2. الدكتور سعد يونس سليمان
OTITIS MEDIA
الدكتور
سعد يونس سليمان

3. * 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

4. 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.

5. 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.

7. 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

8. 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.

9. 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.

10. 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.

11. 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.

12. 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

13. Surgical Treatment

14. ..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

15. 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

16. Normal tympanic membrane

17. Retraction pockets Adhesive OM

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

21. 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.

22. 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.

23. 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.

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

25. 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

26. 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

27. Air bubbles in OME

28. Cart-wheel appearance

29. 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

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

31. Investigation
PTA: CHL of at least 40 dB.

32. 2. Tympanometry

33. 3. Radiology:

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

35. 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

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

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

41. Adhesive otitis media Tympanosclerosis

42. وآخر دعوانا أن الحمد لله رب العالمين
والسلام عليكم ورحمة الله وبركاته