Otitis media

inflammation of the ear, usually distinguished as otitis externa (of the passage of the outer ear), otitis media (of the middle ear), and otitis interna (of the inner ear; labyrinthitis).

1. Asmat ullah MBBS,DLO, MCPS,FCPS ENT Department. Sandemen Provincial Hospital Quetta.

2. Diseases of the Middle ear

3. Otitis Media Definition: It is the inflammation of the mucous membrane of the middle ear cleft.

4. Classif ication Acute otitis media Non Suppurative Suppurative Chronic Otitis media Suppurative Non-Suppurative Specific type of otitis media (tuberculosis syphilis, diphtheria ). Adhesive otitis Media.

5. Non-Suppurat ive Otitis Media Synonyms : Secretory otitis Media Serous otitis Media Otitis media with effusion Glue ear

6. Definition : It is the accumulation of non-inflammatory exudate in the middle ear cavity following a series of Pathological changes in the mucous membrane of the middle ear . Commonly seen in Children. Non-Suppurat ive Otitis Media

7. Etio logy Tubal Occlusion Allergy Hypogammaglobulinemia

8. Symptoms : Blocking sensation of the ears Deafness – conductive type. It is usually Bilateral in Children and unilateral in Adults. The Child’s performance in school will be Low Wooly feelings in the Ear Autophony

9. Associated symptoms: Nasal discharge Nasal Obstruction

10. Signs: Tympanic membrane appears dull and lusterless but may occasionally appears congested in the initial Stage. Retraction of the tympanic membrane Evidence of fluid in the middle ear in which the fluid level may be seen as an air Bubble Mobility of the tympanic membrane is decreased Tuning Fork test

11. Investigations : Plane X-Rays PNS X-Ray Nasopharynx Audiometry PTA Impedance audiometry

12. Treatment : Prevention of the secretory otitis media. Removal of the possible cause, e.g. adenoid- ctomy. Anti allergy Advice the child to sit in the Front Row at School. Myringotomy with grommet insertion.

13. Acute Suppurat ive Otitis Media Definition : It is an Acute suppurative inflammation of the periosteal layer of the middle ear Cleft by suppurative Organisms. Incidence : It is Commonly seen in children but adults may also get affected.

14. Etio logy Routes of Infection : Eustachian tube Traumatic perforation Hematological

15. Common Organisms: Streptococcus Pneumococcus H. Influenza Moraxella catarrhalis Pseudomonas

16. Clinical Features Stage I – Stage of hyperemia Stage II – Stage of exudation Stage III – Stage of Suppuration Stage IV – Stage of coalescent mastoiditis Stage V – Stage of Complications Stage VI – Stage o resolution.

17. Chronic Suppura tive otitis Media Definition: It is defined as Chronic inflammation of mucoperiosteal lining of the middle ear Cleft.

18. Classif ication Tubotympanic type (Safe type) Attico-antral type (Dangerous type)

19. Tubotympanic Etiology Predisposing factors Inadequate Treatment Infection from surrounding areas some disease like tuberculosis are chronic from Beginning Pneumatization of mastoid Exciting Factors Gram negative organisms like pseudomonas, proteus. E.coli Streptococcus Staphylococcus

20. Symptoms : Discharge Active Quiescent Inactive Healed

21. Signs : Non-foul smelling Discharge. Tympanic membrane (Central perforation) Small , pinpoint perforation (less then 25%) Medium size (25-50%) Large Perforation (50-75%) Complete or Total.

22. Investi gations Culture and sensitivity Examination under microscope PTA (mild conductive loss between 20 to 30 dB) Patch Test X-ray of Mastoids X-ray PNS X-ray Soft tissue neck lateral View Diagnostic nasal endoscopy s

23. Attico-An tral Disease Definition : Attico-Antral disease is an unsafe disease because it associated with Cholesteatoma formation. Cholesteatoma : is Defined as a sac in the middle ear which lined by keratinizing stratified squamous epithelium as keratin debris

24. Classification of Cholesteatoma Cholesteatoma Congenital Acquired Primary Acquired Secondary Acquired

25. Theo ries Retraction pocket theory Theory of migration Metaplasia theory Implantation theory

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