Acute catarrhal otitis media
Deafness ? No pain
Treating underlying cause
Inflation of the Eustachian tube
Acute middle ear effusion
More sever variety of catarrhal OM
URTI , Allergy , Barotrauma
More marked sx ( deafness, tinnitus ,vertigo)
Congested , dark orange hue to it , may be retracted ,
little or no movement of the TM, splitted cone of light,
Medical or surgical
ACUTE SUPPURATIVE OTITIS
MEDIA more commoner in children than in adults.
it can follow URTI which is often viral initially or it
can be secondary to the introduction of water through
a perforation .
Viral or bacterial
adenovirus , rhinovirus
streptococcus pneumonia , haemophilus influenza,
sudden onset dull ache in the ear which may become more
fever ( common in children )
examination will show the drum very red & marked
bulging outwards of the TM with loss of surface anatomy
if the TM perforated or if there is preexisting perforation a
copious mucopurulent & occasionally blood stained
discharge coming from the ear
once the drum rupture the pain will decrease to a dull ache
URTI should be treated .
a 5 day course AB given as amoxillin _ clavelinic acid
analgesia for pain if present
myringotomy needed for reliving the sever pain
which is due to accumulated pus in the middle ear
which is not resolved by AB
if there is long standing perforation with recurrent
attacks of AOM so myringoplasty is prepared for.
CHRONIC OTITIS MEDIA
Deafness main sx
Otalgia ? Other pathology ?
CHRONIC MIDDLE EAR EFFUSION :
serous or secretory otitis media
In children & adults ?
chronic Eustachian tube dysfunction or obstruction
due to blockage of the tube in the middle Ear or
URTI as sinusitis , nasopharyngitis , allergic rhinitis
unexplained chronic middle ear effusion specially in
older person? suspicion of nasopharyngeal carcinoma.
blocked feeling in the ear
occasionally tinnitus or mild vertigo
the patient is unable to clear the ear by autoinflation .
retraction of the TM in whole or part , retraction of pars tensa is seen &
the handle of malleus appears shortened & to lie in more horizontal
position. The lateral process of the malleus may thus appear more
prominent . the drum often have a dark or orange hue to it &
occasionally a fluid level may be seen .
Examination of the nose may reveal signs of the sinusitis or allergic
rhinitis , occasionally a nasopharyngeal tumor detected on
examination of the nasopharynx .
Investigation : audiometry will reveal a CHL
diminished or absent TM mobility on tympanogram
show flat curve which indicate –ve middle ear pressure
Treating of underlying cause
myringotomy +/- grommet