Types of Otitis Media by Dr. Haseeb Ahmed - dec 2011

Detailed Presentation on Otitis Media and Its types. 4thyr MBBS presentation during ENT rotation at Ziauddin Medical University.

1. Types of Otitis Media By Prof. Haseeb Ahmed Bhatti 2008-98

2. OTITIS MEDIA DEFINITION Otitis Media is the Inflammation of part or all of the lining mucosa of the middle ear cleft i.e the eustachian tube, tympanic cavity, attic, aditus, antrum and mastoid air cells.

3. CLASSIFICATION of OTITIS MEDIA Otitis media is a broad subject which could be classified according to: (1) Duration (2) Nature of fluid/discharge : Suppurative & Non-Suppurative . (3)Otitis media with effusion and Aero-otitis media (4) Causative organism- bacterial otitis media (common) and specific otitis media e.g. Tubercular and syphilitic otitis media(less common).

4. Classification of Otitis Media (according to the duration of illness) ACUTE Rapid Onset Of symptoms, <3 Weeks coure SUBACUTE Symptoms lasting for 3weeks to 3months CHRONIC Symptoms lasting for 3months and longer

5. TYPES OF OTITIS MEDIA ACUTE Acute otitis media widout effusion Acute otitis media with effusion Aero otitis media Acute viral otitis media CHRONIC Chronic suppurative otitis media(TT&AA) Tuberculous otitis media Syphilitic otitis media

6. Acute Otitis Media (without effusion) It is the acute inflammation of the mucosal lining of the middle ear cleft. The infection affects infants and children more commonly than the adults. Normal AOM

7. AETIOLOGY Extension of Infection from Nasopharynx ( upper respiratory tract infections) Via Eustachion tube Through Perforation or Grommet Often starts with Viral infection (RSV,Rhinovirus,Parainfluenza virus,Influenza virus) followed by Bacterial infection (Strep.Pneumoniae,H.Influenza,M.catarrhalis & Staph. Aureus)

8. Predisposing Factors Recurrent attacks of common cold, URI Tonsilitis Adenoids Chronic rhinitis & sinusitis Nasal Allergy Tumours of nasopharynx Cleft palate Eustachian tube dysfunction

9. PATHOLOGY The progression of disease is divided into four stages: Tubal occlusion-hyperemia Pre-suppuration/Exudation Suppuration Resolution or Complication 1. 2. 3. 4.

10. 1 2 4 3

11. Clinical Presentation Depends upon the Stage of disease Symptoms : Pain( moderate to severe, most severe in presuppuration stage) Decrease in hearing ability Discharge Fever Malaise Headache

12. TREATMENT Medical : Bed Rest Antibiotics Analgesics Nasal decongestants Treatment of Predisposing factors Surgical: Myringotomy Tympanoplasty (if necessory in late stage)

13. OTITIS MEDIA WITH EFFUSION Accumulation of non-purulent/sterile fluid in the middle ear cleft resulting in hearing impairment. Serous OM, Mucoid OM, ‘Glue Ear’

14. PATHOGENESIS

15. AETIOLOGY Eustachian tube dysfunction Allergy Palatal abnormalities Viral Infection Nasopharyngeal tumors/Adenoids Environmental ( bottle feeding,passive smoking etc)

16. CLINICAL FEATURES SYMPTOMS

17. CLINICAL FEATURES OTOSCOPIC FINDINGS

18. DIAGNOSIS History Otoscopy(Pneumatic otoscopy) Pure Tone Audiometry Tympanometry Speech Audiometry X-ray Nasopharynx Soft Tissue

19. TREATMENT

20. AERO-OTITIS MEDIA It Is a Non-Suppurative condition resulting from failure of eustachian tube to maintain middle ear pressure at ambient atmospheric level. (OTITIC BAROTRAUMA)

21. As aircraft climbs, the higher pressure in the ear is equalized with outside air. However, in descent the eustachian tubes do not open automatically and pain is experienced in the ear. This condition is prominent when one is flying with sinus congestion or cold. In extreme cases it may result in injury to the ear. MECHANISM

22. CLINICAL FEATURES

23. C hronic S uppurative O titis M edia CSOM is the chronic (>3 months duration) inflammation of the muco-periosteal lining of the Middle Ear cleft

24. OTITIS MEDIA Acute ASOM/AOM Subacute Chronic CSOM Tubotympanic (Mucosal disease) Atticoantral (Cholesteatoma) Active mucosal disease Inactive disease

25. Diff B/w types of CSOM Tubotympanic Safe type AtticoAntral UnSafe type Discharge Profuse, mucoid, odourles Scanty, Purulent, Foul-smelling Perforation Central Attic or Marginal Granulation Uncommon Common Polyp Pale Red & Fleshy Cholesteatoma Absent Present Complications Rare Common Audiogram Mild to Moderate Conductive deafness Conductive or Mixed deafness

26. CSOM –Tubotympanic Types & Pathology Types Active :when the ear is actively discharging Inactive :when the ear is dry Pathology Perforation is almost always central Mucosa is inflammed, edematous Polyps may be seen Ossicular chain is usually intact Mastoid is usually cellular

27. Tubotympanic CSOM Microbiology Pseudomonas Aeroginosa Proteus E . Coli Pneumococci Streptococci Staphylococcus

28. TREATMENT OPTIONS Suction clearance. Avoidance of water. Treat primary cause in U/LRT. Antibiotics –Systemic and Topical. Surgical disease clearance - Mastoidectomy . Tympanoplasty Closure of TM defect - Myringoplasty Reconstruction of ossicles – Ossiculoplaty

29. Attico-antral type of CSOM “ CSOM with Cholesteatoma ”

30. This type of C.S.O.M. is considered as dangerous / unsafe type. This type of CSOM is associated with formation of Cholesteatoma , granulation tissues & occasionally cholesterol granulomas. If left untreated, it leads to serious complications involving the temporal bone and cranial cavity & brain.

31. What is a Cholesteatoma ? Cholesteatoma is simply “skin in wrong place” Aural cholesteatoma is a bag of Stratified squamous epithelium within the middle ear which contains desquamated epithelial debris (mainly keratin) and germs. (This term is a misnomer: it is neither a tumor nor it contains cholesterol crystals The correct term : a ‘ Keratoma ’.

32. POLYP Cholesteatoma

33. SYMPTOMS

34. Investigations Aural swab Ear discharge can be taken for C/S. X-ray mastoids Audiometry (hearing test) CT scan MRI

35. TREATMENT Surgical Canal wall up Simple or Combined Approach Tympanoplasty Canal wall down Radical Mastoidectom, Modified radical Mastoidectomy, Atticotomy. Reconstructive Myringoplasty Tympanoplasty

36. TUBERCULAR OTITIS MEDIA

37. PATHOLOGY (Slow & Insidius)

38. CLINICAL FEATURES

39. DIAGNOSIS TREATMENT Culture, Histopathology, Cxray ATT, Ear toilet/prevention, Surgery

40. SYPHILITIC OTITIS MEDIA

41. MANAGEMENT History & complete ENT examination Probable diagnosis Investigations Definite diagnosis Antisyphilitic treatment Aural toilet Control of secondary infection Surgery for removal of sequestra

42. So, At the End of the Presentation our objective was….

43. TYPES OF OTITIS MEDIA ACUTE Acute otitis media widout effusion Acute otitis media with effusion Aero otitis media CHRONIC Chronic suppurative otitis media(TT&AA) Tuberculous otitis media Syphilitic otitis media

44. Haseeb Ahmed Bhatti