This document discusses otitis media with effusion (OME), also known as glue ear, which is the presence of fluid in the middle ear cavity with a non-inflamed eardrum. It is one of the most common chronic ear conditions in children. The document covers the prevalence, etiology, diagnosis, natural history and management of OME. Key points include that Eustachian tube malfunction combined with infection are major underlying factors, tympanometry is the most accurate diagnostic test, and the majority of children see spontaneous resolution within 2-3 months without treatment. Treatment options discussed include parent counseling, watchful waiting, and medical therapies like antibiotics in some cases.
One can conduct an otoscopic examination at home with the help of an otoscope. Depending on the quality of the product, the otoscope price ranges between Rs. 10,000 and Rs. 20,000.
Myringotomy (from Latin myringa "eardrum") is a surgical procedure in which a tiny incision is created in the eardrum to relieve pressure caused by excessive buildup of fluid, or to drain pus from the middle ear. A tympanostomy tube is inserted into the eardrum to keep the middle ear aerated for a prolonged time and to prevent reaccumulation of fluid. Without the insertion of a tube, the incision usually heals spontaneously in two to three weeks. Depending on the type, the tube is either naturally extruded in 6 to 12 months or removed during a minor procedure.
One can conduct an otoscopic examination at home with the help of an otoscope. Depending on the quality of the product, the otoscope price ranges between Rs. 10,000 and Rs. 20,000.
Myringotomy (from Latin myringa "eardrum") is a surgical procedure in which a tiny incision is created in the eardrum to relieve pressure caused by excessive buildup of fluid, or to drain pus from the middle ear. A tympanostomy tube is inserted into the eardrum to keep the middle ear aerated for a prolonged time and to prevent reaccumulation of fluid. Without the insertion of a tube, the incision usually heals spontaneously in two to three weeks. Depending on the type, the tube is either naturally extruded in 6 to 12 months or removed during a minor procedure.
Chronic otitis media effusion, also known as chronic middle ear fluid, is a condition characterized by the long-term presence of fluid in the middle ear. The middle ear is the space behind the eardrum that contains the tiny bones responsible for transmitting sound vibrations to the inner ear
In this presentation there is complete content regarding its causes, pathophysiology, clinical manifestations, diagnostic evaluations and managements that can be done.
First of all as we know that otitis media is a disease condition related to ear infection and inflammations.
APA format in a SOAP Note format. 1 page long with questions as to dirkrplav
APA format in a SOAP Note format. 1 page long with questions as to which diagnosis would be accurate and why. I have included the references I need 3 peer review articles to be included
Patient Information:
Initials
: JS
Age
: 11
Sex
: M
Race
: Caucasian
SJ
CC:
Patient complaining of a mild right earache for the last two days and trouble hearing from that ear.
HPI
: James Jones is an 11 year old Caucasian male who presents to the clinic with complaints of a right earache for the last two days. The patient reports worsening pain at night when trying to fall asleep and difficulty hearing out of that ear. The patient rates is earache pain 5/10 and describes it as sharp and constant. The patient has taken 600mg ibuprofen with minimal relief of pain. The patient reports that he has been spending a lot of time swimming in the pool this summer.
Current Medications
:
1. Ibuprofen 600mg PRN for earache pain
Allergies:
NKA
PMHx
: Up to date on all immunizations. No significant PMH.
Soc Hx
: Patient lives with two siblings and supportive parents in a safe neighborhood in Boston. The patient is currently in middle school and enjoys playing soccer, fishing with his dad and swimming in his pool during the summer.
Fam Hx
: Maternal grandmother died of a stroke at the age of 70. No other significant family history.
ROS
:
GENERAL: No fever, fatigue or chills. No weight loss.
HEENT:
Eyes:
No visual loss, blurred vision, double vision or yellow sclerae.
Ears:
Patient reporting pain in right ear and hearing loss.
Nose,
Throat:
No sneezing, congestion, runny nose or sore throat.
SKIN: No rashes or itching.
RESPIRATORY: No shortness of breath, cough or sputum.
GASTROINTESTINAL: No anorexia, nausea, vomiting or diarrhea. No abdominal pain or blood.
NEUROLOGICAL: No headache, dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities. No change in bowel or bladder control.
LYMPHATICS: No enlarged nodes. No history of splenectomy.
ALLERGIES: No history of asthma, hives, eczema or rhinitis.
