1. DRUGS
DO NOT DO DRUGS !!!
Hearing disorders in children/ Hala AlOmari

2. Hearing disorders in children/ Hala AlOmari

3. Otitis media Lecture 8 24 February 2015
Hearing disorders in children/ Hala AlOmari

4. Acute otitis media Chronic otitis media Otitis Media
Hearing disorders in children/ Hala AlOmari

5. Acute otitis media Non-infective Infective Cause
Sudden Eustachian tube obstruction
Barotrauma
Locking of the Eustacian tube
Viral
Bacterial
* often starts as viral but secondary bacterial infection may follow
Pathology
Negative middle ear pressure
Acute retraction of the ear drum (very painful)
Effusion into the middle ear
Infection may follow
Proliferation of bacteria and white blood cells
ear drum bulges under pressure
Ear drum may burst (pus in the ear canal)
Treatment
Swallowing
decongestants
-Antibiotics
- myringotomy
Hearing disorders in children/ Hala AlOmari

6. Acute otitis media- Infective
Symptoms
pain- increasing until the ear drum bursts
Pyrexia ( increased temperatures)
Unwell
Hearing loss
Consequences
Returns to normal
Persistent effusion
Permanent scarring of the ear drum
Perforation persists
Acute mastoiditis
Hearing disorders in children/ Hala AlOmari

7. Acute otitis media- Infective Acute mastoiditis
Very rare
Spread of the infection from the middle ear into the mastoid antrum and mastoid air- cells
Symptoms
Increasing pain
Increasing pyrexia
Swelling of the ear
Hearing disorders in children/ Hala AlOmari

8. Acute otitis media- Infective Acute mastoiditis
Signs
Lateral displacement of the pinna
Maximum tenderness of the antrum (high)
Velvety feel to skin over the mastoid
Tragus not tender (characteristic of otitis externa)
Treatment
Intervenous antibiotics
Cortical mastoidectomy
Hearing disorders in children/ Hala AlOmari

9. Acute otitis media- Infective Acute mastoiditis
Complications
Facial palsy
Labrynthitis
Intracranial pus
_ Subdural abscess
- extradural abscess
- meningitis
- brain abcsess
Hearing disorders in children/ Hala AlOmari

10. Chronic otitis media Forms
Chronic serous otitis media= otitis media with effusion= glue ear
Chronic suppurative otitis media
Long term complications of otitis media.
Hearing disorders in children/ Hala AlOmari

11. Remember
Ear infections are more common in children because their eustachian tubes are shorter, narrower, and more horizontal than in adults, making the movement of air and fluid difficult.
Hearing disorders in children/ Hala AlOmari

12. Chronic serous otitis media_ Causes
Eustachian tube malfunction
Anatomical
Nasal disease
Immune deficiency
Allergic rhinnitis
Adenoids
Cleft palate
Other mass post nasal
Hearing disorders in children/ Hala AlOmari

13. Chronic serous otitis media_ pathology
Middle ear hypoxia
Increase in mucous producing cells
Increase in mucous production
Hearing disorders in children/ Hala AlOmari

14. Chronic serous otitis media_ symptoms
Hearing loss - variable ( dB)
Recurrent otalgia
Speech delay
Behavioural problems
Dizziness
Hearing disorders in children/ Hala AlOmari

15. Chronic serous otitis media_ signs
Fluid behind the ear drum
Dull ear drum
Injection of ear drum
Retracted ear drum
Hearing disorders in children/ Hala AlOmari

16. Chronic serous otitis media_ associated problems
Adenoids
- snoring
- mouth breathing
Cleft palate
- depends on the type of repair
Hearing disorders in children/ Hala AlOmari

17. Chronic serous otitis media_ Investigation
Pure tone audiogram (age appropriate)
Tympanometry
VRA
Eustachian tube function test
Hearing disorders in children/ Hala AlOmari

18. Chronic serous otitis media_ management
Medical
Decongestants
Low dose antibiotics
otovent
Surgical
Grommets
Adenoidectomy
3-4 months watchful waiting before the surgical intervention
Depends also on when the child is seen (winter or summer)
Hearing disorders in children/ Hala AlOmari

19. Chronic otitis media Forms
Chronic serous otitis media= otitis media with effusion= glue ear
Chronic suppurative otitis media
Long term complications of otitis media.
Hearing disorders in children/ Hala AlOmari

20. Chronic suppurative otitis media
Long term perforation
Two forms
Tubotympanic disease
Atticoantral disease
Hearing disorders in children/ Hala AlOmari

21. Chronic suppurative otitis media
Tubotympanic disease
Perforation is central
Ear is safe
Not associated with cholesteatoma
Safe ear disease is characterized as a central perforation of the pars tensa with the inflammatory process affecting the mucosa of the middle ear cleft.
Hearing disorders in children/ Hala AlOmari

22. Chronic suppurative otitis media
Symptoms
Hearing loss , variable dependent on the extent of the perforations
Discharge
Irritation
Investigation
Pure tone audiogram
Eustachian tube function test
Management
Hearing aid
Reconstruction
Hearing disorders in children/ Hala AlOmari

23. Chronic suppurative otitis media
Atticoantral disease
Perforation- marginal in pars tensa at the attic
Affects the middle ear
Unsafe
Associated with cholesteatoma
Hearing disorders in children/ Hala AlOmari

24. Chronic suppurative otitis media
Symptoms and signs
As for tubotympanic disease
Discharge is often offensive
Both forms can have active discharge/ sometimes discharges/ inactive discharge
Hearing disorders in children/ Hala AlOmari

25. Cholesteatoma
Cholesteatoma is a destructive and expanding growth consisting of keratinizing squamous epithelium in the middle ear and/or mastoid process. Although these are not strictly speaking tumours or cancers they can still cause significant problems because of their erosive and expansile properties resulting in the destruction of the ossicles as well as their possible spread through the base of the skull into the brain. They are also often infected and result in chronically draining ears.
Hearing disorders in children/ Hala AlOmari

26. Chronic otitis media Forms
Chronic serous otitis media= otitis media with effusion= glue ear
Chronic suppurative otitis media
Long term complications of otitis media.
Hearing disorders in children/ Hala AlOmari

27. Long term complications of otitis media with effusion
Tympanoscelerosis
Retraction pockets
Atelectasis (drum is floppy)
Adhesive otitis media
Effects
CHL
Altered compliance
Hearing disorders in children/ Hala AlOmari