The American Journal of Medical Sciences and Pharmaceutical Research
78
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TYPE
Original Research
PAGE NO.
82-85
10.37547/tajmspr/Volume07Issue01-11
OPEN ACCESS
SUBMITED
23 October 2024
ACCEPTED
25 December 2024
PUBLISHED
30 January 2025
VOLUME
Vol.07 Issue01 2025
CITATION
Khondamir Jurayev, & Umrbek Akhmadjonov. (2025). Treatment and
prevention of acute suppurative otitis media. The American Journal of
Medical Sciences and Pharmaceutical Research, 7(01), 82
–
85.
https://doi.org/10.37547/tajmspr/Volume07Issue01-11
COPYRIGHT
© 2025 Original content from this work may be used under the terms
of the creative commons attributes 4.0 License.
Treatment and prevention
of acute suppurative otitis
media
Khondamir Jurayev
Assistant, Department of Stomatology and Otorhinolaryngology, Fergana
Medical Institute of Public Health, Fergana, Uzbekistan
Umrbek Akhmadjonov
Student, Fergana Medical Institute of Public Health, Fergana, Uzbekistan
Abstract:
This article provides a comprehensive overview
of the clinical course, diagnosis, effective treatment
methods, and prevention strategies for acute suppurative
otitis media (ASOM). The discussion includes an analysis
of the disease's progression and potential complications
across different age groups, highlighting the importance
of timely and appropriate management. Key treatment
approaches,
such
as
antibiotic
therapy,
pain
management, and surgical interventions when necessary,
are reviewed. Additionally, preventive measures,
including vaccination and lifestyle modifications, are
emphasized to reduce the incidence and severity of
ASOM. This article aims to equip healthcare professionals
with updated knowledge to improve patient outcomes
and mitigate the risks associated with this common yet
potentially serious condition.
Keywords:
Acute
suppurative
otitis
media,
otorhinolaryngology, diagnostics, antibiotic therapy,
prevention.
Introduction:
Acute suppurative otitis media (ASOM) is
a common bacterial infection of the middle ear,
characterized by the accumulation of pus and fluid in
the tympanic cavity. It predominantly affects children
but can also occur in adults, often following upper
respiratory tract infections. ASOM is associated with
significant morbidity, including severe ear pain, hearing
loss, and potential complications such as tympanic
membrane perforation, mastoiditis, and intracranial
infections if left untreated [1,2]. The clinical
presentation, course, and management of ASOM vary
across age groups, necessitating tailored approaches to
diagnosis and treatment. This article aims to provide an
updated review of the clinical course, diagnostic criteria,
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The American Journal of Medical Sciences and Pharmaceutical Research
evidence-based treatment options, and preventive
strategies for ASOM [4-6]. By addressing the unique
challenges posed by this condition in different
populations, this article seeks to enhance clinical
understanding and improve patient care outcomes [7-
9].
THE MAIN PART
Etiology and Pathogenesis
Acute suppurative otitis media (ASOM) is an infectious-
inflammatory disease of the middle ear, primarily
caused by bacterial pathogens. The most common
causative agents include Streptococcus pneumoniae,
Haemophilus influenzae, and Moraxella catarrhalis.
Less frequently, Staphylococcus aureus and certain
Gram-negative bacteria can be involved, particularly in
recurrent or complicated cases. Viral infections, such
as those caused by respiratory syncytial virus (RSV),
influenza, and rhinoviruses, often precede bacterial
infection by compromising mucosal defenses and
facilitating bacterial colonization.
The pathogenesis of ASOM typically begins with
dysfunction of the Eustachian tube, which normally
serves to equalize middle ear pressure and drain
secretions. Upper respiratory tract infections, allergies,
and anatomical abnormalities can lead to Eustachian
tube obstruction, creating a negative pressure
environment in the middle ear. This promotes bacterial
entry from the nasopharynx into the middle ear,
leading to infection and accumulation of purulent
exudate.
As inflammation progresses, the middle ear mucosa
becomes edematous, leading to increased vascular
permeability
and
leukocyte
infiltration.
The
accumulation of pus exerts pressure on the tympanic
membrane, often resulting in pain, conductive hearing
loss, and, in severe cases, spontaneous tympanic
membrane perforation with otorrhea. If left untreated,
ASOM can lead to complications such as mastoiditis,
tympanosclerosis, and intracranial infections.
Factors predisposing individuals to ASOM include
young age, recurrent upper respiratory infections,
allergic rhinitis, adenoid hypertrophy, immune
deficiencies, and exposure to tobacco smoke.
Understanding the etiology and pathogenesis of ASOM
is crucial for effective treatment and prevention
strategies, reducing the risk of complications and
improving patient outcomes.
Clinical signs
Acute suppurative otitis media (ASOM) presents with a
variety of symptoms that depend on the stage of the
disease and the pa
tient’s age. In the early stage,
inflammation of the middle ear leads to ear pain, a
sensation of fullness or pressure, mild to moderate
hearing loss, and general malaise. Fever is often
present, and in young children, signs may include
irritability, crying, and poor feeding.
As the infection progresses, pus accumulates in the
middle ear, increasing pressure on the tympanic
membrane. This results in worsening ear pain, more
pronounced hearing loss, and sometimes fever spikes.
