DISEASES OF MIDDLE EAR CLEFT 

           ASOM  ( Acute Suppurative Otitis Media ) : It is the infection of middle ear mucosa by pyogenic organism . Infection reaches middle ear via Eustachian tube from pharynx .

 MC organism : Streptococcus pneumoniae 

  C/c : Earache On examination : Tympanic membrane is red , capillaries of tympanic membrane are dilated ( cart wheel appearance ) Treatment : Medical management 

 Note : In ASOM patient if there is severe earache plus red bulging tympanic membrane treatment of choice is Myringotomy .Myringotomy for ASOM is done for posteroinferior quadrant . 

 In ASOM in case of perforation if the ear is kept dry it heals by itself . If it remains wet skin grows at the margin of perforation .

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   ACUTE MASTOIDITIS 

      It is the infection of mastoid air cell system . It is the complication of ASOM or CSOM . 

 C/F Fever 

        Pain behind the ear 

        Profuse ear discharge ( some pus is retrospectively transferred from mastoid to middle ear : reservoir sign is positive = pulsatile otorrhea = 'LIGHT HOUSE SIGN'  

  Sign : 1st sign : Ironing of mastoid surface = smooth mastoid surface due to oedema 

  Treatment : IV antibiotic for 48 hours ----->  if no relief surgery done . Cortical mastoidectomy a/c/s Schwartz operation  . 2 steps of this surgery :  2 'E's : E -Expose the disease  E- Excise the disease 

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 4) Petrositis : a/k/s Gradenigo's  syndrome . It is a complication of ASOM or CSOM .

                         C/F Triad - Ear discharge 

                                            Retro orbital pain due to 5th nerve involvement 

                                            Diplopia due to 6th nerve involvement 

 Treatment : Surgery