Microbiology of Middle Ear Infections and Otitis Media Overview
Learn about the microbiology of middle ear infections and get an overview of otitis media, including definitions, anatomy, classification, epidemiology, pathogenesis, risk factors, symptoms, diagnosis, and management. Understand the impact on different age groups, with an emphasis on infants and common risk factors contributing to middle ear infections.
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Microbiology of Middle Ear Infections DR ALI M SOMILY
Objectives Recognize the definition and classification of otitis media Define the epidemiology of otitis media identify the pathogenesis and risk factors List the major symptoms and signs in the clinical presentation and major etiological agents identify the method of diagnosis and management of otitis media
Definitions Middle ear is the area between the tympanic membrane and the inner ear including the Eustachian tube. Otitis media (OM) is inflammation of the middle ear.
OM-Classification http://t2.gstatic.com/images?q=tbn:1tH2Q7X7lqkCwM:http://www.middleearimplants.com/images/fully-implantable-middle-ear-device.jpg Acute OM Secretory ( Serous) OM Chronic OM
http://t0.gstatic.com/images?q=tbn:F1j8DXYrYIv89M:http://www.alleganyhealthdept.com/images/infant.pnghttp://t0.gstatic.com/images?q=tbn:F1j8DXYrYIv89M:http://www.alleganyhealthdept.com/images/infant.png OM- Epidemiology Most common in infants 6 to 18 months of age (2/3 of cases). Improves with age, why ? The Eustachian Tube which vents the middle ear to the nasopharynx , is horizontal in infants, difficult to drain naturally, its surface is cartilage ,and lymphatic tissue lining is an extension of adenoidal tissue from back of the nose. Accompanied with viral URTI http://t3.gstatic.com/images?q=tbn:R9V79ruGIs2kaM:http://content.onestepahead.com/assets/images/product/detail/13735_1.jpg
OM-Pathogenesis and Risk Factors URTI or allergic condition cause edema or inflammation of the tube. Functions of the tube ( ventilation, protection and clearance ) disturbed. Oxygen lost leading to negative pressure Pathogens enter from nasopharynx into middle ear. Colonization and infection result. http://t0.gstatic.com/images?q=tbn:by3MmKmS-3rwXM:http://faculty.ksu.edu.sa/75719/Pictures%2520Library/Respiratory%2520system/Upper%2520respiratory%2520tract.jpg
OM- Other risk factors Anatomic abnormalities Medical conditions such as Cleft palate ,obstruction due to adenoid or NG tube or malignancy, immune dysfunction. Exposure to pathogens from day care. Exposure to smoking. http://t1.gstatic.com/images?q=tbn:J3ptxBEM_0ul-M:http://www.biomedcentral.com/content/figures/1471-2350-5-15-1.jpg http://t2.gstatic.com/images?q=tbn:xqzWfJzPWrDXrM:http://buckheadent.net/images/tons.gif
Images of acute OM http://t3.gstatic.com/images?q=tbn:f0Vfl7IkhnkVjM:http://upload.wikimedia.org/wikipedia/commons/3/39/Otitis_media_incipient.jpg http://t1.gstatic.com/images?q=tbn:qDwZNRe8K2SM0M:http://www.meddean.luc.edu/lumen/MedEd/medicine/pulmonar/pdself/Serous_ottitis_media.jpg http://t1.gstatic.com/images?q=tbn:ewRNPlXlpEjGlM:http://de.academic.ru/pictures/dewiki/79/Otitis_media_schollig.jpg
Images of chronic OM http://t1.gstatic.com/images?q=tbn:Xmx1Gilw3kPdRM:http://www.evmsent.org/images/tmperf.jpg http://t2.gstatic.com/images?q=tbn:1SDGBm5dQug-kM:http://www.uthsc.edu/otolaryngology/images/567.jpg
Images of serous OM http://t3.gstatic.com/images?q=tbn:1QsfEh0rhFpSaM:http://www.rcsullivan.com/www/toml0911.jpg http://t2.gstatic.com/images?q=tbn:VXNqbOkLsY1mmM:http://www.fpnotebook.com/_media/EntSerousOtitisMedia.jpg http://t2.gstatic.com/images?q=tbn:-obOj53sdnbekM:http://www.texasent.com/userfiles/image//Otitis%2520Media%2520Fig3.JPG
