Dr. Abdussalam M jahan ENT depart, Misurata university, faculty of medicine Otitis media

Anatomy of the Ear

Inflammation of Middle ear Chronic OM Acute OM Chronic supp. OM Chronic non Supp.OM A non supp OM A supp. OM A necrotizing OM

Acute inflammation of mucoperiosteal lining of middle ear cleft. Acute OM It is common disease especially in children.. Why. (ET, URTI, AdT, bottle feeding).

: Bacteriology : Streptococcus Hemolyticus Streptococcus pnumoniae Homophiles influenza Route Perforated TM ET

Stages of AOM Tubal occlusion Catarrhal stage Suppuration stage Stage of resolution ET obstruction. → –ve pr. → ME mucosa swollen and hyperaemic. ME full of secretion ME retained Normal rupture of TM → pus come out

C/P of AOM Tubal occlusion Catarrhal stage Suppuration stage Fullness of ear + mild otalgia increase pain + fever discharge, pain disappear, decrease fever sever pain, high fever, deafness

Signs of AOM Congested TM. Pulging of TM. Deafness. Purulent discharge. Perforated TM.

Treatment of AOM Ear cleaning. Systemic AB. Local Ear drops. analgesia. Myringotomy +/-.

Chronic OM Chronic supp. OMChronic non Supp.OM ( ) Safe ( Tubotympanic)Unsafe (Attico antral)

Chronic inflammation of middle ear cleft (ME cavity, ET, Mastoid). CSOM It is common disease in low socioeconomic classes.

( ) Safe ( Tubotympanic)Unsafe (Attico antral) cholesteatoma Definition: it is an epithelial cyst that contains keratin presented in middle ear ( presence of skin in a wrong place).

Tubotympanic (safe) Chronic inflammation Involve the ant part of ME ( tympanic cavity + ET) Microbiology: Grame +ve bacteria

S/S of CSOM safe otorrhea. - profuse - mucopurulent. - odorless. - on / off. Deafness ( -ve Rinne test). TM perforation.. central.

Treatment of safe CSOM Cleaning ( suction or mopping). Systemic AB. Local ear drops. Surgical intervention: myringoplasty

Attico antral (unsafe) Chronic inflammation Involve the post part of ME ( attic, antrum, mastoid) Microbiology: Grame -ve bacteria & anaerobic

Attico antral (unsafe) Cholesteatoma Definition: it is an epithelial cyst that contains keratin presented in middle ear ( presence of skin in a wrong place).

Cholesteatoma CongenitalAcquired secondaryprimary

S/S of CSOM unsafe otorrhea. - scanty. - purulent. - offensive. - continuous. Deafness ( -ve Rinne test). TM perforation, marginal. Polypi or granulation tissues.

Treatment of unsafe CSOM Only Surgical intervention: Mastoidectomy - Ct scan is important in management of CSOM with Cholesteatoma.

Difference between safe and unsafe OM cholesteatoma discharge perforation Site of infection Treatment Yes No Profuse scanty, offensive attic, Antrum peripheral central tympanic cavity, ET medical or surgical always surgical

Complications of CSOM Cranial Intracranial Extracranial

Chronic non Supp.OM Secretory OM or OM with effusion ( glue ear) definition: Collection of fluids behind intact TM with out s/s of inflammation. Common in children under 9 yr. etiology: - ET dysfunction. - post unresolved AOM.

ET dysfunction FunctionalMechanical Increase compliance as in children Adenoid -Deficient mucociliary clearance as in Kartageners syndrome -Abnormal viscid sec: Mucoviscidosis NP tumours Tubal oedema as post RT Tubal scaring as post Ad Secretional Abnormal opening mechanism as in Cleft palate.

So causes of SOM Adenoid hypertrophy. NP carcinoma. Post AOM. Abnormal viscid sec. Abnormal ciliary function. Post op scaring

symptoms of SOM Hearing loss. Feeling of blockage. tinnitus. Symptoms of cause.

Signs of SOM Retracted TM. Fluid level ( hair line). Air bubbles. TFT → CHL.

Investigations of SOM Tympanometry. PTA. X- ray NP. CT scan if needed.

Treatment of SOM mucolytic. Steroids. Decongestant N drop. Valsalva. medical Ventilation tube ( Grommet). Adenoidectomy surgical

Chronic non Supp.OM Adhesive OM definition: It is a complication of SOM, in which the TM become thin, atrophic, and adherent to the middle ear structures. treatment: - grommet. - tympanoplasty.

clinical case: 5 yrs old child presented with: Nasal obstruction + night snoring Chronic nasal discharge. Decrease hearing. On examination: -Retracted TM -Fluid behind TM -TM not perforated. What is Dx and how to confirm.