This document provides information about otitis media with effusion (OME), also known as glue ear. It defines OME as a chronic accumulation of mucus or non-purulent effusion in the middle ear cavity lasting more than 12 weeks. The document discusses the etiology, symptoms, examination findings, and treatment options for OME. Treatment may involve watchful waiting, medical management using decongestants or mucolytics, or surgical insertion of ventilation tubes to drain the middle ear.

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.