Otitis media Dr Abdussalam M jahan ENT depart

Otitis media Dr. Abdussalam M jahan ENT depart, Misurata university, faculty of medicine

Anatomy of the Ear

Inflammation of Middle ear Acute OM A non supp OM A supp. OM A necrotizing OM Chronic supp. OM Chronic non Supp. OM

Acute OM Acute inflammation of mucoperiosteal lining of middle ear cleft. It is common disease especially in children. . Why. (ET, URTI, Ad. T, bottle feeding).

Bacteriology: Streptococcus Hemolyticus Streptococcus pnumoniae Homophiles influenza Route ET Perforated TM

Stages of AOM Tubal occlusion ET obstruction. → –ve pr. → ME mucosa swollen and hyperaemic. Catarrhal stage ME full of secretion Suppuration stage rupture of TM → pus come out Stage of resolution ME retained Normal

C/P of AOM Tubal occlusion Fullness of ear + mild otalgia Catarrhal stage increase pain + fever Suppuration stage sever pain, high fever, deafness discharge, pain disappear, decrease fever

Signs of AOM • • • Congested TM. Pulging of TM. Deafness. Purulent discharge. Perforated TM.

Treatment of AOM • • • Ear cleaning. Systemic AB. Local Ear drops. analgesia. Myringotomy +/-.

Chronic OM Chronic supp. OM Safe ( Tubotympanic) Chronic non Supp. OM Unsafe (Attico antral)

CSOM Chronic inflammation of middle ear cleft (ME cavity, ET, Mastoid). It is common disease in low socioeconomic classes.

Safe ( Tubotympanic) Unsafe (Attico antral) cholesteatoma Definition: it is an epithelial cyst that contains keratin presented in middle ear ( presence of skin in a wrong place).

Tubotympanic (safe) Chronic inflammation Involve the ant part of ME ( tympanic cavity + ET) Microbiology: Grame +ve bacteria

S/S of CSOM safe • otorrhea. - profuse - mucopurulent. - odorless. - on / off. • Deafness ( -ve Rinne test). • TM perforation. . central.

Treatment of safe CSOM • • Cleaning ( suction or mopping). Systemic AB. Local ear drops. Surgical intervention: myringoplasty

Attico antral (unsafe) Chronic inflammation Involve the post part of ME ( attic, antrum, mastoid) Microbiology: Grame -ve bacteria & anaerobic

Attico antral (unsafe) Cholesteatoma Definition: it is an epithelial cyst that contains keratin presented in middle ear ( presence of skin in a wrong place).

Cholesteatoma Acquired primary Congenital secondary

S/S of CSOM unsafe • otorrhea. - scanty. - purulent. - offensive. - continuous. • Deafness ( -ve Rinne test). • TM perforation, marginal. • Polypi or granulation tissues.

Treatment of unsafe CSOM • Only Surgical intervention: Mastoidectomy - Ct scan is important in management of CSOM with Cholesteatoma.

Difference between safe and unsafe OM cholesteatoma discharge perforation No Profuse central Site of infection ETtympanic Treatment Yes scanty, offensive peripheral cavity, medical or surgical attic , Antrum always surgical

Complications of CSOM Cranial Intracranial Extracranial

Chronic non Supp. OM Secretory OM or OM with effusion ( glue ear) definition: Collection of fluids behind intact TM with out s/s of inflammation. Common in children under 9 yr. etiology: - ET dysfunction. - post unresolved AOM.

ET dysfunction Increase compliance children Abnormal opening mechanism as in Cleft palate. Secretional -Deficient mucociliary clearance as in Kartageners syndrome -Abnormal viscid sec: Mucoviscidosis Functional Mechanical Adenoid NP tumours Tubal oedema as post RT Tubal scaring as post Ad

So causes of SOM • • • Adenoid hypertrophy. NP carcinoma. Post AOM. Abnormal viscid sec. Abnormal ciliary function. Post op scaring

symptoms of SOM • • Hearing loss. Feeling of blockage. tinnitus. Symptoms of cause.

Signs of SOM • • Retracted TM. Fluid level ( hair line). Air bubbles. TFT → CHL.

Investigations of SOM • • Tympanometry. PTA. X- ray NP. CT scan if needed.

Treatment of SOM medical • • mucolytic. Steroids. Decongestant N drop. Valsalva. surgical • Ventilation tube ( Grommet). • Adenoidectomy

Chronic non Supp. OM Adhesive OM definition: It is a complication of SOM, in which the TM become thin, atrophic, and adherent to the middle ear structures. treatment: - grommet. - tympanoplasty.

clinical case: 5 yrs old child presented with: Nasal obstruction + night snoring Chronic nasal discharge. Decrease hearing. On examination: Retracted TMFluid behind TMTM not perforated. What is Dx and how to confirm.

THANK YOU Please visit: www. Zahrawi. Ly