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1、ACUTE SUPPURATIVE OTITIS MEDIA(ASOM),Acute suppurative otitis media results from bacterial infection of the middle ear cleft,often as a bacterial complication of the common cold.This is more frequent in children than in adults.,Etiology#The common infective organisms are beta hemolytic streptococcus
2、,pneumo-coccus,Hemophilus influenzae,and staphylococcus.#Eustachian tubes:viral upper respiratory infection,enlarged adenoids,sinus infections,allergy-causing edema in the eustachian tube region,and cleft palate.,#Other cause:traumatic rupture,perforation of the tympanic membrane,from infection foll
3、owing ear surgery.#ASOM is a self-limiting disease,and when treated adequately it rarely leaves any residual change.,Clinical FeaturesSymptoms.Fever,malaiseOtalgiaDecrease in hearingDischarge from the ear canal:muco-purulent or purulent.(perforation of the tympanic membrane).,On ExaminationIn the ea
4、rly stage,the tympanic membrane will show retraction and lack of mobility.Next with the onset of edema and exudation the drum will lose its landmarks,appear thick and dull,and may have a fluid level.The fluid is thick and not clear,as in the case of serous otitis media.,Tympanic membrane outward and
5、 cause bulging of the drum.If untreated the tympanic membrane will rupture,giving rise to a serosanguinous and then mucopurulent or purulent discharge from the ear.Perforation occurs in tympanic membrane central.,Tympanic membrane before perforationwith ASOM,Tympanic membrane after perforation with
6、ASOM,After perforation,pain and fever may not be as marked as in the earlier stages,but there is persistence of purulent discharge and recurrence of pain.Pressure on the mastoid tip will produce pain-mastoid tenderness.Infection may spread to mastoid cause mastoiditis.,Tuning fork tests:a conductive
7、 hearing loss.X-ray film or CT scan examinations in the early stages may show haziness or cloudiness.,TreatmentSymptomatic Treatment.Analgesics:painantipyretics:fever.fluid replacement:prevent of dehydration,The culture and the sensitivity of discharge Antibiotic treatment:Penicillin given systemica
8、lly will manage most of these infections.In children the possibility of Hemophilus influenzae should be kept in mind,and this may require ampicillin if there is no response to penicillin or if the culture and the sensitivity test so indicate.Antibiotics should be given for 5 to 7 days,certainly not
9、less.,Systemic decongestants help reduce swelling and thereby facilitate drainage of the middle ear.These are given for a period of two weeks or more,depending on how quickly the middle ear becomes free of fluid.If the drum appears full and bulging,a myringotomy should be carried out for drainage.,Ear drops also can be value for infection in ASOM.0.25%-1%Chloramphenicol and 0.3%Ofloxacin ear drops are recommended.Before using ear drops,cleaning purulent discharge in ear by 2%hydrogehperoxidesolution.Cold cream can be used to protect skin macerated from ear discharge.,Local treatment,
