Acute otitis media and

mastoiditis
Chunfu Dai M.D & Ph.D
Otolaryngology Department
Fudan Univeristy
Definition
AOM: is an infectious process of the
middle ear cleft and to a variable
extent, of the mastoid air cell
system.
Bacteriology
Streptococcus pneumoniae (48%)
Haemophilus influenzae (31%)
Moraxella catarrhalis (20%)
P-hemolytic streptococcus
(decreased following widespread
immunization program)
Pseudomonas aeruginosa
(uncommon cause of AOM)




















(Doern. Am J Med. 1995;99(6B): 3S-7S; Jacobs et al., AAC 1999:43:1901; Jacobs et al
abstract C-61, ICAAC 1999)
0
10
20
30
40
50
%

P
e
n
i
c
i
l
l
i
n

R
e
s
i
s
t
a
n
c
e

(0.12 - 1.0 g/ml)
( 2.0 g/ml)
1
9
7
9

1
9
8
0

1
9
8
1

1
9
8
2

1
9
8
3

1
9
8
4

1
9
8
5

1
9
8
6

1
9
8
7

1
9
8
8
-
8
9

1
9
9
0
-
9
1

1
9
9
2
-
9
3

1
9
9
4
-
9
5

1
9
9
7

1
9
9
8

16%
18%
29%
33%

7998
Routine of infection
Via eustachian tube
upper respiratory infection
(acute rhinonitis and nasal
pharyngitis)
Upper respiratory
communicative disease
(diaphea, mealse, et al)
Swimming and dive in unclear
water
Anatomic contribution
(Eustachian tube in infant is
wide and short and the two
orifice in the same level)

Routine of infection
Via external acoustic canal
and TM
Perforation
Myringotomy or myrigotosis
Via blood supply
Pathology
Mucosal inflammation
Serous, hemorrhagic,
or purulent exudate in
middle cavity
Rupture of tympanic
membrane
Symptoms
Fever
It may be masked by analgesics or
antibiotic
Otalgia
60% patients can spontaneous remission
Fullness
Hearing loss

Physical findings
Increased vascularization
of the TM, initially located
in pars of flaccida,
frequently spreading
beyond the annulus to
the skin of the external
canal.
Bony landmarks are
visible.
Cholesteatoma Formation
Physical findings
Rapid middle ear
exudation occurs,
Blurring of the mallwall
short process, followed
by edema and bulging of
the pars flaccida.
Physical findings
The progression of this
disease may result in rupture
of TM, releasing the middle
ear contents (beating sign)
leads to relief of otalgia and
retraction of the pars flaccida
Lab tests
Blood counts usually shows leukocytosis
with polymorphonuclear elevation.
CT and MRI is necessary only for the rare
patients with a serious complication
(meningitis or brain abscess)
Hearing tests
Conductive hearing loss
Degree of hearing loss
will depend on the
amount and viscosity of
the middle ear exudate,
TM edema
It vary from 10-50 dB
with predominant
involvement of the low
frequencies
Hearing loss may mixed
when there is labyrinthine
extension.

Managements
Antibiotic therapy
Experiences
Antibiotic sensitivity and bacteriologic culture
Traditional duration 10-14 d
Currently duration 5-7 d


Managements
Nasal decongestants
Best rest, light diet
Avoidance of irritants (smoking)

Managements
Pre-perforation
Pain relief drugs
Surgery: myringotomy
Progression with a red,
bulging TM, severe otalgia
and fever
Otitis media with impending
complications
perforation is not big enough
to drain all pus
Managements
Post-proferation:
Clear-up pus with 3% hydro-oxygen
Antibiotic ear drops
With pus decreased and inflammation
disappeared, alcohol can be used to facilitate
dry ear.

Follow-up
Adequately treated AOM effusion may
persist for 2-6 weeks or even longer.
Managements may require
extended antibiotic treatment
Otoscope and audiometric tests should be
performed 3-4 weeks following apparent
resolution of the acute infection
Insertion of pressure equalization tubes due
to fluid persists beyond 3 months
Acute mastoiditis
Definition: an infection of the mastoid
characterized by diffuse osteitis followed by
rarefaction and breakdown of the bony septae.
Acute coalescent mastoiditis
Haemorrhagic mastoiditis
Masked mastoiditis
Predisposition to pneumatic mastoid
Predilection to kid
Mastoid is mature at age of 4 year old
Acute mastoiditis
Reduction of immune system
Strong bacteria (type III pneumococus,
haemolytic streptococcus)
Obstruction- not effective drainage
Imcompletely treatment
Acute mastoiditis
Symptoms
Symptoms may follow AOM, with or without a
symptom-free interval of a few days to
several weeks or more.
Otalgia
Aural discharge
Conductive hearing loss
fever
Acute mastoiditis
Physical findings
Fever, from a slight elevation to 39
Otorrhea may be absent
Pulsatile may be observed
Tympanic perforation is present, but it may be obscured by
intense edema
Swelling of the superior TM and posterosuperior wall of EAC
Postauricular area
erythema and tenderness
Pitting edema
Obliteration of the postauricular crease


Acute mastoiditis
Radiographic
evaluation
Diffuse
rarefaction of
bone and
breakdown of
cellular sepae
Acute mastoiditis
interventions
Medical management
Antibiotic
Intravenous antibiotic therapy should be maintained for at least
24-48 h after the resolution of symptoms
Then followed with oral antibiotic for 2 weeks
Surgical management
Emergency surgery: simple mastoidectomy
Mastoidectomy + ventilation tube placement