ASOM || Acute Suppurative Otitis Media || ENT Lecture скачать в хорошем качестве

ASOM || Acute Suppurative Otitis Media || ENT Lecture

ASOM || Acute Suppurative Otitis Media || ENT Lecture Middle Ear Anatomy-    • Anatomy of Middle Ear || ENT Lecture   Introduction Go to: v Acute otitis media is defined as an infection of the middle ear space. It is a spectrum of diseases that includes acute otitis media (A0M), chronic suppurative otitis media (CSOM), and otitis media with effusion (0ME). Acute otitis media is the second most common pediatric diagnosis in the emergency department, following upper respiratory infections. Although otitis media can occur at any age, it is most commonly seen between the ages of 6 to 24 months. [1] Infection of the middle ear can be viral, bacterial, or coinfection. The most common bacterial organisms causing otitis media are Streptococcus pneumoniae, followed by non-typeable Haemophilus influenzae (NTHi) and Moraxella catarrhalis. Following the introduction of the conjugate pneumococcal vaccines, the pneumococcal organisms have evolved to non-vaccine serotypes. The most common viral pathogens of otitis media include the respiratory syncytial virus (RSV), coronaviruses, influenza viruses, adenoviruses, human metapneumovirus, and picornaviruses.[2] I3][4] Otitis media is diagnosed clinically via objective findings on physical exam (otoscopy) combined with the patient's history and presenting signs and symptoms. Several diagnostic tools are available such as a pneumatic otoscope, tympanometry, and acoustic reflectometry, to aid in the diagnosis of otitis media. Pneumatic otoscopy is the most reliable and has a higher sensitivity and specificity as compared to plain otoscopy, though tympanometry and other modalities can facilitate diagnosis ifpneumatic otoscopy is unavailable. Treatment of otitis media with antibiotics is controversial and directly related to the subtype of otitis media in question. Without proper treatment, suppurative fluid from the middle ear can extend to the adjacent anatomical locations and result in complications such as tympanic membrane (TM) perforation, mastoiditis, labyrinthitis, petrositis, meningitis, brain abscess, hearing loss, lateral and cavernous sinus thrombosis, and others.[5] This has led to the development of specific guidelines for the treatment of OM. In the United States, the mainstay of treatment for an established diagnosis of AOM is high-dose amoxicillin, and this has been found to be most effective in children under two years of age. Treatment in countries like the Netherlands is initially watchful waiting, and if unresolved, antibiotics are warranted[6]. However, the concept of watchful waiting has not gained full acceptance in the United States and other countries due to the risk of prolonged middle ear fluid and its effect on hearing and speech, as well as the risks of complications discussed earlier. Analgesics such as non- steroidal anti-inflammatory medications such as ibuprofen can be used alone or in combination to achieve effective pain control in patients with otitis media. Etiology Otitis media is a multifactorial disease. Infectious, allergic, and environmental factors contribute to otitis media. [Z][8][9][10] [11] [12] These causes and risk factors include: • Decreased immunity due to human immunodeficiency virus (HIV), diabetes, and other immuno-deficiencies • Genetic predisposition • Mucins that include abnormalities of this gene expression, especially upregulation of MUCSB • Anatomic abnormalities of the palate and tensor veli palatini • Ciliary dysfunction • Cochlear implants . Vitamin A deficiency • Bacterial pathogens, Streptococcus pneumoniae, Haemophilus influenza, and Moraxella (Branhamella) catarrhalis are responsible for more than 95% • Viral pathogens such as respiratory syncytial virus, influenza virus, parainfluenza virus, rhinovirus, and adenovirus • Allergies • Lack of breastfeeding . Passive smoke exposure Go to • Daycare attendance • Lower socioeconomic status • Family history of recurrent AOM in parents or siblings Epidemiology Go to: Otitis media is a global problem and is found to be slightly more common in males than in females. The specifîc number of cases per year is difficult to determine due to the lack of reporting and different incidences across many different geographical regions. The peak incidence of otitis media occurs between six and twelve months of life and declines after age five. Approximately 80% of all children will experience a case of otitis media during their lifetime, and between 80% and 90% of all children will experience otitis media with an effusion before school age. Otitis media is less common in adults than in children, though it is more common in specific subpopulations such as those with a childhood history of recurrent OM, cleft palate, immunodeficiency or immunocompromised status, and others. [13][14] #middleearinfection #earinfection #mbbslectures #mbbsfighters