ACUTE SUPPURATIVE OTITIS MEDIA ( ASOM ) – Stage of Suppuration on Oto-endoscopy

Young boy present with complain of right ear severe pain , ear blockage , common cold & cough since last night .


It is an acute inflammation of middle ear by pyogenic organisms.

Cause : the disease follows viral infection of upper respiratory tract but soon followed by pyogenic organisms in the middle ear.

Source of Infection :
1) Via eustachian tube -It is the most common route of infection from nose , naso-pharynx , tonsils & pharynx .
2) Via external ear – Traumatic perforation of tympanic membrane .

Predisposing Factors
Anything that interferes with normal functioning of eustachian tube predisposes to middle ear infection.
1. Recurrent attacks of common cold, URTI .
2. Nose allergy.
3. Chronic rhinitis and sinusitis.
4. Infections of tonsils and adenoids.
5. Tumours of nasopharynx.

The disease has the following stages:
1. Stage of tubal occlusion -Oedema and congestion of nasopharyngeal end of eustachian tube blocks the tube, leading to absorption of air and negative intratympanic pressure.
2. Stage of pre-suppuration -If tubal occlusion is prolonged, pyogenic organisms invade tympanic cavity causing hyperaemia of its lining. Inflammatory exudate appears in the middle ear. Tympanic membrane becomes congested.
3. Stage of suppuration-This is marked by formation of pus in the middle ear and to some extent in mastoid air cells. Tympanic membrane starts bulging to the point of rupture.
4. Stage of resolution – The tympanic membrane ruptures with release of pus and subsidence of symptoms. Inflammatory process begins to resolve. If proper treatment is started early or if the infection was mild, resolution may start even without rupture of tympanic membrane.
5. Stage of complication – If virulence of organism is high or resistance of patient poor, resolution may not take place and disease spreads beyond the confines of middle ear.

Treatment :
1) Antibiotic
2) Decongestant nasal drops
3) Analgesics , antipyretics & anti inflammatory .
4) Ear toilet
5) Myringotomy


Author: design

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