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1、ACUTESUPPURATIVEOTITISMEDIA(ASOM)Acutesuppurativeotitismediaresultsfrombacterialinfectionofthemiddleearcleft,oftenasabacterialcomplicationofthecommoncold.Thisismorefrequentinchildrenthaninadults.Etiology#Thecommoninfectiveorganismsarebetahemolyticstreptococcus,pneumo-coccus,Hemophilusinfluenzae,ands
2、taphylococcus.#Eustachiantubes:viralupperrespiratoryinfection,enlargedadenoids,sinusinfections,allergy-causingedemaintheeustachiantuberegion,andcleftpalate.#Othercause:traumaticrupture,perforationofthetympanicmembrane,frominfectionfollowingearsurgery.#ASOMisaself-limitingdisease,andwhentreatedadequa
3、telyitrarelyleavesanyresidualchange.ClinicalFeaturesSymptoms.Fever,malaiseOtalgiaDecreaseinhearingDischargefromtheearcanal:muco-purulentorpurulent.(perforationofthetympanicmembrane).OnExaminationIntheearlystage,thetympanicmembranewillshowretractionandlackofmobility.Nextwiththeonsetofedemaandexudatio
4、nthedrumwillloseitslandmarks,appearthickanddull,andmayhaveafluidlevel.Thefluidisthickandnotclear,asinthecaseofserousotitismedia.Tympanicmembraneoutwardandcausebulgingofthedrum.Ifuntreatedthetympanicmembranewillrupture,givingrisetoaserosanguinousandthenmucopurulentorpurulentdischargefromtheear.Perfor
5、ationoccursintympanicmembranecentral.TympanicmembranebeforeperforationwithASOMTympanicmembraneafterperforationwithASOMAfterperforation,painandfevermaynotbeasmarkedasintheearlierstages,butthereispersistenceofpurulentdischargeandrecurrenceofpain.Pressureonthemastoidtipwillproducepain-mastoidtenderness
6、.Infectionmayspreadtomastoidcausemastoiditis.Tuningforktests:aconductivehearingloss.X-rayfilmorCTscanexaminationsintheearlystagesmayshowhazinessorcloudiness.TreatmentSymptomaticTreatment.Analgesics:painantipyretics:fever.fluidreplacement:preventofdehydrationThecultureandthesensitivityofdischargeAnti
7、biotictreatment:Penicillingivensystemicallywillmanagemostoftheseinfections.Inchildrenthepossibilityof Hemophilus influenzae shouldbekeptinmind,andthismayrequireampicillinifthereisnoresponsetopenicillinorifthecultureandthesensitivitytestsoindicate.Antibioticsshouldbegivenfor5to7days,certainlynotless.
8、Systemicdecongestantshelpreduceswellingandtherebyfacilitatedrainageofthemiddleear.Thesearegivenforaperiodoftwoweeksormore,dependingonhowquicklythemiddleearbecomesfreeoffluid.Ifthedrumappearsfullandbulging,amyringotomyshouldbecarriedoutfordrainage.EardropsalsocanbevalueforinfectioninASOM.0.25%-1%Chloramphenicoland0.3%Ofloxacineardropsarerecommended.Beforeusingeardrops,cleaningpurulentdischargeinearby2%hydrogehperoxidesolution.Coldcreamcanbeusedtoprotectskinmaceratedfromeardischarge.Local treatment
