otitis media with effusion / secretory otitis media

BRIG ANWAR UL HAQ03018513303

Otitis MediaWith

Effusion

INTRODUCTION

BRIG ANWAR UL HAQGRADUATION - 1985ARMY MEDICAL COLLEGEFCPS - 1997WORKED

ALL ACROSS PAKISTAN UN UK SAUDI ARABIA

CPSP SUPERVISOR - 2004DIRECTOR OF MEDICAL EDUCATION

QUETTA INSTITUTE OF MEDICAL SCIENCES

BRIG ANWAR UL HAQ

Otitis MediaWith

Effusion

PAKISTAN ZINDABAD

PUNJAB

PUNJABPUNJABAYE

LAHORELAHOREAYE

OMEChronic accumulation of mucus/non

purulent effusion within the middle ear and in mastoid air cell system (Middle Ear Cleft).

Duration >12 weeks

SynonymsGlue earSerous otitis media Chronic nonpurulent otitis media

Etio-PathologyPreceded by an episode of AOM with

Otalgia and fever.

Inflammation of eustachian tube epithelium

Flat cuboidal mucosa Partially replaced by thickened Pseudo Stratified Mucus secreting epithelium.

Goblet cells are usually presentMucus secreting cells are formed.

Etio-PathologyCharacteristics of effusionmixture of the secretions of the

epithelial cells goblet cells mucus glands along inflammatory transudate/exudate

Viscous Goblet Cells Mucous glands

Etio-PathologyBacteriologyStreptococcus Pneumonia Haemophilus Influenzae Branhamella Catarrhalis

The incidence of pathogens was higher in the younger children

Etio-PathologyEustachian tube dysfunction Viral upper respiratory tract infection, allergic reaction,

Pollutents Cigarette smoke. Adenoids GERD

Craniofacial Abnormalitiescleft palate Poor ET function.bifid uvulaDown and turner syndromes are prone to have

OME.

Down and Turner Syndrome

Bottle Feeding

Etio-PathologyAllergyAllergy – Swelling - Infection

GERDIts common in childrenPepsin is found in the effusion.Investigations are required to clarify

the role.

Etio-PathologyPrevalanceAge

Bimodal - infancy - primary schoolPeak - one year of age.

SeasonWinter>SummerRespiratory Tract InfectionsEar Infections

Etio-PathologyAOM EpisodeLargest single factorAntibiotics - No effectsContact with other childrenHereditabilityGreater concordance

monozygotic - Higher Incidence

dizygotic - Lesser Incidence

Etio-PathologyRacePrevalence is different in different races

GenderNo difference in male or females

Smoking No effect of parenteral smoking detected.

LAHORELAHOREAYE

Symptoms

No symptoms

Deafness

Tinnitus

Pain Ear

Symptoms

Associated Symptoms

Nasal Blockage

Nasal Discharge

Pain Throat

Fever

Examination GPESystemic Examination

Repiratoty SystemENT Examination

NoseNasopharynxEars

Pneumatic Otoscopy Tunning Fork Tests

OtoscopyDifferent Combinations of

Retraction of the pars tensa Variations in its colour.

OtoscopyColour

yellow Bluefluid levels air bubbles

PositionRetractedFull

MobilityReduced

Retraction

Bubbles

Air Fluid Level

Bulging

TYMPANOMETERY

PURE TONE AUDIOMETERY

X RAY NECK LAT VIEW FOR ADENOIDS

LAHORE

TreatmentNo Treatment

Spontaneous Recovery

Medical Management-AIMS

Speed up the resolutionAntibiotics

Benefits in first two weeks long term (>6 weeks) - not recommended

Nasal Decongestants No Significant effect.

Mucolytics No Significant result.

Medical Management-AIMS

Speed up the resolutionAntibiotics

Benefits in first two weeks long term (>6 weeks) - not recommended

Nasal Decongestants No Significant effect.

Mucolytics No Significant result.

ManagementNasal topical Steroids

No difference in resolution.Systemic Steroids

Not Recommended.Counseling and hearing tactics.

Disabilities can be minimized by hearing tactics.

Other Approach Auto Inflation-3.5 times more likely to improve. Higher efficacy found in older children.

ManagementNasal topical Steroids

No difference in resolution.Systemic Steroids

Not Recommended.Counseling and hearing tactics.

Disabilities can be minimized by hearing tactics.

Other Approach Auto Inflation-3.5 times more likely to improve. Higher efficacy found in older children.

ManagementNasal topical Steroids

No difference in resolution.Systemic Steroids

Not Recommended.Counseling and hearing tactics.

Disabilities can be minimized by hearing tactics.

Other Approach Auto Inflation-3.5 times more likely to improve.

Higher efficacy found in older children.

ManagementSurgical Management.Ventilation Tubes Insertion.

Posterosuperior insertion is not recommended –damages the Ossicular Chain

No difference in radial or circumferential inscion or anterosuperior and anteroinferior position.

To maximize the duration-insertion in anteroinferior is recommended . Made with Teflon,Silicone,Titanium,Gold. Aspirate as much of the middle ear fluid as possible through the

myringotomy before inserting VT, there is no evidence that is required. Topical preparations are used to prevent tube block with blood or infection.

Myringotomy with aspiration. Not shown to be effective.

Ventilation tubes

ManagementVentilation TubesSynonyms Myringotomy tube, Tympanostomy tube Pressure equalization (PE) tube.

Types1. Grommets (dumbbell shaped)

Short stay tubes that gets extruded within 6 months

Shephard’s grommet Armstrong’s grommet Donaldson’s grommet Shah’s grommet

2. T-tube (‘T’ shaped) For long term purposes that stays at least 1-2 years.

Management

AdenoidectomyMechanism - Unclear.Removes a chronic source of infection Nasopharynx.

E:\PRESENTATIONS\Animations\EAR\Glue Ear.flv

OutcomesHearingVT alone - 12 dB.Adenoidectomy - additional 3-4dB.

ComplicationsDisplacement of tube to middle ear

Perforation of TM.Scarring and weakening of the TM.

Early extrusion or blockage.Cholesteatoma formation.