DISEASES OF EAC, SOM Acute otitis media

Disease and treatment

1. DISEASES OF EXTERNAL EAR, SEROUS OTITIS MEDIA & ACUTE OTITIS MEDIA

2. Pinna

3. External Ear Deformities PRE AURICULAR TAGS PRE AURICULAR SINUS MACROTIA POLYOTIA

4. SEROMA PERICHONDRITIS

5. Diseases of External Auditory Canal Impacted wax Furunculosis Otomycosis Otitis externa Keratosis obturans EAC cholesteatoma Exostosis & Osteoma Foreign body

6. Eustachian Tube Narrow osteocartilaginous channel connecting tympanic cavity to nasopharynx. Allows passage of: Gases- for middle ear ventilation Liquid- for middle ear clearance

7. FEATURES INFANT ADULT Length (mm) ~13-18mm ~31-38mm Cartilaginous Portion Less than 2/3 of tube 2/3 of tube Bony Portion Larger & Wider Relatively smaller Pharyngeal Orifice Height ½ but similar width Height 8mm, width 2mm Angulation with respect to base of skull 10 degree (more horizontal) 45 degree Tensor Veli Palatini Action Less Efficient More Efficient Ostmann’s Pad Fat Less Prominent Prominent Isthmus angulation Absent 160 degree

8. To recapitulate… TM is oval in shape 8 mm x 10 mm 3 layers 130 microns thick Pars Tensa Radial fibers- manubrium to annulus Circular fibers- short process of incus to the annulus. Pars Flaccida (Shrapnell’s ) Above ant & post malleolar folds

9. Otitis Media Non- Suppurative Squamosal Otitis Media with Effusion Otitic barotrauma Suppurative Inactive Active Inactive Mucosal Active Tubercular

10. Otitis Media with Effusion Non-purulent effusion in middle ear cleft Increased secretory activity of middle ear mucosa ET dysfunction 50% of all children- before the first birthday 80% of all children - before the third birthday Prevalence bimodal at 2 & 5 yrs M > F; more during winters Above 15 yrs - prevalence 0.6%

11. Aetiopathogenesis ET dysfunction Infection Allergy Craniofacial abnormality GERD Barotrauma Biofilm formation ET dysfunction Obstruction Adenoid hyperplasia Tumours (nasopharyngeal carcinoma) Palatal defects Barotrauma Hyperbaric oxygen therapy Oedema during radiation therapy Spread of Infection Chronic adenoiditis Chronic rhino-sinusitis Chronic tonsillitis High prevalence in HIV patients Infection Strep. pneumoniae H. influenza Moraxella catarrhalis

12. History • Decreased hearing Recurrent URI Mouth breathing and snoring Evaluation Otoscopy ( preferably Pneumatic) Dull, opaque TM, loss of light reflex Air fluid level Restricted mobility Tympanometry Mild hearing loss Adenoid Facies

13. Treatment • High spontaneous recovery rate • Myringotomy with Ventilation tube insertion + adenoidectomy. Medical Management • Speeds up the resolution • Antibiotics - Benefit in first two weeks and long term is not recommended (>6 weeks) • Nasal Decongestants

14. Nasal topical Steroids Systemic Steroids Counseling and hearing tactics. Auto Inflation -3.5 times more likely to improve Higher efficacy found in older children A - SHEPHARD’S GROMMET B - ARMSTRONG’S GROMMET C - DONALDSON’S GROMMET D - SHAH’S GROMMET E - T TUBE

15. Otitic barotrauma Inability to maintain middle ear pressure at ambient atmospheric level Rapid descent in flight, underwater diving or compression in pressure chamber “Locking” of pharyngeal end of ET – sudden –ve pressure in middle ear Sudden, severe earache, deafness, tinnitus Vestibular symptoms uncommon Preventive measures

16. Acute Otitis Media Inflammation of the middle ear cleft – rapid onset – infective origin. Sporadic / Resistant / Persistent / Recurrent Clinical features Earache, otorrhoea , hearing loss, ear pulling Restlessness, decreased feed. Rhinitis Cough Fever Infective Viral (RSV, Influenza, Parainfluenza, Rhino, Adeno) Bacteria (Streptococcus pneumoniae, H.influenza and M. catarrhalis)

17. Stage of tubal occlusion/ Hyperemia Deafness, earache Retracted TM, Loss of cone of light with CHL Stage of Presuppuration / Exudative Severe earache, deafness, tinnitus, fever and restlessness Congested TM, Cart wheel appearance with CHL.

18. Stage of Suppuration Excruciating pain, deafness, high grade fever. Bulging congested TM with or without mastoid antrum tenderness. Stage of Resolution/ Complication

19. Investigations – Tympanometry, Swab in persistent discharge. CBC – (Recurrent AOM – ID anemia , WBC disorders)

20. Management Conservative – Analgesics and antipyrexials Antibiotics Antihistamines and decongestants Myringotomy in Bulging TM Surgery – limited role in uncomplicated cases

21. Complications Extracranial TM perforation Acute mastoiditis Petrositis Facial nerve palsy Labyrinthitis. Intracranial Meningitis Extradural abscess Sudural empyema Sigmoid sinus thrombosis Cerebritis Brain abscess Otic hydrocephalus.