Serous otitis media

basic understanding of glue ear

1. SEROUS OTITIS MEDIA Dr Chandra Bhan Assistant professor MRAMC

2. S YNO N YMS Serous Otitis Media Secretory Otitis Media Glue Ear Mucoid otitis media otitis media with effusion Exudative otitis media Tubotympanic catarrh

3. DEFINITION Chronic a ccumulation of non purulent serous or muc oid fluid within middle ear cleft. Time that fluid has to be present for the condition to be chronic is usually taken as 12 weeks . Mostly a ffects children Insidious onset Sterile in nature. Behind an intact and retracted TM . With conductive hearing loss

4. 50% of all children- before the first birthday, 80% of all children - before the third birthday – have OME Prevalence bimodal at 2 & 5 yrs when child first attends play group school & when goes to primary school More during winters Each episode of ASOM increases odd ratio of developing OME by 12 M > F

5. AETIOLOGY ET Malfunctioning. Obstruction Adenoid hyperplasia Tumours (nasopharyngeal carcinoma) Palatal defects Palatal paralysis Hyperbaric oxygen therapy Oedema during radiation therapy Spread of Infection Chronic adenoiditis Chronic rhino-sinusitis Chronic tonsillitis High prevalence in HIV patients

6. Increased Secretions Allergy Milk Cigarette smoke (specially mother smoking) Obstruct the ET by oedema and increases the secretion as mucosa act as shock organ in such cases. Infections Unresolved AOM Viral Infections

7. PATHOGENESIS Eustachian tube dysfunction Failure of aeration Failure of drainage Increased secretion in ME Due to Increase in secretory glands Spontaneous resolution if Drainage via ET restablished Perforation of the tympanic membrane ocure If both continue  OME

8. CLINICAL FEATURES Hearing loss - up to 40 db Mild otalgia Ear fullness Tinnitus Children Delayed Speech and defective speech Poor Academics SYMPTOMS

9. Clinical Features: Signs Conductive h earing Loss - TFT Otoscopy - Signs of TM retraction. - Loss of light reflex -Colour – Yellow/Grey/ Blue -Thin blood vessel along handle of malleus ant periphery of tm Signs of Effusion Air Bubbles Fluid Levels

10. Pneumatic Otoscopy Used to assess the mobility and position of TM Observe TM movement by  Increasing Pressure in EAM – Siegel’s speculum  Increasing pressure in ME - Valsalva namoeuver TM may be Mobile/ Partially Mobile/ Immobile

11. Eva l ua t i o n TFT- Rinne - negative Weber- lateralized towards more diseased ear. ABC –normal both ear Audiometr y Pure Tone Audiometry Bilateral Conductive Hearng Loss 20 – 40 dB Sometimes SNHL due to fluid pressing round window

12. Tympanometry (sensitivity 96 %) Assess compliance of TM Mobility of TM on increase/ decrease of pressure in EAM Graphic representation 4 patterns  A/As/Ad/B/C In OME – B & C Reduced compliance with flat curve with a shift to negative side.

13. T y m p a n o g r a m 20 12

14. Radiology Xray Skull Latera l view  Adenoid Hyperplasia Xray Mastoid Schuller’s View  Clouding of air cell MRI  Absence of fluid does not imply an absence of OME, as one-third of patients in MRI study had fluid in mastoid, but not in the mesotympanum (Kew et al) Nasal and nasopharyngeal examination.

15. TREATMENT Medical Treatment Nasal decongestants Systemic Triaminic Syr 5-10 ml 8 hrly Phenylpropanolamine 12.5 mg/5ml Chlorpheniramine 2 mg/5ml Pseudoephedrine 25 mg Local Nasivion – Oxymetazoline 0.05% drops . Otrivin – Xylometazoline 0.1% drops .

16. Anti-allergy measures  Antihistamines  Nasal Steroids spray Surface tension lowering agent  N acetyl cyteine 30 mg tds X 15 days beneficial Antibiotics (no long term benefit, can be used for initial 2 wks) Middle Ear Aeration  Valsalva Maneuver

17. Surgical Treatment Myringotomy Myringotomy with ventillation tubes (improves hearing by 12 dB) Adenoidectomy (improves hearing by 8 dB) Tonsillectomy Cortical Matoidectomy (in failure of ventilation tube cases)

18. Ventilation tubes Also known as grommet Inserted through radial incision in AS or AI quadrant of TM. Longer a tube stays in situ longer it can be potentially benefit On other hand, longer a tube is in situ the greater the chance of complications like- Infection Granulation tissue Permanent perforation Thinning of TM with possible retraction

19. TYPES Shepard Armstrong Reuter Bobbin Good ie t tube Silicone T tube Shah tube FUNCTION Ventilate the middle ear Drain the middle ear Improve the hearing Epithelium will revert back to normal

20. Complications of ventilation tubes Intra op   Displacement into middle ear Damage to ossicles Early post op     Blockage Granulation around tube Ear infection Otorrhoea Late post op    Permanent perforation Tympanosclerosis TM atrophy & retraction

21. SEQUELAE OF OME Adhesive Otitis Media / TM atelectasis TM atrophy  Retraction Pockests  Cholesteatoma Ossicular Necrosis Tympanosclerosis Cholesterol grannuloma

22. Thank You