Microbiology of OM http://t1.gstatic.com/images?q=tbn:avYNveKQwqRGfM:http://www.msevans.com/cnsinfections/h-influenzae.jpg http://t0.gstatic.com/images?q=tbn:MGJUENYImbkqwM:http://textbookofbacteriology.net/themicrobialworld/S.pneumoniae1.jpg http://t2.gstatic.com/images?q=tbn:Na9KOCmMV9oAwM:http://www.gslabs.com/images/saureus2.jpg http://t2.gstatic.com/images?q=tbn:mlz6bFjW6h_T-M:http://www.vetbact.org/vetbact/include/getvetbaktimage.php%3Fimgid%3D238%26imgtable%3Dvetbact_images%26images%3D0 http://t3.gstatic.com/images?q=tbn:I37L4EcCa2rF5M:http://farm3.static.flickr.com/2240/2402321868_539a568ec7_o.jpg http://t2.gstatic.com/images?q=tbn:MkzqdnjQrCYNzM:http://www.mc.maricopa.edu/~johnson/labtools/Dbiochem/opto4b.jpg
Microbiology of OM-continue Go to fullsize image Go to fullsize image Go to fullsize image Go to fullsize image Go to fullsize image Go to fullsize image Go to fullsize image
OM-Microbiology-Bacterial Causes Acute OM S.pneumoniae,(40%) group B Streptococcus, H.influenzae (non typable) ,Gram negative bacteria and P.aeruginosa < 3months of age S.pneumoniae, H.influenzae ,others eg, S.pyogenes, Moraxella catarrhalis, S.aureus > 3 months of age
OM-Microbiology-cont. Serous OM Chronic OM Same as chronic OM, but Mixed flora in 40% of cases Most of the effusions are sterile P.aeruginosa, H.influenzae, S.aureus, Proteus species, K.pneumoniae, Moraxella catarrhalis, anaerobic bacteria. Few acute inflammatory cells
OM-Viral causes RSV -74% of viral isolates Rhinovirus Parainfluenza virus http://t3.gstatic.com/images?q=tbn:gIH_nUuEjo67FM:http://template.bio.warwick.ac.uk/staff/easton/IMAGES/Diagrams/3dvirus.jpg Influenza virus
Clinical presentation Acute OM Mostly Bacterial ,often a complication of viral URTI First 1-2 days: Fever (39oC), irritability, earache (otalgia) , muffled nose. Bulging tympanic membrane ,poor mobility and obstruction by fluid or inflammatory cells on otoscopic examination.
3-8 days: Pus and ear exudate discharge spontaneously (otorrhea) and pain and fever begin to decrease. 2-4 weeks : Healing phase, discharge dies up and hearing becomes normal.
Serous OM Collection of fluid within the middle ear as a result of negative pressure produced by altered eustachian tube function. Represent a form of chronic OM or allergy-related inflammation Tends to be chronic , with non purulent secretions. Cause hearing deficit.
Chronic OM Usually result from unresolved acute infection due to in adequate treatment or host factors that perpetuate the inflammatory process. Result in destruction of middle ear structures and significant risk of permanent hearing loss.
Diagnostic approaches of OM Clinical examination Tympanometry ( detect presence of fluid) Gram stain and culture of aspirated fluid to determine the etiologic agents. http://t1.gstatic.com/images?q=tbn:9V291FPaYcZ7lM:http://www.tchain.com/otoneurology/testing/images/audio5.gif http://t1.gstatic.com/images?q=tbn:qDwZNRe8K2SM0M:http://www.meddean.luc.edu/lumen/MedEd/medicine/pulmonar/pdself/Serous_ottitis_media.jpg
Management of OM Acute OM requires antimicrobial therapy & careful follow up. Antimicrobial usually empirical depending on the most likely bacterial pathogens, usually to cove S.pneumonia and H.influenzae. Drainage of exudate may be required. Chronic or serous OM need complex management, possibly surgical.
Complications Intracranial Extracranial Meningitis Hearing loss Extradural abscess Tympanic membrane perforation http://t1.gstatic.com/images?q=tbn:UKwRtXWPyE792M:http://top-10-list.org/wp-content/uploads/2009/09/Meningitis.jpg Sudural empyema Mastoiditis Brain abscess Cholestatoma http://t3.gstatic.com/images?q=tbn:nwKnADJQFFwfDM:http://www.ferne.org/Lectures/acep_2005_peds/perron_pic_11.jpg others Labyrinthitis http://t3.gstatic.com/images?q=tbn:33OTr-ilCLStzM:http://de.academic.ru/pictures/dewiki/77/Mastoiditis1.jpg others
