Otitis Media with Effusion

Common cause of deafness in children.

1. BRIG ANWAR UL HAQ 00923018513303 O titis M edia W ith E ffusion

2. OME Chronic accumulation of mucus/non purulent effusion within the middle ear and in mastoid air cell system (Middle Ear Cleft). Duration >12 weeks

3. Synonyms Glue ear Serous otitis media Chronic nonpurulent otitis media

4. Etio -Pathology Preceded by an episode of AOM with Otalgia and fever. Inflammation of eustachian tube epithelium Flat cuboidal mucosa Partially replaced by thickened Pseudo S tratified Mucus secreting epithelium. Goblet cells are usually present Mucus secreting cells are formed.

5. Etio -Pathology Characteristics of effusion mixture of the secretions of the epithelial cells goblet cells mucus glands along inflammatory transudate / exudate Viscous Goblet Cells Mucous glands

6. Etio -Pathology Bacteriology Streptococcus Pneumonia Haemophilus Influenzae Branhamella Catarrhalis The incidence of pathogens was higher in the younger children

7. Etio -Pathology Eustachian tube dysfunction Viral upper respiratory tract infection, allergic reaction, Pollutents Cigarette smoke. Adenoids GERD Craniofacial Abnormalities cleft palate Poor ET function. bifid uvula Down and turner syndromes are prone to have OME.

8. Down and Turner Syndrome

9. Bottle Feeding

10. Etio -Pathology Allergy Allergy – Swelling - Infection GERD Its common in children Pepsin is found in the effusion. Investigations are required to clarify the role.

11. Etio -Pathology Prevalance Age B imodal - infancy - primary school Peak - one year of age. Season Winter>Summer Respiratory Tract Infections Ear Infections

12. Etio -Pathology AOM Episode Largest single factor Antibiotics - No effects Contact with other children Hereditability G reater concordance monozygotic - Higher Incidence dizygotic - Lesser Incidence

13. Etio -Pathology Race Prevalence is different in different races Gender No difference in male or females Smoking No effect of parenteral smoking detected.

14. Symptoms No symptoms Deafness Tinnitus Pain Ear

15. Symptoms Associated Symptoms Nasal Blockage Nasal Discharge Pain Throat Fever

16. Examination GPE Systemic Examination Repiratoty System ENT Examination Nose Nasopharynx Ears Pneumatic Otoscopy Tunning Fork Tests

17. Otoscopy Different combinations of Retraction of the pars tensa Variations in its colour .

18. Otoscopy Colour yellow Blue fluid levels air bubbles Position Retracted Full Mobility Reduced

19. Retraction

20. Bubbles

21. Air Fluid Level

22. Bulging

23. TYMPANOMETERY

24. PURE TONE AUDIOMETERY

25. X RAY NECK LAT VIEW FOR ADENOIDS

26. Treatment No Treatment Spontaneous Recovery

27. Medical Management-AIMS Speed up the resolution Antibiotics Benefits in first two weeks long term (> 6 weeks) - not recommended Nasal Decongestants No Significant effect. Mucolytics No Significant result.

28. Medical Management-AIMS Speed up the resolution Antibiotics Benefits in first two weeks long term (> 6 weeks) - not recommended Nasal Decongestants No Significant effect. Mucolytics No Significant result.

29. Management Nasal 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.

30. Management Nasal 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.

31. Management Nasal 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.

32. Management Surgical 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.

33. Ventilation tubes

34. Management Ventilation Tubes Synonyms Myringotomy tube, Tympanostomy tube Pressure equalization (PE) tube . Types 1. 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.

35. Management Adenoidectomy Mechanism in -Unclear. R emoves a chronic source of infection Nasopharynx .

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

37. Outcomes Hearing VT alone - 12 dB. Adenoidectomy - additional 3-4dB.

38. Complications Displacement of tube to middle ear Perforation of TM. Scarring and weakening of the TM. Early extrusion or blockage. Cholesteatoma formation.

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