OMSK New

 

Current concepts in the pathogenesis and treatment of chronic chron ic suppur suppurative ative otitis medi media a dr. Afif Zjauhari, Sp.THT Sp.THT-KL -KL http://www.free-powerpoint-templates-design.com

 

INTRODUCTION

 

• •

•

No inflammation No perforated Tympanic Membrane (TM) No fluid

 

INFECTION

 

ALLPPT Layout Clean Text Slide for your Presentation

Acute Otits Acute Otits Media: Media: Sign of inflammation Presence of fluid •

•

 

Acu Acute te Oti Otits ts Med Media ia

Inadequate medication

Chronic Suppurative Otitis Media: Perforated TM Presistent drainage • •

 

INSI IN SIDE DENC NCE E

ND

EPIDEMIOLOGY

 

PowerPoint Presentation Get a modern PowerPoint that is beautifully designed.

Get a modern PowerPoint PowerPoint Presentation that is beautifully designed.

Get a modern PowerPoint PowerPoint Presentation that is beautifully designed.

 

Greenland 0 – 4 yr 14 % •

•

3-8 38y yrr 19 -20 -20% %

 

MIKROBIOLOGY

 

The mostofcommon cause OM is bacterial infection

AOM is predominantly caused by

 

India

P. aeruginosa

Nepal

Singap

The most common pathogen that cause CSOM are

Followed by

ore

Nigeria S. aureus

 

Pakist an P. aeruginosa

The most common pathogen that cause CSOM are

Iran

Followed by

Saudi  Arabia

S. aureus

 

The differences in the various studies could be due to

The differences in the patient population studied

Geographical variation

 

More than one type of bacterial

CSOM can also be characterized by coinfections

Viral pathogen

Fungi

 

enter 

P. aerugi nosa

External canal

Middle ear 

Bacteria damage tissues

Inactivay ivayes es antibi antibiotics otics Inact by various enzymes and

Interferes with normal body

1

toxins

3

defences

2

 

HE RING LOSS

 

isathe most common Hearing se loss sequ quel ela of CSOM

can cause CHL (conductive hearing loss) obstruction in the transmission of sound waves

SNHL (sensorineural hearing loss) inner ear (cochlea)

damage

 

CHL,, CHL result from : Effusion (pus)

Tympanic membrane perforation

Can hinder the conductance of sound to the inner ear 

 

SNHL

Infection of the middle ear 

Toxins

Inflammatory mediators

Nitrit oxide, Nitrit oxide, arachidonic arachidonic acid, histamine,

Penetrate the round window membrane and pass into the inner ear 

Can cause cochlear damage

cytokines  

The cochlea has 3 rows of outer   hair cells (OHCs) and 1 row of   inn nne er hair cells (IHCs)

OHC help in the amplification and tuning of sound waves IHC help to converting mechanical energy of

sound into an electrical impuls  

Any damage to outer or inner hair cells can cause severe hearing hear ing imp impair airmen mentt, which can be irreve irrevers rsibl ible e and per perman manent ent

 

THER PY

 

Aural

Toilet

Topical antibiotics Otic insufflation powder (chloramphenicol,

Keeping draining ear clean and dry 2-3x/ weeks

sulfamethoxazol, and amphotericin B)

 

OTOTOPICAL

ANTIBIOTICS

Quinolones + Corticosteroids Antibiotic drops + aural toilet

When ???

-Inflammation of the external auditory canal or middle ear mucosa -Grranul -G anulat atio ion n ti tissu ssue e is prese present nt

Therapy CSOM

 

SYSTEM SYS TEMIC IC

NTIBIO NTIB IOTIC TICS S

Primary treatment (3 weeks)

Failure

P. aeruginosa & Oral

MRSA: Quinolones TrimetropinSulfametoxazole

ntibiotic

•

•

Sulfafurazole

Amoxiclav Erythromycin

 

SURGERY

Tympanomastoidectomy:   Chronic Cholesteatomatous OM

•

Tympanoplasty:

Mastoidectomy:   Abscess formation in the mastoid •

•

  6 to 12 months after resolution resolutio n of the infection.

 

Recurrent Disease

Cholesteatoma

Oral Antibiotics Only Non Antibiotic Drops

Non-compliance with the treatment

P. aeruginosa or MRSA

regimen

 

CONCLUSIONS •

CSOM  com commo mon n chr chroni onicc inf infect ectiou iouss dis diseas ease e wo world rldwid wide. e.

•

Top opica icall an antib tibiot iotics ics,, (limit (limited ed to non ot otot otox oxic) ic)..

•

Surgery  risk riskss of wo wors rsen enin ing g he hear arin ing g

Bacteriophages  Safe  Economical  Self-replicating  Effective

Resistant bacteria

bactericidal  

Than Th ank k You