otitis part 3

NON- SUPPURATIVE DISEASES OF EAR

MUCOUS OTITIS AND SEROUS OTITIS

The accumulation of fluid in the

middle ear

The absence of acute

inflammation

MUCOUS OTITIS

• The disease is the commonest cause of hearing loss in childhood. This disease is also called “glue ear”.

• It is almost invariably bilateral and the fluid is in most cases thick and mucoid. The condition is very common about the age of 4 or 5.

MUCOUS OTITIS

• Its cause is the result of low-grade infection occurring in association with inadequate Eustachian tube function.

• It is possible that administration of antibiotics early in an attack of otitis media may sterilize the contents of the middle ear, and an inadequate Eustachian tube may prevent evacuation of fluid and re-entrance of air.

MUCOUS OTITIS

• The only symptom is impaired hearing. In some children the hearing loss is first noticed by the schoolteacher or a visiting relative; many are only discovered during routine audiometric screening.

• There is no pain!

MUCOUS OTITIS

• The drum is lustreless and often has a yellow or orange tint.

MUCOUS OTITIS

• There are two main clinical signs:

1. the lack of mobility of the drum

2. the discovery of a negative Rinne

Treatment of MUCOUS OTITIS

Treatment must be surgical.Operation consists of an

anterior myringotomy, aspiration of the thick mucoid material, and the insertion of a plastic tube or 'grommet'. The 'grommet' provides for adequate ventilation of the middle-ear space and is essentially an artificial Eustachian tube.

Treatment of MUCOUS OTITIS

if the adenoids are very large or infected they should be removed and it also seems reasonable to treat any infection in the nose or sinuses.

SEROUS OTITIS

• Usually the fluid is thin and watery and probably is a transudate. It is nearly always unilateral.

• The upper respiratory infections and allergy are probably predisposing factors.

• Occasionally a lesion in the nasopharynx, such as carcinoma, may present.

SEROUS OTITIS

• The onset is usually acute.

• The ear feels blocked and hearing is impaired.

• The patient may be aware of a splashing sensation inside the ear when moving the head and may also notice that hearing varies in different head positions as the fluid moves around the middle-ear cavity.

SEROUS OTITIS

• On examination of the drum the line of the fluid level is often visible, and this remains horizontal as the head is moved.

• Occasionally bubbles may be seen behind the drum.

• In contrast to the findings in children, the hearing loss is often slight

Treatment of SEROUS OTITIS

Frequently the fluid will clear on a short course of an antihistamine.

Treatment of SEROUS OTITIS

If the fluid persists, then inflation of air through a Eustachian catheter will usually disperse it.

Treatment of SEROUS OTITIS

• Occasionally the fluid must be removed through a myringotomy incision.

SENSORI-NEURAL HEARING LOSS

SENSORI-NEURAL HEARING LOSS

SENSORI-NEURAL HEARING LOSS

• Sensori-neural hearing loss can be recognized by the fact that the patient has impaired hearing, but, on tuning-fork testing, air conduction remains better than bone conduction.

• Audiometrically, it is usually found that the loss is most severe in the high frequencies.

SYMPTOMS

Ear noise

Progressive hearing loss

SYMPTOMS

Distortion of hearing

I can hear, but I can't make out what people say

SYMPTOMS

No pain!No pain!

No fever!No fever!

No discharge from the ear!

No discharge from the ear!

Symptoms of SENSORI-NEURAL HEARING LOSS

• Unilateral or bilateral hearing loss

• Distortion of hearing ('I can hear, but I can't make out what people say' )

• The tympanic membrane is generally be normal

• This is the case when “the patient doesn’t hear and the doctor doesn’t see anything”

Causes

Viral infection (influenza, mumps)

CausesBlood circulation disturbances

arterial hypertension, atherosclerosis

cervical osteochondrosis

atherosclerosis

Causes

Drug ototoxicity (quinine and salicylates, antibiotics of the aminoglycoside group, diuretics).

Causes

Cranial injury

TreatmentConservative Hearing aid