O.
GENERAL: Patient comes to the clinic with his grandmother, patient appears uncomfortable, is rubbing his right ear and having difficulty hearing.
HEENT: PEERLA.
Ears:
Right ear canal is erythematous and edematous with pus present, tympanic membrane is difficult to visualize. Hearing difficulty with right ear. Left ear canal is intact without erythema or edema, tympanic membrane is clear and intact.
Nose
: Nose is patent without any rhinorrhea.
Throat:
Oropharynx is clear, without erythema or exudates, mucous membranes are moist, pink and intact. (Sullivan, 2012).
SKIN: Skin color is normal for patient, intact, without rashes or lesions. Skin turgor is good.
RESPIRATORY: LS CTA bilaterally, no sternal retractions noted.
GASTROINTESTINAL: Abdomen is soft, nontender, nondistended. + BS in all quadrants. No bruits noted. No splenomegaly or masses present.
NEUROLOGICAL: Cranial ...
cleft lip and palate are the most common type of congenital anomalies. the worldwide prevalence of cleft lip and cleft palate ranges from 0.8 to 2.7 cases per 1000 live births. cleft lip is called cheiloschisis and cleft plate is called palatoschisis. Cleft lip is a gap or indentation in the lip or split continued up to the nostril due to the failure of fusion of the maxillary and medial nasal process.
Cleft palate is the condition in which the two plates of the skull that forms hard palate are not completely joined due to the failure of fusion of the lateral palatine processes, nasal septum and medial palatine process. EMBRYOLOGYPrimary palate forms during the 4-7th week of gestation when two maxillary processes and two medial nasal processes fuse.
Secondary palate forms in 6-9th weeks of gestation when palatal shelves change from vertical to horizontal position and fuse. Tongue migrates Antero-inferiorly.
Cleft lip occurs when an epithelial bridge fails.
Clefts of primary palate occur anterior to incisive foramen and clefts of secondary palate occur posterior to the incisive foramen.
ETIOLOGY Genetic: Non-syndromic inheritance (risk increases with parents or siblings or both affected); chromosome aberrations, associated with other syndromes like Van der Woude syndrome.
Environmental teratogens: Intrauterine exposure to the anticonvulsant phenytoin, alcohol, retinoic acid, maternal smoking, Rubella virus, thalidomide, aminopterin.
Maternal/intrauterine condition: Maternal diabetes mellitus and amniotic band syndrome.
Advanced paternal age
Unknown
CLASSIFICATION Prof. Balakrishnan (1975) classified cleft lip and palate according to the Indian context and divided them into three groups.
Group 1: Only cleft lip, which may be unilateral (right/ left), bilateral, or midline.
Group 2: Only cleft palate, which may be which also can be unilateral (right/left), bilateral, or submucosa.
Group 3: Includes cleft lip, alveolus, and cleft palate, which can be unilateral, bilateral, or midline. LAHSAL system for the classification of cleft lip and/or palate (2005) modified by Royal College of Surgeons Britain: LAHSAL system is a diagrammatic classification of cleft lip and palate. According to this classification, the mouth is divided into six parts. LAHSAL code indicates a complete cleft with a capital letter and an incomplete cleft with a small letter.
CLINICAL FEATURES Cleft lip: Notched vermilion border and may involve alveolar ridge.
Cleft palate: Nasal distortion, exposed nasal cavities.
Misaligned teeth.
Passage of milk through nasal passages during feeding.
Recurrent ear infection.
Speech difficulties.
Poor weight gain and failure to thrive.
DIAGNOSIS Newborn examination at birth
Palpate with a gloved finger or visual examination flashlight
In-utero ultrasonography
PROBLEMS OR COMPLICATIONS OF A CHILD WITH CLEFT LIP AND CLEFT PALATE Immediate Problems:
Feeding difficulty:
Infant with an unrepaired cleft palate will have ...
Management of Orofacial Cleft Dr. Sunil (2).pptx Management of Orofacial Clef...ssuser12303b
Management of Orofacial Cleft Dr. Sunil (2).pptxManagement of Orofacial Cleft Dr. Sunil (2).pptxManagement of Orofacial Cleft Dr. Sunil (2).pptxManagement of Orofacial Cleft Dr. Sunil (2).pptx
An ear infection (sometimes called acute otitis media) is an infection of the middle ear, the air-filled space behind the eardrum that contains the small vibrating bones of the ear. Children are more likely to get an ear infection than adults.
