ACUTE OTITIS MEDIA

Today Mbah Dukun share information about kind of ear disease. what is that, mbah? it's called ACUTE OTITIS MEDIA. maybe you've never heard about this disease, but you might have it before. Okey mbah dukun start to explain. Just click options below

 1. DEFINITION

2. ETIOLOGY 

3. PATHOGENESIS

4. DIAGNOSIS

5. TREATMENT AND THERAPY

6. COMPLICATIONS

DEFINITION
 Acute otitis media is an inflammation of the mucosa of the middle ear cavity, eustachius tube, and aditus ad antrum caused by bacterial or viral infection with clinical symptoms of ear pain, fever, and even hearing loss, tinnitus and vertigo.  generally takes place within 3-6 weeks.


Etiology
The main cause of acute otitis media (AOM) is the invasion of pyogenic bacteria into the middle ear in a state that is normally sterile.  Common bacterial causes of AOM include hemolytic streptococcus, Staphylococcal aureus, Pnemococcus.  In addition, occasionally found also Haemofilus influenza, Escherichia coli, Streptococcus anhemolitikus, Proteus vulgaris and Pseudomonas aurogenosa.  Haemofilus influenza is often found in children aged under 5 years old.  Upper respiratory tract infections are recurrent and tubal dysfunction eustachii also be the cause of the AOM in children and adults.

Incidence
Acute otitis media most commonly suffered by children ages 3 months-3 years.  But not infrequently also the adults.  Children are more often exposed to AOM due to several things, including:
1.  Child's immune system is not perfect
2.  Tuba eusthacius children are shorter, wider and lies horizontally
3.  Adenoid children relatively larger and situated adjacent to the mouth of the fallopian tubes so that disrupt the opening of the eustachii tube eusthachii.  Adenoids are easy to track the spread of infected bacteria and viruses into the middle ear.

Pathogenesis
AOM trigger factors can be initiated by the occurrence of upper respiratory tract infection accompanied by the repeated disruption of the body by the cilia of the tubal mucosa eusthachii, enzymes and antibodies that cause negative pressure resulting in bacterial invasion of the mucosa of the nasopharynx into the middle ear through the eustachii tube and settled in  in the middle ear becomes acute otitis media.

There are 5 stages of acute otitis media (AOM) based on changes in middle ear mucosa, namely:
1.  tubal occlusion Stadium
Marked with a picture of the tympanic membrane retraction due to negative middle ear pressure.  Sometimes the tympanic membrane appears normal or pale cloudy color.  Effusions may have occurred but difficult to detect.

2.  Hiperemia Stadium

 


Dilated blood vessels that appear in some or all of the tympanic membrane accompanied by edema.  Secretions are beginning to form serous exudate is still so difficult to assess.




3.  Suppuration Stadium

 
Severe edema of the mucosa of the middle ear accompanied by the destruction of superficial epithelial cells and the formation of purulent exudate in the tympanic cavity causing the tympanic membrane protruding toward the outer ear canal (bulging).  Clinical symptoms, the patient seems to ache, pulse, fever, and pain in the ear intensified.  In the circumstances further, ischemia can occur due to the pressure of growing purulent exudate, thrombophlebitis in the veins of small even to necrosis of the mucosa and submucosa.


4.  Perforation Stadium
Rupture of the tympanic membrane so that the pus out of the middle ear into the outer ear canal.  Sometimes the secret expenditures are pulsation.  This stage is often caused by late delivery of antibiotics and the high virulence of germs.







5.  Resolution Stadium
Characterized by a gradual normal tympanic membrane perforation of the tympanic membrane to close the back and no purulent secretions.  This occurs if the tympanic membrane was intact, good endurance and low-virulence bacteria.

DIAGNOSIS
Diagnosis AOM should meet the following 3 things:
1.  sudden onset (acute)
2.  The discovery of signs of effusion (effusion: fluid collection in a body cavity) in the middle ear.  Effusions evidenced by observing the following signs:
a.  Deployment tympanic membrane
b.  Limited / lack of movement of the tympanic membrane
c.  The existence of the shadow of fluid behind the tympanic membrane
d.  Discharge from the ear
3.  Signs / symptoms of inflammation of the middle ear as evidenced by the presence of either one of the following signs:
a.  Redness of the tympanic membrane
b.  Ear pain that interferes with sleep and normal activity
Children with AOM may experience ear pain, discharge from the ear, decreased hearing, fever, difficulty eating, nausea and vomiting and cranky.  However these symptoms are not specific to that diagnosis AOM AOM can not be based on history alone.  Middle ear effusions examined with otoscope to see clearly the situation in the tympanic membrane / tympanic membrane is bulging, erythema and even yellow and dingy and the presence of yellowish fluid in the ear canal.  If confirmation is required, generally performed with a pneumatic otoscope (an instrument used to see the tympanic membrane which is equipped with a small air pump to assess tympanic membrane response to changes in air pressure).  Movement of the tympanic membrane is less visible with this examination.  This examination can be used as additional tests to confirm the diagnosis of AOM.  But generally AOM can already be enforced by ordinary otoscope examination.  Middle ear effusions can also be proved by tympanosyntesis (stabbing of the tympanic membrane).  But this examination is not performed on any child.  Among other indications of the need tympanosyntesis AOM in infants younger than 6 weeks with a history of intensive care in hospital, children with immune disorders, children who are not members of the response to some antibiotics or with very severe symptoms and complications.