In cases where the tympanic membrane perforates,
there is a sudden relief of pain accompanied by purulent
ear discharge (otorrhea).
In infants and young children, symptoms may be less
specific. They may present with restlessness, frequent
touching or pulling at the ear, disturbed sleep, and
reduced appetite. In severe or complicated cases,
symptoms such as persistent fever, swelling behind the
ear (suggesting mastoiditis), dizziness, or neurological
signs may indicate the spread of infection.
The severity of clinical signs varies among individuals,
with young children and immunocompromised patients
at higher risk for complications. Early recognition of
symptoms is essential for timely intervention and
prevention of long-term auditory damage.
Diagnostics
Accurate diagnosis of acute suppurative otitis media
(ASOM) is essential for effective management. The
diagnostic process includes clinical evaluation,
otoscopic examination, and, in some cases, additional
tests:
Clinical History: Symptoms such as ear pain, fever,
hearing loss, and irritability (in children) are key
indicators. A recent upper respiratory tract infection or
a history of recurrent ear infections may also suggest
ASOM.
Otoscopic Examination: Findings include a bulging
tympanic membrane, indicating fluid or pus in the
middle ear; erythema and opacification, showing
redness and loss of transparency of the eardrum;
perforation, which may present as a visible hole in the
tympanic membrane with or without discharge; and
decreased mobility, assessed using pneumatic
otoscopy.
Tympanometry:
This
test
measures
tympanic
membrane compliance and middle ear pressure to
confirm fluid accumulation.
Audiometry: Used in cases of persistent hearing loss to
assess the degree and type of hearing impairment.
Tympanocentesis: Aspiration of middle ear fluid for
culture and sensitivity testing is reserved for severe,
recurrent, or treatment-resistant cases to identify
causative pathogens and guide antibiotic therapy.
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The American Journal of Medical Sciences and Pharmaceutical Research
Treatment Methods
The management of ASOM focuses on relieving
symptoms, eradicating infection, and preventing
complications. Treatment strategies vary based on the
patient’s age, severity of symptoms, and risk factors.
Antibiotic Therapy: First-line antibiotics, such as
amoxicillin
or
amoxicillin-clavulanate,
are
recommended for uncomplicated cases, especially in
children under two years of age or those with severe
symptoms. Macrolides or cephalosporins may be used
for penicillin-allergic patients. The duration of
treatment typically ranges from 5 to 10 days,
depending on age and severity.
Pain Management: Analgesics like acetaminophen or
ibuprofen are essential to alleviate ear pain and fever.
Topical anesthetic ear drops may provide additional
relief in older children and adults.
Surgical Interventions: In cases of treatment failure,
recurrent infections, or complications such as
mastoiditis, tympanostomy tube placement or
myringotomy may be necessary to drain pus and
relieve pressure.
Observation: In mild cases, particularly in older
children and adults, a watchful waiting approach may
be appropriate, with antibiotics prescribed only if
symptoms persist or worsen after 48
–
72 hours.
Prevention
Preventive measures are crucial to reducing the
incidence and severity of ASOM, particularly in high-
risk populations such as young children.
Vaccination: Immunization against Streptococcus
pneumoniae (pneumococcal conjugate vaccine) and
Haemophilus influenzae type b (Hib vaccine) has
significantly reduced the incidence of ASOM. Annual
influenza vaccination is also recommended to prevent
viral upper respiratory infections that can lead to
ASOM.
Breastfeeding: Encouraging exclusive breastfeeding for
the first six months of life has been shown to lower the
risk of ear infections due to the transfer of maternal
antibodies and immune-boosting factors.
Avoiding Risk Factors: Reducing exposure to tobacco
smoke, limiting pacifier use, and promoting good
hygiene practices can help prevent upper respiratory
infections that predispose to ASOM.
Early Treatment of Upper Respiratory Infections:
Prompt management of colds, sinusitis, or other
respiratory infections can reduce the risk of secondary
bacterial otitis media.
Education and Awareness: Educating parents and
caregivers about the signs and symptoms of ASOM, as
well as the importance of timely medical care, can help
prevent complications and improve outcomes.
CONCLUSIONS
Acute suppurative otitis media (ASOM) is a common and
potentially serious condition that requires prompt
diagnosis and appropriate management to prevent
complications and improve patient outcomes. The
clinical presentation varies across age groups, with
children being particularly susceptible due to
anatomical and immunological factors. Accurate
diagnosis relies on a thorough clinical history, otoscopic
examination, and, when necessary, additional tests such
as tympanometry or tympanocentesis.
Effective treatment involves a combination of antibiotic
therapy, pain management, and, in severe or recurrent
cases, surgical interventions such as tympanostomy
tube placement. Preventive measures, including
vaccination, breastfeeding, and reducing exposure to
risk factors, play a critical role in reducing the incidence
and severity of ASOM.
Healthcare providers must remain vigilant in recognizing
the signs and symptoms of ASOM, particularly in young
children who may present with nonspecific complaints.
Public health initiatives aimed at increasing vaccination
rates and educating caregivers about preventive
strategies are essential to further reduce the burden of
this condition.
By integrating evidence-based treatment approaches
with robust preventive measures, the medical
community can significantly improve the quality of life
for patients affected by ASOM and minimize the risk of
long-term complications. Continued research and
advancements in diagnostic and therapeutic options will
further enhance the management of this common yet
challenging condition.
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