1.By Dr. Muaid I. Aziz FICMS

2. AOM CATARRHAL EFFUSION SUPPURATIVE COM EFFUSION SUPPOARATIVE TUBOTYMPANIC ATTICOANTRAL 3. AOM Its a viral or bacterial infection of mucosal lining of the ME+ MAC More commoner in children than adult ? 1. adenoid 2. URTI 3. ET 4. ET disorders ET dysfunction Patulous ET 5. AOM Types Catarrhal Effusion Suppurative 6. Acute catarrhal otitis media URTI Deafness ? No pain Examination Nose Pharynx Ear Audiometry 7. Treatment Treating underlying cause Nasal decongestant Inflation of the Eustachian tube 8. Acute middle ear effusion More sever variety of catarrhal OM Cause : URTI , Allergy , Barotrauma More marked sx ( deafness, tinnitus ,vertigo) Examination Congested , dark orange hue to it , may be retracted , little or no movement of the TM, splitted cone of light, fluid level Medical or surgical 9. ACUTE SUPPURATIVE OTITIS MEDIA more commoner in children than in adults. it can follow URTI which is often viral initially or it can be secondary to the introduction of water through a perforation . Viral or bacterial adenovirus , rhinovirus streptococcus pneumonia , haemophilus influenza, branhamella catarrhalis. 10. sudden onset dull ache in the ear which may become more sever hearing loss fever ( common in children ) examination will show the drum very red & marked bulging outwards of the TM with loss of surface anatomy if the TM perforated or if there is preexisting perforation a copious mucopurulent & occasionally blood stained discharge coming from the ear once the drum rupture the pain will decrease to a dull ache 11. Treatment URTI should be treated . a 5 day course AB given as amoxillin _ clavelinic acid analgesia for pain if present nasal decongestant antihistamine drugs myringotomy needed for reliving the sever pain which is due to accumulated pus in the middle ear which is not resolved by AB if there is long standing perforation with recurrent attacks of AOM so myringoplasty is prepared for. 12. CHRONIC OTITIS MEDIA Deafness main sx Discharge ? Otalgia ? Other pathology ? CX ? malignacy ? 13. CHRONIC MIDDLE EAR EFFUSION : serous or secretory otitis media In children & adults ? aetiology chronic Eustachian tube dysfunction or obstruction due to blockage of the tube in the middle Ear or nasopharynx URTI as sinusitis , nasopharyngitis , allergic rhinitis unexplained chronic middle ear effusion specially in older person? suspicion of nasopharyngeal carcinoma. 14. Clinical features blocked feeling in the ear occasionally tinnitus or mild vertigo the patient is unable to clear the ear by autoinflation . On examination retraction of the TM in whole or part , retraction of pars tensa is seen & the handle of malleus appears shortened & to lie in more horizontal position. The lateral process of the malleus may thus appear more prominent . the drum often have a dark or orange hue to it & occasionally a fluid level may be seen . Examination of the nose may reveal signs of the sinusitis or allergic rhinitis , occasionally a nasopharyngeal tumor detected on examination of the nasopharynx . Investigation : audiometry will reveal a CHL diminished or absent TM mobility on tympanogram will show flat curve which indicate ve middle ear pressure 15. Treatment Treating of underlying cause myringotomy +/- grommet Hearing aids 16. Chronic suppurative otitis media Tubo - tympainc CSOM Attico - antral CSOM ( tympanomastoid ) 17. Tubo-tympanic CSOM AETIOLOGY PATHOLOGY C/F Mucopurulent discharge Deafness ( mild to moderate sever ?) Examination Central perforation ( ant. ,posterior , kidney shaped or subtotal) Otitis externa Nose , nasopharynx , pharynx should examined (tonsil ,adenoid, sinus infection) Hearing test X-R ( PNS , postnasal space , mastoid ) Mastoid X-R ( cellular, sclerotic),erosion? Swab for c/s 18. CX is rare & are not serious Polyp OE More sever HL 19. TREATMENT Treating URTI Local treatment Thorough cleaning of ear canal (mopping , or suction clearance) AB + steroid ( 5 days) local +/- systemic Preventive measures Surgery ( myringoplasty)( recurrent , deafness with disabilities) 20. Atticoantral CSOM TYMPANOMASTOID ? Serious cx ? Granulation tissue or polyp ?meaning? 21. pathology Cholesteatoma Granulation tissue with osteitis Cholesterol granuloma 22. Cholesteatoma DEFINITION ( fat or keratin) TYPES 23. Congenital cholesteatoma 24. THEORIES Congenital cholesteatoma . Metaplasia Ingrowth of squamous epithelium Retraction pocket 25. Granulation tissue 26. Cholesterol granuloma Dark brown gelatinous material with bone destruction In combination of previous pathology Dark blue TM Cholesterol crystals 27. Clinical features Discharge Deafness Bleeding Otoscopy Foul smell dicharge Perforation Polyp , GT , cholesteatoma 28. Investigations Hearing assessment Radiology 29. Treatment EUM + suction clearance Polyp or GT ? Medical or surgical ? Mastoidectomy 30. COMPLICATIONS OF OM Extracranial Intracranial 31. EC COMPLICATIONS Mastoiditis ( acute, masked, chronic) Petrositis Labyrinthitis Facial nerve pulsy 32. mastoiditis 33. presentation Increasing Pain , tenderness behind the ear Ear discharge ,no discharge(masked) Fever (child) Increasing pulse Deafness 34. Examination Downwards ,outwards protruded auricle Fluctuant swelling Sagging of posterior meatal wall Perforated TM with pulsating discharge Intact TM 35. Investigation ( XR) , hearing assessment Treatment AB SURGERY 36. INTRACRANIAL COMPLICATIONS meningitis Extradural abscess Subdural abscess Brain abscess Lateral sinus thrombosis 37. thanks