Because ear infections usually go away on their own, treatment can begin with pain control and monitoring of the problem. Sometimes antibiotics are used to kill the infection. Some people are prone to multiple ear infections. This can cause hearing problems and other serious complications.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
1. 06/18/14 1
Also
“Serous Otitis Media”, Mucoid Otitis Media”,
Glue Ear”, “Middle Ear Effusion”- Often abbreviated as “OME”
Dr. Ghulam Sequlain
ENT Surgeon
2. 06/18/14 2
“Otitis Media with Effusion”
is the presence of fluid in the middle ear
cavity with an eardrum that is not inflamed.
3. 06/18/14 3
Otitis media with effusion is one of the
commonest chronic otological conditions of
childhood.
Acute and Chronic forms have been
classified according to the mode of onset
or according to duration,
but this distinction is not very clear.
4. 06/18/14 4
PREVALENCE
At any point in time 5-10% of
children aged 1-6 years will
have OME in both ears. About
20% will have it in only one ear.
OME is more common in
winter.
Children often outgrow OME at
age of 6-7 years. Those children
with persisting OME after this
age have chronic eustachian
tube dysfunction and are very
high risk of developing serious
complications of OME.
5. 06/18/14 5
ETIOLOGY Several Factors:
Eustachian Tube Malfunction
Cleft Palate
Submucous cleft palate
Palatal palsy
Altered Mucuciliary System
Infection (Nose, Sinuses, tonsils, adenoids, pharynx)
Allergy. Middle ear effusion may occur as a part of nasal allergy.
Surfactant deficiency
Ultrastructural changes in cilia.
Fibrocystic disease
Hormonal factors
Other factors
Nasopharyngeal Disproportions
Craniofacial abnormalities
Racial facors affeting the shape and function of eustachian tube and
nasopharynx.
Adenoids
Neoplasms.
6. 06/18/14 6
The major underlying factors responsible for
production of otitis media with effusion are a
combination of EUSTACHIAN TUBE MALFUNCTION
with superadded INFECTION.
7. 06/18/14 7
The Eustachian Tube:
The middle ear is normally full of air. The moist
lining of the middle ear slowly absorbs oxygen
and nitrogen from the middle ear at a rate of 1
ml per day. Thus small amounts of air must
continually pass up the eustachian tube to
ensure the middle ear remains full of air. The
ear drum can only vibrate normally when the ear
canal and the middle ear are both full of air.
The eustachian tube has three functions:
To allow air to pass up or down the tube,
To allow middle ear secretions to drain
into the nasopharynx,
To prevent reflux of fluid back up the tube
into the middle ear.
8. 06/18/14 8
The eustachian tube is
normally closed and only
opens momentarily during
swallowing and yawning.
We normally swallow several
times a minute while awake
and once every five minutes
while asleep.
The eustachian tube in
children has poor support from
the cartilage and bone
surrounding the tube, and the
Tensor veli palatini muscle is
not as strong as it is in adults,
with the result that children
have much greater difficulty
equalizing middle ear
pressure.
9. 06/18/14 9
The eustachian tube works most efficiently when we
are upright. It works at 2/3 efficiency when we are at
an angle of 20 deg, and at 1/3 when we are lying
flat.
A child’s eustachian tube is shorter than an adult’s
and almost horizontal. Because of this, middle ear
secretions may not drain down the tube very well,
and nasopharyngeal secretions and fluids may reflux
into the eustachian tube more readily than in an
adult.
10. 06/18/14 10
DIAGNOSIS & SCREENING
HISTORY
Reduced Hearing especially with background noise like TV or in the
classroom.
Educational or behavioral problems. Mood Variations like quiet and
withdrawn to loud and aggressive. They can be very difficult to deal
with.
In younger children it may present as speech and language delay or
as an articulation defect.
Some times attention is drawn to it by frequent episodes of otalgia
which indicate an exacerbation of acute suppurative otitis media
superimposed on the middle ear effusion.
Sometimes presentation is with complications such as otorrhoea
secondary to perforation of the tympanic membrane.
11. 06/18/14 11
CLINICAL PRESENTATION
It is possible to recognize certain clinical subgroups of
otitis media with effusion:
Latent or overt hearing impairment without significant post nasal obstruction,
otalgia or URTI.
