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Secretory otitis media

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CSOM TUBO TYMPANIC DISEASE
CSOM TUBO TYMPANIC DISEASE
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Secretory otitis media

  1. 1. Secretory Otitis Media Dr. Mohammed Shafeeq.
  2. 2. SECRETORY OTITIS MEDIA ● Synonyms – – Serous Otitis Media/ – Mucoid Otitis Media/ – ● Otitis media with effusion/ 'GLUE EAR' Hippocrates in 450 BC
  3. 3. SECRETORY OTITIS MEDIA ● ● It is an insidious onset inflammation of the middle ear characterized by accumulation of non-purulent effusion in the middle ear cleft Incidence – Most commonly seen in school going children (3-8yrs age group)
  4. 4. SECRETORY OTITIS MEDIA ● PATHOGENESIS – – Malfunctioning of Eustachian Tube Increased secretory activity of middle ear mucosa
  5. 5. ● ET dysfunction – – – Politzer in 1867 Eustachian tube fails to aerate middle ear and also unable to drain secretions due to functional ET obstruction (decreased tubal stiffness/inefficient opening mechanism. Results in inadequate ventilation of middle ear with resulting negative middle ear pressure
  6. 6. ● Increased secretory activity of middle ear mucosa – – Brieger in 1914 As a result of inflammatory response – hypertrophy of middle ear mucosa – hyperplasia of mucous glands – Increased secretions
  7. 7. ● ETIOLOGY – ET dysfunction : Adenoid hypertrophy, Chronic rhinitis/sinusitis, Chronic tonsillitis/ Benign/Malignant tumours of oropharynx, palatal defects – Allergy – Unresolved AOM – Viral infections
  8. 8. ● MICROBIOLOGY Bacteria – S. pneumoniae, H. Influenzae (60%) Others – Staph. aureus, B. catarrhalis, group A Streptococcus. Virus – Respiratory Syncytial Virus (RSV)
  9. 9. ● SYMPTOMS – Hearing Loss – Delayed & Defective speech – Mild ear aches
  10. 10. ● SIGNS Otoscopy: – – – – – Severely retracted TM with foreshortening of HOM / reduced TM mobility TM may be dull/opaque and may have an amber hue Thin leash of blood vessels along HOM/ periphery of TM Fluid level/ air bubbles may be seen Severe cases, middle ear fluid – purplish/blue - haemorrhage
  11. 11. INVESTIGATIONS – Audiometry : CHL 20-40 dB, may be assoc. with SNHL – Impedance audiometry : objective test, presence of fluids – reduced compliance/ flat curve with shift to negative side – X-ray mastoids – may show clouding of air cells due to fluid
  12. 12. TREATMENT ● ● Aim – removal of fluid/ prevention of recurrence MEDICAL: – – – – Decongestants – topical/systemic Anti allergic measures – antihistamines/steroids Antibiotics – Amoxicillin, AmoxicillinClavulanate (30-40mg/kg/day in 3 divided doses) / Cefixime (8-10mg/kg/day in 2 divided doses) Middle ear aeration – Valsalva manoeuvre/ Politzerisation/ ET catheterisation
  13. 13. ● SURGICAL – Myringotomy & aspiration of fluid – Ventilation tube/Grommet insertion – ● ● Surgical treatment of causative factor (adenoidectomy / tonsillectomy) Myringotomy with grommet insertion with/without adenoidectomy has become ultimate treatment in chronic SOM. Indications for surgery in SOM : – Chronic effusion more than 3 months – CHL > 15 db – Nasopharyngeal neoplasms for which RT may be necessary
  14. 14. MYRINGOTOMY It is a procedure in which incision is made on TM for purpose of draining suppurative/non suppurative effusion of middle ear and/or provide aeration in case of ET dysfunction by inserting ventilation tube (grommet) ● STEPS: – – – – Pt put under microscope, ear canal cleared of debri/wax Using myringotome small radial incision made on postero inferior / antero inferior quadrant of TM, and effusion is sucked out If aspirate is thick/glue like two incisions are made – anteroinferior & antero superior quadrants of TM – 'Beer can principle' Ventilation tube is inserted
  15. 15. ● Myringotomy – Post OP care : – In SOM wad of cotton is left for 24-48hrs – TM incision heals rapidly – No water entry for atleast 1 week – ● If grommet inserted prevent water entry as long as grommet in position Complications – Injury to IS jt – Injury to jugular bulb – Middle ear infection
  16. 16. COMPLICATIONS ● Atelectasis of middle ear ● Ossicular necrosis ● Tympanosclerosis ● Retraction pockets & Cholesteatoma ● Cholesterol granuloma
  17. 17. Thank You

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