responding to medical treatment
Acute otitis media with complications
Otitis media with effusion
Indications
Chronic otitis media with
effusion longer than 3 months
Recurrent acute otitis media
Indications
Acute mastoiditis with impending or existing
complications, without resolution after medical treatment
Chronic suppurative otitis media nonresponsive to
medical treatment
Indications:
Chronic suppurative otitis media with cholesteatoma, with
impending or existing complications
Chronic mastoiditis with destruction of surrounding bony
structures
Indications
Dry TM perforation and/or ossicular chain discontinuity
or fixation
Chronic suppurative otitis media, done in combination
with mastoidectomy
https://www.researchgate.net/profile/Timothy_Cox/publication/51817708/figure/fig1
http://microtiaearsurgery.com/microsite/wp-content/tn3/3/AM_RLAT3.png
http://img.medscapestatic.com/pi/meds/ckb/62/19262tn.jpg
http://img.medscapestatic.com/fullsize/migrated/488/345/cou488345.fig2.jpg
https://encrypted-tbn0.gstatic.com/images?q
https://www.researchgate.net/profile/Jonathan_Kay/publication/236227174/figure/fig1/AS:
299544374988807
WHO Primary Ear and Hearing Care Training Resource. Switzerland, 2006.