1、ACUTESUPPURATIVEOTITISMEDIA(ASOM)Acutesuppurativeotitismediaresultsfrombacterialinfectionofthemiddleearcleft,oftenasabacterialcomplicationofthecommoncold.Thisismorefrequentinchildrenthaninadults. Etiology#The common infective organisms are beta hemolytic streptococcus, pneumo-coccus, Hemophilus infl

2、uenzae, and staphylococcus. #Eustachian tubes: viral upper respiratory infection, enlarged adenoids, sinus infections, allergy-causing edema in the eustachian tube region, and cleft palate. #Othercause:traumaticrupture,perforationofthetympanicmembrane,frominfectionfollowingearsurgery.#ASOMisaself-li

3、mitingdisease,andwhentreatedadequatelyitrarelyleavesanyresidualchange.Clinical Features Symptoms. Fever, malaiseOtalgiaDecrease in hearingDischarge from the ear canal: muco-purulent or purulent . ( perforation of the tympanic membrane).On ExaminationIn the early stage, the tympanic membrane will sho

4、w retraction and lack of mobility. Next with the onset of edema and exudation the drum will lose its landmarks, appear thick and dull, and may have a fluid level. The fluid is thick and not clear, as in the case of serous otitis media. Tympanicmembraneoutwardandcausebulgingofthedrum.Ifuntreatedthety

5、mpanicmembranewillrupture,givingrisetoaserosanguinousandthenmucopurulentorpurulentdischargefromtheear.Perforationoccursintympanicmembranecentral.TympanicmembranebeforeperforationwithASOMTympanicmembraneafterperforationwithASOMAfterperforation,painandfevermaynotbeasmarkedasintheearlierstages,butthere

6、ispersistenceofpurulentdischargeandrecurrenceofpain.Pressureonthemastoidtipwillproducepain-mastoidtenderness.Infectionmayspreadtomastoidcausemastoiditis.Tuningforktests:aconductivehearingloss.X-rayfilmorCTscanexaminationsintheearlystagesmayshowhazinessorcloudiness.Treatment Symptomatic Treatment. An

7、algesics : painantipyretics : fever. fluid replacement : prevent of dehydration ThecultureandthesensitivityofdischargeAntibiotictreatment:Penicillingivensystemicallywillmanagemostoftheseinfections.InchildrenthepossibilityofHemophilusinfluenzaeshouldbekeptinmind,andthismayrequireampicillinifthereisno

8、responsetopenicillinorifthecultureandthesensitivitytestsoindicate.Antibioticsshouldbegivenfor5to7days,certainlynotless.Systemicdecongestantshelpreduceswellingandtherebyfacilitatedrainageofthemiddleear.Thesearegivenforaperiodoftwoweeksormore,dependingonhowquicklythemiddleearbecomesfreeoffluid.Ifthedrumappearsfullandbulging,amyringotomyshouldbecarriedoutfordrainage.EardropsalsocanbevalueforinfectioninASOM.0.25%-1%Chloramphenicoland0.3%Ofloxacineardropsarerecommended.Beforeusingeard