Common cause of deafness in children.

1. BRIG ANWAR UL HAQ
00923018513303
Otitis Media
With
Effusion

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 Stratified
 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.

12. Etio-Pathology
Prevalance
 Age
 Bimodal - infancy
 - primary school
 Peak - one year of age.
 Season
 Winter>Summer
 Respiratory Tract Infections
 Ear Infections

13. Etio-Pathology
AOM Episode
 Largest single factor
 Antibiotics - No effects
 Contact with other children
Hereditability
 Greater concordance
 monozygotic - Higher
Incidence
 dizygotic - Lesser Incidence

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

15. Symptoms
 No symptoms
 Deafness
 Tinnitus
 Pain Ear

17. Symptoms
 Associated Symptoms
Nasal Blockage
Nasal Discharge
Pain Throat
Fever

18. Examination
 GPE
 Systemic Examination
 Repiratoty System
 ENT Examination
 Nose
 Nasopharynx
 Ears
Pneumatic Otoscopy
Tunning Fork Tests

19. Otoscopy
 Different combinations of
 Retraction of the pars tensa
 Variations in its colour.

20. Otoscopy
 Colour
 yellow
 Blue
 fluid levels
 air bubbles
 Position
 Retracted
 Full
 Mobility
 Reduced

22. Retraction

23. Bubbles

24. Air Fluid Level

28. Bulging

35. TYMPANOMETERY

36. PURE TONE AUDIOMETERY

37. X RAY NECK LAT VIEW FOR ADENOIDS

38. Treatment
 No Treatment
 Spontaneous Recovery

39. 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.

40. 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.

41. 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.

42. 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.

43. 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.

49. 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.

50. Ventilation tubes

51. 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.

52. Management
Adenoidectomy
 Mechanism in -Unclear.
 Removes a chronic source of infection
Nasopharynx.

53.  E:PRESENTATIONSAnimationsEARGlue
Ear.flv

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

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