Upload
ophthalmgmcri
View
303
Download
1
Embed Size (px)
Citation preview
OTITIS MEDIA WITH EFFUSION Also known as (syn. Secretory otitis
media,Mucoid otitis media,glue ear,middle ear effusion)
by Dr.Madhu priya
(Asst.Prof)
Department of ENT MGMC&RI
How Does The Ear Work?
EUSTACHIAN TUBE Connects nasopharynx
with tympanic cavity
FUNCTIONS OF ET Ventilation and regulation of middle ear
pressure Protection against a)nasopharangeal sound pressure b)reflux of nasopharangeal secretions Clearance of middle ear secretions
DISORDER OF EUSTACHIAN TUBE Normally ET is closed
It opens intermittently during swallowing,yawning and sneezing through the active contraction of TVPM.
Air, composed of oxygen,carbon dioxide,nitrogen and water vapour,normally fills the middle ear and mastoid.
When the tube is blocked,first oxy is absorbed,but later other gases,carbon dioxide and nitrogen also diffuse out into the bld---results in neg pressure in middle ear and retraction of TM---”LOCKING” of the tube with collection of transudate and later exudate and even haemorrhage (Acute OME)
What is glue ear? Insidious condition Glue ear is defined as
inflammation of the middle ear, accompanied by the accumulation of fluid in the middle-ear cleft (serous or mucoid,not purulent), without the symptoms and signs of acute inflammation
Effusion is thick and viscid,sometimes may be thin and serous
Commonly seen in school going children
AETIOLOGY MALFUNCTIONING OF THE TUBE Mechanical obstruction-URI,allergy,sinusitis,nasal
polypi,DNS,hypertrophic adenoids,nasopharangeal tm/mass
Functional-Sniffling,abnormal ciliary function of the tube(kartagener’s syndrome,situs inversus,bronchiectasis,cystic fibrosis,chronic sinusitis),palatal defects,Down syndrome,barotrauma
Both
Aetiology contd.. Allergy-seasonal or perennial allergy to foodstuffs Unresolved otitis media Infections Viral-adeno and rhino viruses Bacterial-The same flora found in AOM can be
isolated in OME. With OME, the inflammatory process clearly resolves, and the volume of bacteria decreases.
AETIOLOGY contd… Other risk factors More common in: Bottle feeding Feeding while supine Attending day-care Having a sibbling with OM Allergies to common environmental entities Low socio-economic status Low birth weight Parental history of OME Living in a home in which people smoke Recurrent URI
CLINICAL FEATURES OF MEE SYMPTOMS: PRESENTATION Deafness-h/o aural fullness or an ear being
plugged or diminished hearingo Insidious onseto Rarely exceeds 40dB
Delayed and defective speech-most common morbidity encountered
Earaches are rare or mild
Tugging at ear or repeated inserting of finger
CLINICAL FEATURES cont… SIGNS Otoscopic findings: Opacification of the
drum (other than due to scarring)
Loss of the light reflex, or a more diffused light reflex
Indrawn, retracted, or concave drum
Decreased or absent mobility of the drum
Presence of bubbles or fluid level
Yellow or amber colour change to the drum
Fullness or bulging of the drum, though this is not typical
INVESTIGATIONS contd… HEARING TESTS: 1)TUNING FORK TESTS:
conductive deafnes
2)PURE TONE AUDIOMETRY:
Best way to assess hearing Only suitable for children
who are 4 yrs and older There is C.H.L. of 20-40
dB,sometimes there is ass S.N.H.L. d/t fluid present on R.W. membrane
INVESTIGATIONS contd… 3)IMPEDENCE
AUDIOMETRY/TYMPANOMETRY:
Objective test useful in children and infants
Presence of fluid is indicated by reduced compliance and flat curve with a shift to negative side
Management (medical ) Decongestants Antiallergic measures Antibiotics Middle ear aeration
Surgical Myringotomy Grommet insertion Cortical mastoidectomy Surgical treatment of causative factor
Sequeale of chronic SOM Atrophic TM & atelectasis of ME Ossicular necrosis Tympanosclerosis Retraction pockets Cholesterol granuloma