inflammation of the ear, usually distinguished as otitis externa (of the passage of the outer ear), otitis media (of the middle ear), and otitis interna (of the inner ear; labyrinthitis).

2. Asmatullah
MBBS,DLO,MCPS,FCPS
ENT Department.
Sandemen Provincial Hospital
Quetta.

3. Diseases of the Middle ear

4. Otitis Media
Definition:
It is the inflammation of the mucous membrane of the middle ear cleft.

5. Classification
1) Acute otitis media
a) Non Suppurative
b) Suppurative
2) Chronic Otitis media
a) Suppurative
b) Non-Suppurative
3) Specific type of otitis media (tuberculosis syphilis, diphtheria).
4) Adhesive otitis Media.

6. Non-Suppurative Otitis Media
Synonyms :
• Secretory otitis Media
• Serous otitis Media
• Otitis media with effusion
• Glue ear

7. Definition : It is the accumulation of non-inflammatory
exudate in the middle ear cavity following a series of
Pathological changes in the mucous membrane of the
middle ear . Commonly seen in Children.
Non-Suppurative Otitis Media

8. Etiology
1. Tubal Occlusion
2. Allergy
3. Hypogammaglobulinemia

9. Symptoms :
• Blocking sensation of the ears
• Deafness – conductive type. It is usually Bilateral in Children and
unilateral in Adults.
• The Child’s performance in school will be Low
• Wooly feelings in the Ear
• Autophony

10. Associated symptoms:
1. Nasal discharge
2. Nasal Obstruction

11. Signs:
• Tympanic membrane appears dull and lusterless but may occasionally
appears congested in the initial Stage.
• Retraction of the tympanic membrane
• Evidence of fluid in the middle ear in which the fluid level may be seen as
an air Bubble
• Mobility of the tympanic membrane is decreased
• Tuning Fork test

13. Investigations :
• Plane X-Rays
• PNS
• X-Ray Nasopharynx
• Audiometry
• PTA
• Impedance audiometry

15. Treatment :
• Prevention of the secretory otitis media.
• Removal of the possible cause, e.g. adenoid- ctomy.
• Anti allergy
• Advice the child to sit in the Front Row at School.
• Myringotomy with grommet insertion.

16. Acute Suppurative Otitis Media
Definition :
It is an Acute suppurative inflammation of the periosteal layer of
the middle ear Cleft by suppurative Organisms.
Incidence :
It is Commonly seen in children but adults may also get affected.

18. Etiology
Routes of Infection :
1. Eustachian tube
2. Traumatic perforation
3. Hematological

19. Common Organisms:
• Streptococcus
• Pneumococcus
• H. Influenza
• Moraxella catarrhalis
• Pseudomonas

20. Clinical Features
1. Stage I – Stage of hyperemia
2. Stage II – Stage of exudation
3. Stage III – Stage of Suppuration
4. Stage IV – Stage of coalescent mastoiditis
5. StageV – Stage of Complications
6. StageVI – Stage o resolution.

21. Chronic Suppurative otitis Media
Definition:
It is defined as Chronic inflammation
of mucoperiosteal lining of the middle
ear Cleft.

22. Classification
• Tubotympanic type (Safe type)
• Attico-antral type (Dangerous type)

23. Tubotympanic
Etiology
• Predisposing factors
• InadequateTreatment
• Infection from surrounding areas
• some disease like tuberculosis are chronic from Beginning
• Pneumatization of mastoid
• Exciting Factors
• Gram negative organisms like pseudomonas, proteus. E.coli
• Streptococcus
• Staphylococcus

24. Symptoms :
• Discharge
• Active
• Quiescent
• Inactive
• Healed

25. Signs :
• Non-foul smelling Discharge.
• Tympanic membrane (Central perforation)
• Small , pinpoint perforation (less then 25%)
• Medium size (25-50%)
• Large Perforation (50-75%)
• Complete orTotal.

26. Investigations
• Culture and sensitivity
• Examination under microscope
• PTA (mild conductive loss between 20 to 30 dB)
• PatchTest
• X-ray of Mastoids
• X-ray PNS
• X-ray Soft tissue neck lateralView
• Diagnostic nasal endoscopy s

27. Attico-Antral Disease
Definition :
Attico-Antral disease is an unsafe disease because it associated with
Cholesteatoma formation.
Cholesteatoma :
is Defined as a sac in the middle ear which lined by keratinizing stratified
squamous epithelium as keratin debris

28. Classification of Cholesteatoma
Cholesteatoma
Congenital Acquired
Primary
Acquired
Secondary
Acquired

29. Theories
1.Retraction pocket theory
2.Theory of migration
3.Metaplasia theory
4.Implantation theory

31. ThankYou