Rajesh Kumar Sharma

Assistant Professor
HCON- Dehradun
 It is an acute inflammation, confined to
the mucoperiosteal lining of the middle ear
cavity caused by pyogenic organisms.
 Causative organism :- streptococcus
pneumonoiae, H. influenzae, Beta hemolytic
streptococcus, staphylococcus pyogenes
Anatomical obstruction caused by the
adenoids and nasopharyngeal tumour.
Infections like adenoids, tonsillitis, rhinitis,
phryngitis, sinusitis and influenza.
Poor hygiene, forceful blowing of the nose
pushes infection into the ear through the
Eustachian tube.
 Water enters in nose and ear while swimming
and bathing.
Infant fed with bottle in supine position, there
is a chance of milk entering eustechian tube.
Trauma to external ear, slap on the ear
ruptures eardrum.
Head injury fracture of temporal bone.
Blood borne infection rarely enters middle
ear.
 Change in atmospheric pressure. e.g.
flying, diving and low body resistance.
 Catarrhal stage
Stage of exudates
Stage of perforation
Stage of complication
Stage of healing
Edema and hyperaemia of nasopharyngeal end
of Eustachian tube

Block the tube

Absorption of air & negative ITP

Retraction of tympanic membrane

Eustachian tube is occluded and middle
ear is congested

Exudates collects in the middle ear

Drum is pushed laterally.

Exudates is mucoid and turn purulent.

 Fullness in ear Antibiotic drugs
Earache penicilline
Fever Analgesics
Nasal decongestants
Diminished hearing
Tinnitus

Sign & symptoms Treatment

Soon after hyperaemia exudation takes place
from the dilated permiable capillaries.
It may contains fibrin, RBCs and poly-morpho-
nuclear leucocytes ect.
 Increased pain Broad spectrum
Fever antibiotic -
Vomiting Amoxycillin, &
clavulanic acid
Hearing impairemant
Analgesics
Drum is bulging
Nasal decongestants
Point of perforation
occurs
Mastoid tenderness

Sign & symptoms Treatment

 Pus collected in middle ear pushes the drum
and stretched out drum is perforated by
pressure and nacrosis occrs.
Exudate escapes into external auditory canal.
 Immediate relief from Antibiotic -
pain & fever Amoxycillin, &
Increased hearing clavulanic acid
impairement Thorough cleaning of
Otorrohoea is blood external ear
stained mucoid and Antibiotics and steroid
purulant ear drops
Perforation of drum Nasal decongestants

Sign & symptoms Treatment

 Infection spreads to the mastoid antrum
causing mastoiditis, intracranial & extra
cranial complications(facial palsy),
labyrinthitis, brain abscess, meningitis etc.
Sign & symptoms depends upon the area
involved.
Treatment :- antibiotics & surgically
evacuation of the abscess cavity (cortical
mastoidectomy)
 History
Physical examination
Complete blood count
Audiometric , Rhinnes, Webers and whisper
voice test
Bacteriological examination of ear discharge
for culture and sensitivity
 Antibiotics:- erythromycine, ampicillin,
penicillin, sulponamides.
Decongestant phanylephrine hydrochloride,
pseudoephedrine
Analgesics
Bed rest
 Myringotomy : eardrum is incised to drain the
middle ear
Myringoplasty
Local treatment:-
It is advised before perforation, instill glycerin
and carbolic ear drop to relive pain.
After the perforation antibiotic ear drop such as
chloramphenicol, tetracycline, neomycine,
soframycine 30 % are used.
Ear discharged is removed by swab.
Keep the ear clean and dry
 Perforation of tympanic membrane
Cholesteatoma
Tympanosclerosis
Mastoiditis
Permanent hearing loss
 Acute pain R/T fluid accumulation,
inflammation or infection
Fear R/T hearing loss and lack of information
Deficient knowledge regarding disease
condition, surgery,
Risk for infection R/T broken skin, pressure
necrosis, chronic disease, or surgical
procedure