TREATMENT of  ACUTE OTITIS MEDIA
1.  Antibiotics
AOM is generally a disease that will heal by itself. About 80% of AOM cured in 3 days without antibiotics.  Use of antibiotics does not reduce complications, including decreased hearing.
If symptoms do not improve within 48-72 hours or there is worsening of symptoms, antibiotic given.  American Academy of Pediatrics (APP) which categorize AOM observable and should be treated with antibiotics as following;
a. <6 months of Antibiotics
b. 6 months - 2 years of Antibiotics
c. > 2 years of antibiotics if symptoms are severe. if symptoms are mild, do observations

Mild Symptoms if mild ear pain and fever <39 C in 24 last hour.  While the severe symptoms are moderate to severe ear pain or fever 39 C.
Options observation for 48-72 hours can only be performed on children age 6 months-2 years with mild symptoms during the examination or diagnosis of doubtful in children over 2 years.  Analgesia should still be given during the observation.
The first choice of antibiotics in AOM is amoxycilin. American Academy of Family Physicians (AAFP) recommends dosing 40mg/kgweight/daystandards in children with low risk (age> 2tahun, not in intensive care, had not received antibiotic treatment within 3 last month).  While high doses administered 80mg/kgweight/day in children with high risk (age <2 years, in treatment, there is a history antibiotics in the last 3 months and are resistant to giving amoxycilin low dose).  Meanwhile, The Centre for Disease Control and Prevention (CDC) recommends antibiotic therapy on the AOM as follows:

CONDITIONS OF TREATMENT
Otitis media with bulging tympanic membrane  High-dose amoxycilin (80 - 100mg/kgweight/day per oral) for 7 days
Otitis media without bulging tympanic membrane  Delays antibiotics, (Spontaneously cured)
recurrent otitis media  delays antibiotics, used influenza vaccine
Otitis media bacterial resistance e.c against high-dose amoxycilin  High-dose clavulanate amoxycilin (80-90 mg / kg / day orally for 7 days), cefuroxime axetil (30 mg / kg 2 times / day orally); ceftriaxone (IM 50mg/kgweight/day during 3 days)

Delays antibiotics and antibiotic treatment settings performed to otitis media without bulging because, generally, it recover spontaneously without antibiotic treatment. Setting prescribing can be done by administering acetaminophen in case of otalgia and fever, and if after giving it, a fever still on going and no improvement of clinical symptoms for 3 days, so amoxycilin just given in high doses.  Antibiotics in the AOM will produce symptAOMtic improvement in 48-72 hours.  In the first 24 hours occurred stabilization, while the 24 second hours began repairs.  If the patient does not improve in 3 days or re-emerged in 14 days there may be other diseases or treatment provided is not adequate / inadequate or has even happened bacterial resistance to antibiotics. If the patient is allergic to alternative antibiotics Penicilin class used were cefuroxime axetil, ceftriaxone injection (2-3x50mg/kgweight/day) or second-generation cephalosporins such as cefdinir, cefpodoxime or cefuroxime. Another option is a class of macrolides such as azithromycin and clarithromicyn.
2.  Analgesia / pain relief
Besides antibiotics, treatment should be accompanied AOM pain relievers. Analgesia is commonly used is simple analgesia such as paracetamol or ibuprofen.  However, it should be noted that the use of ibuprofen should be ensured that the children do not have indigestion Since the granting of ibuprofen can aggravate the situation.

COMPLICATIONS
Acute otitis media is not treated promptly with antibiotics can be continued become chronic otitis media (COM) and mastoiditis.  Another complication that can periosteal abscess occurs as up to meningitis and brain abscess even can also result in permanent hearing loss due to rupture tympanic membrane and if it has to disrupt auditory function will also cause problems in speech and language in children.