Obvious postnasal obstruction with hearing impairment but only occasionally
URTI, minimal allergy and rarely otalgia.
Upper and Lower RTI with generalized nasal obstruction and hearing
impairment without otalgia of which there may be three groups:
Non-specific catarrahal conditions
Rhinosinusitis
Allergy.
Recurrent otalgia and hearing impairment with only occasional occasional
otorrhoea, few URTIs, occasional mild nasal obstruction and / or mild allergy
Acute URTIs which are infequentluy tonsillitis, leading to otalgia, with
hearing impairment and occasional otorrhoea
Cases with chronic irreversible eustachian tube malfunction, eg., cleft
palate, Down’s other syndromes with craniofacial anomalies, or
ultrastructural cilial abnormalities of the respiratory tract mucosa.
13. 06/18/14 13
Degree of retraction of the pars tensa
may be assessed by the extent of
splitting and derangement of the light
reflex, by the rotation and displacement
of the malleus handle, and by the
prominence of the lateral process of the
malleus.
14. 06/18/14 14
The pars flaccida may be
indrawn to a variable
degree.
Attic retraction and
sometimes erosion of the
outer attic wall may occur at
later stage. The degree of
retraction of the TM reflects
the negative middle ear
pressure which reduces the
mobility of the TM.
The mobility can be
assessed by a pneumatic
otoscope or Siegle’s
pneumatic speculum.
15. 06/18/14 15
The colour and loss of
translucency of the
membrane range from
pale grey or amber to a
black or so called blue
drum.
It may be thickened , dull
and opaque or thin and
reflective.
Increased vascularization
of radial vessels is very
frequent and sometimes
of malleolar vessels.
18. 06/18/14 18
Tuning Fork Tests:
In children over 4 years
Rinne’s Test: A negative Rinne test predict
a hearing loss of 15 to 20 db.
19. 06/18/14 19
AUDIOLOGICAL ASSESSMENT
PURE TONE AUDIOMETRY
(Limited Diagnostic Value)
It does however, provide some
assessment of the severity of
the disease and as a guide by
which to monitor the progress
and the effects of treatment.
A hearing loss of 20-40 db is
common with OME. A 60 db
hearing loss can occaionally
occur but this should raise the
possibility of an underlying
sensorineural hearing loss.(1 in
1000).Audiograms are difficult to
obtain in children under 4 years.
FFA, Play audiometry, child
audiometry are used.
20. 06/18/14 20
TYMPANOMETRY
(Diagnostic)-
90% accuracy
The impedance meter
produces sound in the
ear canal at a constant
rate of 226 cycles per
second and constantly
measures the amount
of sound returning from
the eardrum under
different pressure
conditions.
Type “A” Tympanogram: Normal
The peak of a normal or type A tympanogram should fall
within the boundaries of middle ear pressure of -100 to
+100 (mmH20 ) and compliance 0.3 to 1.5 (Cm3)
Contd…
21. 06/18/14 21
Type “B” Tympanogram: OME
When the middle ear is filled with fluid the eardrum does not vibrate
well in response to sound wave no matter what pressure is applied to
ear drum. The recording is a flat graph. Wax or pus will give a low
volume and type B result. Perforated TM or functioning VT will give a
very high volume and B result.
Type “C” Tympanogram: Eustachian tube dysfunction.
Type “B/C”Typanogram:
This occurs when the middle ear is partly full of fluid and partly full of
air.In this situation the hearing loss is same as for OME. The
tympanogram has no definable peak, but is not flat. This represents a
stage before the middle ear is completely full of fluid, or the earliest
stage of resolution of the effusion.
22. 06/18/14 22
NATURAL HISTORY
The majority of children with OME of recent
onset improve spontaneously within 2-3 months.
An important part of treating OME of recent
onset is to wait for 2-3 months. The rate of
spontaneous improvement after 3 months is
very low, and the rate of complications
increases- hearing loss, speech and learning
delays, behavioural problems and complications
involving ear drum and middle ear itself.
23. 06/18/14 23
There are numerous forms of treatment of otitis
media with effusion and , as yet, a correct
management approach remains to be defined
(Lim, 1985)
Management of the effect of effusion on hearing
thresholds varies according to the duration and
severity of the hearing loss.
