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PROGRESSION AND ASSESSMENT OF OTITIS MEDIA - Coggle Diagram
PROGRESSION AND ASSESSMENT OF OTITIS MEDIA
Progression of OM
Stage II: Exudation
Description
Exudation occurs where fluids that leak out of blood vessels accumulate in the middle ear
Common Signs and Symptoms
Ear fullness
Otalgia
Hearing loss
Tinnitus
Autophony
Clinical features
Absence of cone of light
Mastoid area may be tender and swollen
Difficult to pinpoint tympanic membrane's landmarks
Bulging tympanic membrane
Cartwheel cppearance
Stage I : Mucosal hyperemia
Description
Inflammation of the mucous membrane lining the Eustachian tube and middle ear.
Clinical features
Acute tubo-otitis or eustachitis
The Eustachian tube, which connects the middle ear to the back of the throat, becomes swollen and may be partially blocked.
Development
Similarly in cases like bacterial or viral infections, the mucosal lining swells and secretes mucous abnormally.
This negative pressure will then cause engorgement of the blood vessels of the mucosal membrane, swelling, and excessive secretion of mucous.
Consequently, the eustachian tube is unable to open and close accordingly for ventilation, creating a negative pressure in the middle ear.
Stage IV (a): Resolution
Description
Resolution can occur by its own
Appropriate medical intervention
Antibiotics
Myringotomy
Grommet insertion
Can take 3 days minimum or longer (>3 months) to resolve based on the severity of the infection
Common Signs and Symptoms
Tinnitus improved (for certain cases)
Hearing improved (for conductive hearing loss cases)
No ear fullness, otorrhea, otalgia and fever
Perforation (spontaneously with suppuration)
Common Signs and Symptoms
Fever (if infection persists)
Otorrhea
Autophony
Tinnitus
Hearing loss
Otalgia
Clinical features
Perforation seen on the tympanic membrane
Description
Overstretching the tympanic membrane causes it to rupture
Fluid accumulation increase tension of tympanic membrane
Stage III: Suppuration
Common Signs and Symptoms
Fever
Autophony
Tinnitus
Hearing loss
Otalgia
Ear fullness
Clinical features
Reddened ear canal
Yellowish fluid behind the tympanic membrane
Bulging tympanic membrane
Description
Formation of pus
Bacterial or viral infection
Stage IV (b): Coalescence and Complications
Coalescence
Mastoid bone erosion
Mucopurulent discharge
Recurring pain
Mastoid tenderness
low-grade fever
leukocytosis
Conductive hearing loss
Complications
Facial nerve paralysis
Acute mastoiditis, petrositis, labyrinthitis
Conductive/sensorineural hearing loss
Lateral sinus thrombosis
Subperiosteal mastoid abscess, an extradural abscess, a brain abscess, leptomeningitis, and sigmoid sinus thrombophlebitis
Assessments of OM
Stage III: Suppuration (with perforation)
Otoscopic examination: pus formation / bulging of TM, TM perforation, wet ear canal with discharge
Tympanometry
Type B with large ECV (perforated TM)
Cannot be done if patient has active discharge
ASR : absence of reflexes
PTA : shows conductive loss; bone at normal level
Stage II: Exudation
Otoscopic examination: Bulging TM, cartwheel appearance
Tympanometry: type B with normal ECV
ASR: absence of reflexes
PTA: conductive loss; bone at normal level
Stage IV: Resolution
ASR : presence of reflexes
PTA: normal or near normal hearing level
Tympanometry :Can be type C or Ad (if still resolving) / type A (if have fully resolved)
Otoscopic examination : TM scarring (if perforated) / dull TM / normal TM
Stage I: Mucosal hyperemia
ASR: Can be normal, elevated, absent
Eustachian tube function test: failed
Tympanometry: Type C tympanogram suggesting eustachian tube dysfunction.
PTA: It reveals a decrease in perception up to 20-35dB
Otoscopic examination: Slightly reddened / Dull and retracted TM
What is Otitis Media?
Inflammation of the middle ear, caused primarily by Eustachian tube dysfunction
Can be classify based on:
Types
Duration
