Acute Necrotizing Otitis Media

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🧠 Acute Necrotizing Otitis Media (ANOM)

📌 What is Acute Necrotizing Otitis Media?

Acute Necrotizing Otitis Media (ANOM) is a severe, necrotizing variant of Acute Suppurative Otitis Media (ASOM).

It typically affects infants and children following certain viral illnesses.

What viral illnesses cause Acute Necrotizing Otitis Media?

🦠 Causative Organisms of Acute Necrotizing Otitis Media

Beta-hemolytic Streptococcus (most common)
Viruses that precede bacterial invasion

🔬 Pathogenesis of Acute Necrotizing Otitis Media

Starts as a typical ASOM but progresses rapidly due to virulent organisms.
Leads to necrosis or gangrene of:
- Soft tissues of the middle ear
- Sometimes even bone (e.g., ossicles, mastoid air cells)

What is the most vulnerable site in Acute Necrotizing Otitis Media?

What are the different structures affected in Acute Necrotizing Otitis Media?

🩺 Clinical Features of Acute Necrotizing Otitis Media

Profuse, foul-smelling otorrhea
Large or total central perforation (often kidney-shaped)
Severe conductive hearing loss
Necrotic tissue visible in ear canal and middle ear
May follow an upper respiratory or viral illness

💊 Treatment of Acute Necrotizing Otitis Media

Antibacterial Therapy
- Start early, continue for 7–10 days minimum
- Target beta-hemolytic Streptococcus
Cortical Mastoidectomy
- Only indicated if:
  - No response to antibiotics
  - Complications like acute mastoiditis

📉 Outcomes of Acute Necrotizing Otitis Media

There are five possible outcomes:

Healing with remnant scar at central perforation site
Permanent conductive hearing loss after healing
Persistent kidney-shaped perforation with hearing loss
Persistent perforation with chronic mucoid discharge
Secondary acquired cholesteatoma due to squamous epithelial ingrowth from meatus

What are the differences between Acute Necrotizing Otitis Media (ANOM) and Acute Suppurative Otitis Media (ASOM)?

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