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
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Starts as a typical ASOM but progresses rapidly due to virulent organisms.
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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
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Antibacterial Therapy
- Start early, continue for 7–10 days minimum
- Target beta-hemolytic Streptococcus
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Cortical Mastoidectomy
- Only indicated if:
- No response to antibiotics
- Complications like acute mastoiditis
- Only indicated if:
📉 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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