2 Types Otitis Media with effusion (O.M.E.) Adhesive otitis media TympanosclerosisBaro-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 mediaSeromucinous / exudative otitis mediaCatarrhal otitis mediaGlue ear
4 Etiology 1. Eustachian tube dysfunction Vacuum in M.E. extravasation of fluid Lack of drainage of M.E. secretions2. Upper respiratory tract allergy / viral infection Increase M.E. secretions3. Low grade middle ear infection Inadequate treatment of A.S.O.M.
8 Predisposing conditions Child going to a nurseryEarly weaning with formula milkParents who smokeRecurrent respiratory infectionsCrowded living conditionPoor nutritionCleft palate
9 Clinical Symptoms Mild deafness in a young child Deafness increases during U.R.T.I.Mild otalgiaBlocking sensation in earDelayed & defective speech due to deafness
10 Clinical signs 1. Otoscopy: Blue eardrum with restricted mobility Retraction of T.M. in early stageBulging of T.M. in later stagesFluid level + air bubbles seen behind T.M.2. Tuning Fork Tests: conductive deafness
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.
30 Ear Popper DeviceBased 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.
32 EARDOC deviceEARDOC ™ 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 treatmentMyringotomy (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 treatmentLaser or radio-frequency assisted myringotomy: grommet insertion not requiredCortical mastoidectomy: for refractory cases with loculated fluid in mastoidTreatment for predisposing factors: adeno-tonsillectomy / antral wash / polypectomy
63 Sequelae of O.M.E. T.M. atrophy & atelectasis Adhesive otitis media TympanosclerosisCholesterol granulomaOssicular necrosisRetraction pocket & cholesteatoma
64 Prevention of O.M.E. Avoid irritants like cigarette smoke Identify & avoid any allergensConsider a smaller day care centre (< 6 children)Wash hands & toys frequentlyUse air filters & provide fresh air at homeEncourage breastfeedingUse of pneumococcal vaccine
65 Adhesive Otitis MediaPathology: TM atrophy + atelectasis (due to dissolution of fibrous layer) + adhesions in M.E. cavity, following chronic O.M.E.Clinical Features:1. Conductive deafness2. Thin retracted T.M. with no mobility
72 Pathogenesis E.T. has collapsible cartilaginous part & rigid bony part Allows expulsion of airfrom middle ear into E.T.but not suction of air intomiddle ear via ET.
73 EtiologyFailure 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 earDuring descent: middle ear pressure is less than Atmospheric Pressure barotrauma occurs
74 Pathology in normal Middle Ear Symptoms Pressure DifferencePathology in normal Middle EarSymptoms- 60 mm HgHyperaemia + edema + exudation + T.M. retractionOtalgia, deafness, tinnitus- 90 mm Hg (less in pt with cold)Locking of E.T. (collapse of lumen), microscopic hemorrhageSevere otalgia- 100 to 400 mm HgT.M. ruptureFrank blood otorrhoea
75 Treatment Nasal decongestants + H1 anti-histamines Politzerization for middle ear aerationMyringotomy + grommet insertion done for:refractory casespresence 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.