Deseases of middle ear asom,som - dr.madhu priya 15.02.16

Deseases of middle ear asom,som - dr.madhu priya 15.02.16

1. 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

2. How Does The Ear Work?

3. EUSTACHIAN TUBE
Connects nasopharynx
with tympanic cavity

4. 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

5. 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)

6. 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

7. 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

8. 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.

9. 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

10. CLINICAL FEATURES OF MEE
SYMPTOMS:
PRESENTATION
Deafness-h/o aural fullness or an ear being
plugged or diminished hearing
oInsidious onset
oRarely exceeds 40dB
Delayed and defective speech-most common
morbidity encountered
Earaches are rare or mild
Tugging at ear or repeated inserting of finger

11. 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

13. 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

14. INVESTIGATIONS contd…
3)IMPEDENCE
AUDIOMETRY/TYMPAN
OMETRY:
Objective test useful
in children and infants
Presence of fluid is
indicated by reduced
compliance and flat
curve with a shift to
negative side

15. Management (medical )
Decongestants
Antiallergic measures
Antibiotics
Middle ear aeration

16. Surgical
Myringotomy
Grommet insertion
Cortical mastoidectomy
Surgical treatment of causative factor

18. Sequeale of chronic SOM
Atrophic TM & atelectasis of ME
Ossicular necrosis
Tympanosclerosis
Retraction pockets
Cholesterol granuloma