MANAGEMENT
24. 06/18/14 24
PARENT COUNSELLING
What can parents do for their child with Otitis Media with Effusion
DO NOT give the baby or child a bottle to drink in its cot or bed.
Babies should be breast or bottle fed in a “Head Up” position and not lying
flat.
Breast feeding helps to protect against ear infections. Breast feed for as
long as possible.
Although not proven to work it makes good sense for the mother to get her
child to blow his or her nose frequently to clear mucous from the nose. It
may also force air bubbles up the eustachian tube into the middle ear .
Cigarette smoking has been shown to cause OME and other resp. problems
as well. Do not smoke in the house, car, or near children.
If the child has other evidence of a cow’s milk allergy then a 6-8 week trial of
a diet free from dairy foods is worth trying.
If the child has Hay Fever try and find the source of the allergy and get rid of
it if possible.
Ask the teacher to put a child with OME at the front of the classroom and
always speak directly to the child. Lip reading helps to reinforce the child in
hearing.
Tilting the head of the bed up 8-12 inches may improve drainage from the
middle ear.
25. 06/18/14 25
MEDICAL TREATMENT
Treating nasal allergies : It has been shown in a number of trials that
antihistamines and decongestants, when given on their own, donot
improve OME. Intranasal steriods may help in Hay Fever.
A course of antibiotics: Greatly increase the chance of OME getting
better in the short term. Some studies have used ten days antibiotics,
and others upto thirty days, both with good results. If the child does not
improve after a course of antibiotics this is because of chronic
eustachian tube dysfunction and ventilation tube are likely to be
needed.
Inflation of Middle Ear: Valsalva’s Manoeuvre can be effective in older
children and adults. Otovent, a low pressure balloon blown up by the
nose increasing intranasal pressure is helpful.
Removal of Adenoids: Adenoidectomy reduces the chances of getting
a recurrence of OME, but not all benefit from removal of adenoids.
Mouth breathers or snorer’s best benefit.
Mucolytic Agents are some times helpful.
Role of Vasoconstrictor drops:
26. 06/18/14 26
SURGICAL TREATMENT
If OME persists for three months despite above measures it can
persist for many months or years and may result in a number of
complications, therefore surgical intervention is required.
MYRINGOTOMY: SURGICAL DRAINAGE OF MIDDLE EAR FLUID.
This allows air back into the middle ear cleft and the child’s hearing
returns to normal immediately, but the wound heals within few days
and condition my recur.
MYRINGOTOMY WITH VENTILATION
TUBE INSERTION:
This is done after myringotomy i.e.,
making a small cut in the TM, fluid is
sucked and a small tube is inserted to
keep the opening patent from weeks to
months.
27. 06/18/14 27
What are Ventilation Tubes?
Also called as
Tympanostomy tubes,
Pressure Equalising
Tubes, or Grommets.
These are small dumbell
shape tubes with a small
hole in the centre that
allows air to pass from
the ear canal into the
middle ear cavity.
They may have a small
thread, wire or tail on
their outer end.
They act as artificial
eustachian tubes
28. 06/18/14 28
Are Ventilation tubes a cure for OME?
About 50% or more children will require one set of ventilation
tubes. Another 50% will require reinsertion. Removal of
adenoids will further help to reduce the chance of OME
recurring.
Children with recurring OME despite several sets of ventilation
tubes are a very difficult group to treat:
►Should they have another set of small ventilation tubes which
may last only for few months?
►Should they have large ventilation tubes with a high rate of
complications?
►Should they have hearing aids?
►Should they be left with OME and a hearing loss and also the
risk of middle ear complications.
The underlying problem is chronic eustachian tube dysfunction
which may not resolve until 12-15 years of age.
29. 06/18/14 29
Should OME in single ear be
treated?
It is not necessary to treat OME urgently if it is in one ear
only.
Regular followup is required to ensure other ear remains
normal, and to check for complications of OME.
It may be worthwhile treating OME in one ear only in
following circumstances:
In Recurring acute otitis media,
learning and behavioural problems,
pain or retraction of the ear drum.
30. 06/18/14 30
What are Complications of
Ventilation Tubes?
TM perforation occur in 1% children with small tubes
and 30% in large tubes.
Infection from water getting into the middle ear does
occur esp. soapy water.
Tympanosclerosis,
Fall into the middle ear requiring removal under G/A,
Granulation tissue formation around the tube.