Acute Suppurative Otitis Media

Shixun Zhong Ph.D.

Department of Otolaryngology
The First Affiliated Hospital
Chongqing Medical University
 Definition

• Acute otitis media is an acute

purulent inflammation of the
lining of the middle ear caused
by purulent bacteria.
• Characterized by otalgia, purulent discharge, hyperemia
and perforation of eardrum.
• Bacteriology:
– Streptococcus pneumoniae
– hemolytic streptococcus
– haemophilus influenzae
– Staphylococcus
 Route of infection

• Eustachian tube：
– Upper respiratory tract
infection
• common cold, acute rhinitis,
acute tonsillitis
– Swim, dive
– Acute infectious disease
• measles, scarlet fever or
influenza
– Breast-feeding
• External auditory
canal-eardrum
– Injury, tympanocentesis
• Hematogenous infection
 Clinical features

• Symptoms：
– General symptoms
• fever, malaise, anorexia, vomiting, and diarrhea.
• More evident in child
• subside after tympanic membrane perforation
occurs
 Clinical features

• Symptoms：
– Local symptoms：
• Otalgia: sharp before perforation
• Aural fullness，tinnitus, hearing loss
• Otorrhea: mucoid discharge initially, mucopurulent
later
 Clinical features

• Signs：
– otoscopy：
• Hyperemic, bulging,
poor mobility
• Perforation, purulent
discharge

- Palpation: tenderness at mastoid or antrum

Stage of congestion
Stage of exudation
Stage of suppuration
convalescence stage
 Clinical features

• Audiometry：
– Usually conductive hearing loss
• Blood test：WBC ↑
• Nasopharyngoscopy：
 Diagnosis

History + Clinical features + Laboratory

 Differential diagnosis

• Acute otitis externa and furuncle：

– Earache, swelling in canal
– No or mild inflammation on
eardrum
– Normal hearing
 Differential diagnosis

• Acute myringitis：
– Earache
– No ear discharge
– Bulla on eardrum
 Treatment

• General management：
– Antibiotics:
• penicillin, ampicillin, Cefixime etc.
• 10-14 days；
– Analgesics
– Antipyretics
– Oral decongestants, antihistamines
– Supportive treatment
 Treatment

• Local management：
– Before perforation：
• Eardrops: 3%
carbolic acid in
glycerin
• myringotomy
– Indication:
• 1% ephedrine nose
drops
 Treatment

• Local management
– After perforation：
• aural toilet and eardrops
– 3% hydrogen peroxide solution
– 0.25% chloromycetin solution
– 0.3% ofloxacin solution
– 3% jiemycin solution
 Treatment
• Treatment of causative factors：
– Adenoidectomy
– Tonsillectomy
– Rhinitis
– Sinusitis
Thank You