الدكتور سعد يونس سليمان OTITIS MEDIA الدكتور سعد يونس سليمان

* Otitis Media with Effusion Lecture Objectives Acute Otitis Media (AOM) Chronic Middle Ear Disease * Otitis Media with Effusion * Chronic Suppurative Otitis Media Cholesteatoma Acute Mastoiditis

Acute Otitis Media (AOM) Definition; Is an acute inflammation of the lining of the middle ear cleft. It is extremely common in children but can occur at any age. There is nearly always a preceding history of URTI.

Sources of infection 1- Through the ET following URTI. 2- Through the EAM if there is a pre-existing perforation of the TM. 3- Blood borne infection.

Age Acute otitis media is distinctly more common in infants and children than in adults. This is due to: Hypertrophy of adenoids More frequent URTI Less effective Eustachian tube function Teething (lowers resistance) Inability to blow the nose Bottle feeding facilitates acute otitis media

Bacteriology The commonest bacteria isolated are: Pneumococci There is initial viral infection which paves the way for pyogenic infection. The commonest bacteria isolated are: Pneumococci H. influenzae Branhamella catarrhalis, a beta lactamase producing organism.

Pathology URTI Infection of the ET (salpingitis) Absorption of air Exudates which may later become purulent. This suppuration if not treated leads to rupture of the TM and relief of pain.

Clinical Picture The onset is fairly sudden and commonly there is a preceding URTI: Pain (earache) sharp lancinate in character. Conductive hearing loss Mucopurulent discharge indicates rupture of the TM and usually associated with pain relief. Constitutional symptoms as pyrexia, malaise, vomiting and diarrhea.

Examination Otoscopy: Redness and injection Outwards bulging mucopurulent discharge Examination of the nose and oropharynx Tuning fork test: Conductive hearing loss; *Rinne test is negative and *Weber test is lateralized to the affected ear. P.T.A.: Conductive hearing loss.

Treatment Medical: Treatment of URTI. Bed rest, heat application and analgesics Decongestant nose drops Antibiotics: given for 7-10 days as follow; Amoxycillin constitutes the first choice. Amoxycillin-clavulanic acid combination. Erythromycin , Co-trimoxazole , Cefixime AOM with discharge; Dry mopping Prevent water from entering the ear. Swab for c/s Antibiotic-steroid drops

Surgical Treatment

..Severe pain not responding to treatment. A swab will be taken.. Surgical Myringotomy ..Severe pain not responding to treatment. A swab will be taken.. The object of myringotomy Pain relief Facilitate healing

Prognosis of ASOM Healing Open perforation Tympanosclerosis: white chalk-like patches on the surface of the TM produced by calcium deposition. Adhesive OM: ..to the medial wall of the middle ear. ..to the ossicles

Normal tympanic membrane

Retraction pockets Adhesive OM

Chronic Otitis Media (COM) 1. Non-suppurative: Also called: Secretory otitis media Otitis media with effusion (OME). Glue ear 2. Suppurative. 3. Tuberculous.

Otitis Media with Effusion (OME, Glue ear or Secretory otitis media) Definition; Accumulation of non-purulent fluid in the middle ear, occurring in the absence of acute inflammation. It may vary from thin serous fluid to thick viscid material. …The most frequent cause of acquired hearing loss in childhood. It is usually bilateral it is usually intermittent.

Aetiology 1. Occlusion of Eustachian tube 2. Unresolved acute otitis media * Failure of natural immunity * Inadequate antibiotic therapy 3. Nasal allergy. 4. Barotrauma; descent in an airplane or diving 5. Cleft palate.

Pathophysiology ET obstruction Air absorption and vacuum formation. The TM drawn inwards Transudation of `sterile` secretion CHL with time this thin fluid changes to thick glue one.

Clinical picture When we suspect OME? Children: repeated tonsillitis with adenoid hypertrophy + CHL = OME Adult: CHL following influenza or common cold = OME

Insidious conducive hearing loss: OME is the commonest cause of hearing loss in childhood between 4-6 years of age. Tinnitus: Crackling, bubbling noises and sensation of fluid in the ear. Pain occurs only if acute infection supervenes

Examination 1. Otoscopy: *Dull *Retracted The TM is *Dull *Retracted *Often has a yellow orange tint. *Dilated blood vessels (cart-wheel appearance). *Air bubbles or a fluid level

Air bubbles in OME

Cart-wheel appearance

2. Siegle`s pneumatic speculum: This is used for checking the integrity and mobility of TM . Normally, The TM is mobile but it is immobile in OME This is used for checking the integrity and mobility of TM . Normally, The TM is mobile but it is immobile in OME

3. Tuning fork test Rinne test : -ve (BC > AC) Weber test : lateralized to the affected ear.

Investigation PTA: CHL of at least 40 dB.

2. Tympanometry

3. Radiology:

Treatment Treatment of the predisposing factors Adenoidectomy Treatment of nasal and sinus infection Closure of cleft palate.

Medical Treatment Decongestant Antihistamines Mucolytic agents Steroid nasal spray Antibiotics: ? long term low dose may be effective in 50% of cases. Repeated auto-inflation Politzerization Valsalva Maneuver

Surgical Surgery should ONLY be recommended for diseases persistent more than 3 months Myringotomy Aspiration of thick mucoid material Insertion of Grommet

Complications of OME 1. Retraction pockets and cholesteatoma. 2. Tympanosclerosis. 3. Adhesive otitis media.

Adhesive otitis media Tympanosclerosis

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