8. Course and treatment of acute purulent otitis media. The paracentesis.

What is acute purulent otitis media- POM

acute bacterial infection of the middle ear

What is the etiology of POM

• preceded by viral URT infection

• bacteria- S. pneumonia, S. pyogenes, H. influenzae, Moraxella, E. coli

What are the risk factors of POM

• overcrowded + poor hygienic conditions

• malnutrition

• passive smoking

• nasopharyngeal colonisation of bacteria

• anatomical and immunological variations- Down’s syndrome

How do you diagnose POM

• History, otoscopy, pneumoscopy

• Hearing tests: PTA, Weber, Rinne

• Tympanogram: Type B curve

• Imaging: plain X-ray, CT for complications

• Laboratory tests: culture and sensitivity testing

What is the treatment of POM

• Antibiotics

• Nasal drops, heating ear region, suction of excretion

• Paracentesis if refractory to therapy + severe pain, fever, bulging of TM

What is paracentesis

Paracentesis is the incision of the tympanic membrane (myringotomy) along with aspiration

How is paracentesis performed

• Performed under local or general anesthesia in its anterior inferior or posterior inferior quadrants

• Effusion removed by suction from middle ear and culture is needed

• The incision will close spontaneously in 1-2 weeks

  • can prevented by inserting a tympanostomy tube

What is the indication for paracentesis

• bulging tympanic membrane

• after adequate antibiotic treatment- still acute middle ear infection

• suspicion of complications

  • mastoiditis, facial paresis, labyrinthitis, meningitis