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Non-Suppurative Otitis Media

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Presentation on theme: "Non-Suppurative Otitis Media"— Presentation transcript:

1 Non-Suppurative Otitis Media
Dr. Vishal Sharma

2 Types Otitis Media with effusion (O.M.E.) Adhesive otitis media
Tympanosclerosis Baro-traumatic otitis media

3 Otitis Media with effusion
Presence of serous or mucoid effusion in middle ear cleft with no frank pus. Synonyms: Secretory / Serous otitis media Seromucinous / exudative otitis media Catarrhal otitis media Glue ear

4 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.

5 Causes for E.T. dysfunction
1. Eustachian Tube obstruction Intrinsic edema = infection / allergy / trauma Extrinsic = adenoid / nasopharyngeal tumour / post – Radiotherapy scarring Functional = floppy Eustachian tube 2. Patulous Eustachian tube: reflux of secretions

6 Causes for E.T. dysfunction
3. Palatal abnormality:  cleft palate / palatal palsy 4. Muco-ciliary pathology:  Infection / allergy / smoking  Kartagener’s syndrome / Young’s syndrome  Surfactant deficiency / Immune deficiency

7 Causes of E.T. dysfunction

8 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

9 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

10 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

11 Otoscopy

12 Blue ear drum

13 Left retracted ear drum

14 Right air-fluid level

15 Left air-fluid level

16 Right air bubbles

17 Left air bubbles

18 Investigations

19 P.T.A.: low frequency conductive deafness
Pure Tone Audiometry P.T.A.: low frequency conductive deafness

20 C curve in ear drum retraction
Impedance Audiometry C curve in ear drum retraction

21 B curve in middle ear effusion
Impedance Audiometry B curve in middle ear effusion

22 X-ray mastoid & Nasopharynx
clouding of mastoid air cells + adenoid mass

23 Medical treatment Antibiotic (Co-amoxyclav) for 2-4 weeks
Nasal decongestants (systemic + topical) H1 anti-histamines Auto-inflation of Eustachian tube by Valsalva maneuver Analgesic for acute earache

24 Non-medical, Non-surgical treatment
Politzerization Otovent balloon Ear popper device Eardoc device

25 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.

26 Otovent balloon device

27 Technique of inflation

28 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.

29 Ear Popper Device

30 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.

31 EARDOC device

32 EARDOC device 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.

33 Surgical treatment 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).

34 Surgical treatment Laser or radio-frequency assisted myringotomy: grommet insertion not required Cortical mastoidectomy: for refractory cases with loculated fluid in mastoid Treatment for predisposing factors: adeno-tonsillectomy / antral wash / polypectomy

35 Myringotomy & grommet insertion

36 Myringotome

37 Right Myringotomy incision

38 Left Myringotomy incision

39 Myringotomy performed

40 Beer can principle

41 Glue like fluid

42 Shepard’s Grommet

43 Armstrong’s grommet

44 Donaldson grommet

45 Shah’s grommet

46 T-tube grommet

47 Grommet insertion

48 Right grommet in position

49 Left grommet in position

50 Grommet in ant-sup quadrant

51 T-tube grommet in situ

52 Grommet extrusion Grommet gets extruded on its own due to
endothelium growing on its inner surface. Extrudes after 6 - 9 months.

53 Grommet extrusion

54 Healed tympanic membrane

55 Complications of Grommet insertion

56 Tympanosclerosis

57 T.M. Perforation

58 T.M. Perforation

59 Granulation over grommet

60 Grommet lost inside

61 Radiofrequency assisted myringotomy

62 Cortical Mastoidectomy

63 Sequelae of O.M.E. T.M. atrophy & atelectasis Adhesive otitis media
Tympanosclerosis Cholesterol granuloma Ossicular necrosis Retraction pocket & cholesteatoma

64 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

65 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

66 Adhesive Otitis Media

67 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

68 Left grommet in position

69 Tympanosclerosis Deposition of hyaline (acellular + avascular
collagen) + calcium deposits in submucosal tissue of T.M. & M.E. cavity following long- standing otitis media

70 Tympanosclerosis Treatment: 1. Hearing Aid
2. Surgery (long term results are poor) Remove tymapnosclerotic plaque & perform tympanoplasty

71 Barotrauma of middle ear

72 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.

73 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

74 Pathology in normal Middle Ear Symptoms
Pressure Difference Pathology in normal Middle Ear Symptoms - 60 mm Hg Hyperaemia + 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 - 100 to 400 mm Hg T.M. rupture Frank blood otorrhoea

75 Treatment Nasal decongestants + H1 anti-histamines
Politzerization for middle ear aeration Myringotomy + grommet insertion done for: refractory cases presence of haemotympanum

76 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.

77 Thank You

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