Acute supperative otitis media is a pyogenic bacterial infection of the middle ear. It is a common disorder occurring at all ages and particularly in children.
Aetiology:
The predisposing factors include the following:
i. Nasopharyngeal or nasal packs
ii. Adenoids
iii. High deviated nasal septum.
iv. Nasal polyp
v. Rhinitis and sinusitis
vi. Tumours of the nose and nasopharynx.
vii. Anatomical factor: Short, straight and wide Eustachian tube in young children.
viii. Carelessness on the part of the mother in keeping the baby in a flat position while feeding, thus allowing milk to regurgitate into the nasopharynx and to the middle ear cavity through Eustachian tube.
Eustachian tube is the commonest route through which the infection travels from the nose and nasopharynx to the middle ear. The attack usually follows a common cold or influenza. The viral infection damages the mucosal barrier and bacteria invade as secondary organisms. The commonest organisms include betahemolytic and non-hemolytic streptococcus, Hemophilus influenza, Pneumococcus and Staphylococcus aureus.
The other path by which infection may reach the middle ear is a traumatic perforation in the tympanic membrane.
Pathology and Clinical Presentation:
Stage of tympanic congestion: Hyperiaemia of the mucoperiosteum of the middle ear. Patient complains of pain and fullness in the ear. The tympanic membrane looks congested. No significant hearing loss at this stage.
Stage of exudation: In this stage exudates collects in the tympanic cavity due to constant inflammatory process. The patient complains of marked pain in the ear with deafness. The tympanic membrane shows bulging and looks more congested. Constitutional symptoms like fever and malaise occur.
Stage of suppuration: The pent up inflammatory exudates causes pressure necrosis and perforation of the tympanic membrane. The perforation is central. Intensity of pain diminishes but hearing loss persists. The mucosa of the middle ear cavity if seen through the perforation is much congested and thickened. The discharge is serosanguinous at the onset and mucopurulent later on.
Stage of convalescence or recovery: The disease subsiding and the recovery process begins.
Stage of coalescent mastoiditis: Continued infection and absence of proper therapy leads to inflammatory changes in mastoid cells. The pain which had diminished following stage of suppuration intensifies with increasing deafness and profuse discharge continues to drain from the ear. Fever and bodyache recur.
Treatment:
ASOM has been described as a self-limiting disease provided the patient does not develop a complication.
Despite these advocates, the overwhelming consensus remains that antibiotics are the initial therapy of choice for AOM for 3 very valid reasons. First, after the institution of antibiotic therapy, a marked decline in the suppurative complications of ASOM is noted. Second, practitioners cannot predict with certainty which patients will develop complications. Third, studies have demonstrated that the use of antibiotics improves patient outcomes in both the early and late phases of ASOM.
Most common antibiotics that can be used in this condition are:
Amoxicillin/ Augmentin: Adult 250 – 500 mg PO q8hr; Pediatric: 90 mg/kg/d q8 - 12hr.
Clarithromycin: Adult: 250 – 500 mg PO q12hr; Pediatric: 15 mg/kg/d q12hr
Azithromycin: Adult: 500 mg on day1 then 250 mg/d for 2 – 5 days; Pediatric: 10 mg/d on day 1 then 5 mg/d on day 2 -5 days.
Ceftriaxone: Adult: 1-2 g/d IM for 3 days; Pediatrics: 50 mg/kg/d IM for 3 days.
In Ayurveda Lakshmi Vilas Rasa, Sanjivini vati work well in this condition.
Surgical:
Tympanocentesis and myringotomy are the procedures used to treat ASOM
