Presentation on theme: "Non-Suppurative Otitis Media Dr. Vishal Sharma. Types 1.Otitis Media with effusion (O.M.E.) 2.Adhesive otitis media 3.Tympanosclerosis 4.Baro-traumatic."— Presentation transcript:
Non-Suppurative Otitis Media Dr. Vishal Sharma
Types 1.Otitis Media with effusion (O.M.E.) 2.Adhesive otitis media 3.Tympanosclerosis 4.Baro-traumatic otitis media
Otitis Media with effusion Presence of serous or mucoid effusion in middle ear cleft with no frank pus. Synonyms: 1.Secretory / Serous otitis media 2.Seromucinous / exudative otitis media 3.Catarrhal otitis media 4.Glue ear
Etiology 1. Eustachian tube dysfunction Vacuum in M.E. extravasation of fluid Lack of drainage of M.E. secretions 2. Upper respiratory tract allergy / viral infection Increase M.E. secretions 3. Low grade middle ear infection Inadequate treatment of A.S.O.M.
Predisposing conditions Child going to a nursery Early weaning with formula milk Parents who smoke Recurrent respiratory infections Crowded living condition Poor nutrition Cleft palate
Clinical Symptoms Mild deafness in a young child Deafness increases during U.R.T.I. Mild otalgia Blocking sensation in ear Delayed & defective speech due to deafness
Clinical signs 1. Otoscopy: Blue eardrum with restricted mobility Retraction of T.M. in early stage Bulging of T.M. in later stages Fluid level + air bubbles seen behind T.M. 2. Tuning Fork Tests: conductive deafness
Blue ear drum
Left retracted ear drum
Right air-fluid level
Left air-fluid level
Right air bubbles
Left air bubbles
Pure Tone Audiometry P.T.A.: low frequency conductive deafness
Impedance Audiometry C curve in ear drum retraction
Impedance Audiometry B curve in middle ear effusion
X-ray mastoid & Nasopharynx clouding of mastoid air cells + adenoid mass
Medical treatment 1.Antibiotic (Co-amoxyclav) for 2-4 weeks 2.Nasal decongestants (systemic + topical) 3.H1 anti-histamines 4.Auto-inflation of Eustachian tube by Valsalva maneuver 5.Analgesic for acute earache
Politzerization Rubber tube attached to Politzer bag is put into one nostril & both nostrils pinched. Pt is asked to swallow repeatedly & Politzer bag is squeezed simultaneously.
Otovent balloon device
Technique of inflation
Otovent balloon device Balloon is inflated by blowing air out of nose. When fully inflated, balloon neck is pinched off and nasal occluder is inserted into one nostril. Child is instructed to swallow as balloon is deflated into nasal cavity. Portion of air from balloon enters Eustachian tube & ventilates middle ear.
Ear Popper Device
Based on Politzer Maneuver, EarPopper Device delivers a safe, constant, regulated stream of air into nasal cavity. During swallowing, air is diverted to Eustachian tube clearing & ventilating middle ear.
EARDOC generates & transmits special vibration waves which travel through temporal bone to reach middle ear & Eustachian tube. The waves ease middle ear pressure & drain trapped fluids. As a result edema & pain are reduced.
Surgical treatment 1.Myringotomy (Tympanocentesis) + grommet (Pressure Equalization tube) insertion: Radial incision made in antero-inferior quadrant. For thick fluid, 2 incisions made in antero-inferior quadrant & antero-superior quadrant (Beer can principle).
Surgical treatment 2.Laser or radio-frequency assisted myringotomy: grommet insertion not required 3.Cortical mastoidectomy: for refractory cases with loculated fluid in mastoid 4.Treatment for predisposing factors: adeno- tonsillectomy / antral wash / polypectomy
Myringotomy & grommet insertion
Right Myringotomy incision
Left Myringotomy incision
Beer can principle
Glue like fluid
Right grommet in position
Left grommet in position
Grommet in ant-sup quadrant
T-tube grommet in situ
Grommet extrusion Grommet gets extruded on its own due to endothelium growing on its inner surface. Extrudes after months.
Healed tympanic membrane
Complications of Grommet insertion
Granulation over grommet
Grommet lost inside
Radiofrequency assisted myringotomy
Sequelae of O.M.E. 1.T.M. atrophy & atelectasis 2.Adhesive otitis media 3.Tympanosclerosis 4.Cholesterol granuloma 5.Ossicular necrosis 6.Retraction pocket & cholesteatoma
Prevention of O.M.E. Avoid irritants like cigarette smoke Identify & avoid any allergens Consider a smaller day care centre (< 6 children) Wash hands & toys frequently Use air filters & provide fresh air at home Encourage breastfeeding Use of pneumococcal vaccine
Adhesive Otitis Media Pathology: TM atrophy + atelectasis (due to dissolution of fibrous layer) + adhesions in M.E. cavity, following chronic O.M.E. Clinical Features: 1. Conductive deafness 2. Thin retracted T.M. with no mobility
Adhesive Otitis Media
Treatment: 1. Hearing Aid 2. Surgery (long term results are poor) a. Tympanotomy + release adhesions + put silastic sheet b/w promontory & TM. b. Grommet insertion
Left grommet in position
Tympanosclerosis Deposition of hyaline (acellular + avascular collagen) + calcium deposits in submucosal tissue of T.M. & M.E. cavity following long- standing otitis media
Tympanosclerosis Treatment: 1. Hearing Aid 2. Surgery (long term results are poor) Remove tymapnosclerotic plaque & perform tympanoplasty
Barotrauma of middle ear
Pathogenesis E.T. has collapsible cartilaginous part & rigid bony part Allows expulsion of air from middle ear into E.T. but not suction of air into middle ear via ET.
Etiology Failure of Eustachian tube to equalize rapid increase in pressure difference b/w middle ear & atmosphere, over a long period. During ascent: middle ear pressure is more than Atmospheric Pressure no barotrauma in normal middle ear During descent: middle ear pressure is less than Atmospheric Pressure barotrauma occurs
Pressure Difference Pathology in normal Middle Ear Symptoms - 60 mm HgHyperaemia + edema + exudation + T.M. retraction Otalgia, deafness, tinnitus - 90 mm Hg (less in pt with cold) Locking of E.T. (collapse of lumen), microscopic hemorrhage Severe otalgia to 400 mm Hg T.M. ruptureFrank blood otorrhoea
Prevention 1. Avoid air travel during cold / nasal allergy 2. During descent while flying: Do repeated swallows (lozenges / gum) Do intermittent Valsalva maneuvre Avoid sleeping (as swallowing is decreased) 3. Pt with previous episode: take nasal decon- gestant + antihistamine 30 min before descent.