Otitis media with effusion ome

OTITIS MEDIA WITH EFFUSION

(OME)
1

DR. SUPREET SINGH NAYYAR, AFMC

www.nayyarENT.com 2012

Synonyms
2

Serous Otitis Media

Secretory Otitis Media

“Glue Ear”


Definition
3

 Chronic accumulation of mucus within middle ear
and sometimes mastoid air cell system
 Time that fluid has to be present for the condition to
be chronic is usually taken as 12 weeks (Scott Brown)
 Affects children

 Insidious onset

 Sterile effusion in middle ear

 Behind an intact but retracted TM

 With hearing loss


Epidemiology
4

 First Episode
 50% of all children- before the first birthday
 80% of all children - before the third birthday
 Scott Brown – Prevalence bimodal at 2 & 5 yrs when child first
attends playgroup school & when goes to primary school
 Above 15 yrs  prevalence 0.6%
 More during winters
 More than a third of consultations to pediatricians each year
 Each episode of ASOM increases odd ratio of developing OME
by 12
 Chinese children have lower prevalence
 M>F


Aetiology
5

ET Dysfunction
 Obstruction
 Adenoid hyperplasia
 Tumours (nasopharyngeal carcinoma)
 Palatal defects
 Barotrauma
 Hyperbaric oxygen therapy
 Oedema during radiation therapy
 Spread of Infection
 Chronic adenoiditis
 Chronic rhino-sinusitis
 Chronic tonsillitis
 High prevalence in HIV patients


Aetiology contd.
6

Increased Secretions
 Allergy
 Milk
 Cigarette smoke (specially mother smoking)

 GERD

 Infections
 Unresolved AOM

 Viral Infections


Pathogenesis
7

 Eustachian tube dysfunction
 Failure of aeration
 Failure of drainage
 Increased secretion in ME
 Increase in secretory glands

 Spontaneous resolution if
 Drainage via ET restablished
 Perforation of the tympanic membrane

 If both continue  OME


Risk Factors: Host
8

 Age < 2 years
 Gender ( Males > Females)
 Race (Caucasian)
 Genetic predisposition
 Sibling with history of OME
 Down’s syndrome, cleft palate, tumors,
immunodeficiency states
 Poor mastoid pneumatization
 Maxillectomy
 Prolonged intubation
 Cystic fibrosis

Risk Factors: Environment
9

 Allergies
 Second hand smoke + wood burning stoves
 Not breastfeeding
 Seasonal - winters
 Attending day care centre with > 4 children
 Low socioeconomic group
 Use of pacifiers


Clinical Features: Symptoms
10

 Hearing loss
 Mild otalgia
 Ear fullness
 Tinnitus

 Children
 Delayed Speech

 Poor Academics


Clinical Features: Signs
11

 Hearing Loss - TFT
 Otoscopy (sensitivity 85 – 93%)
 Signs of retraction
 Loss of light reflex
 Colour – Yellow/Grey/ Blue
 Stage of retraction
 Signs of Effusion
 Air Bubbles
 Fluid Levels


Clinical Features: Signs
12

 Pneumatic Otoscopy
 Used to assess the mobility and position of TM

 Observe TM movement by

 Increasing Pressure in EAM – Siegel’s
 Increasing pressure in ME - Valsalva
 Mobile/ Partially Mobile/ Immobile


Evaluation
13

 Audiometry (sensitivity 92 %)
 Pure Tone Audiometry

 Bilateral Conductive Hearng Loss

 Air-Bone Gap
 20 – 40 dB


Evaluation
14

 Tympanometry (sensitivity 96 %)
 Assess compliance of TM

 Mobility of TM on increase/ decrease of pressure in EAM

 Graphic representation

 4 patterns

 A/As/Ad/B/C
 In OME – B & C

 William’s test for ET patency


Tympanogram
15


Newer methods
16

 Sonotubometry

 Acoustic reflectometry


Evaluation
17

 Radiology
 Xray Skull Lateral View

 Adenoid Hyperplasia
 Xray Mastoid Schuller’s View

 Clouding
 MRI
 Absence of fluid does not imply an absence of OME, as one-third
of patients in MRI study had fluid in mastoid, but not in the
mesotympanum (Kew et al)


Nasopharynx evaluation
18

 Post rhinoscopy
 Nasopharyngoscopy
 EBV titres (in adults)
 EBV IgA anti VCA

 EBV IgA anti EA


Treatment
19

 Medical Treatment
 Decongestants
 Systemic
 Triaminic Syr 5-10 ml 8 hrly
• Phenylpropanolamine 12.5 mg/5ml
• Chlorpheniramine 2 mg/5ml
 Actifed Tab ½ tab BD/ TDS
 Pseudoephedrine 25 mg
 Triprolidine 2.5 mg

 Local
 Nasivion – Oxymetazoline 0.05% drops
 Otrivin – Xylometazoline 0.1% drops


Treatment
20

 Medical Treatment
 Anti-allergy measures
 Antihistamines – Azelastine 2mg daily x 8 wks proven to be
beneficial
 Topical Nasal Steroids
 Surface tension lowering agent
 N acetyl cyteine 30 mg tds X 15 days beneficial
 Antibiotics (no long term benefit, can be used for initial 2
wks)
 Amoxycillin
 Augmentin
 Middle Ear Aeration
 Valsalva Manouevre
 Politzerisation


Treatment
21

 Surgical Treatment
 Myringotomy
 Myringotomy with ventillation tubes (improves hearing by 12
dB)
 Grommet
 T Tubes
 Adenoidectomy (improves hearing by 8 dB)
 Tonsillectomy
 Cortical Matoidectomy (in failure of ventilation tube cases)
 Research methods
 Percutaneous mastoid vent following CM
 CO2 assisted 2 mm circular perforation in AI quadrant for adult OME


Ventilation tubes
22

 Longer a tube stays in situ longer it can be
potentially of benefit
 On other hand, longer a tube is in situ the greater the
chance of complications
 Infection
 Granulation tissue
 Permanent perforation
 Thinning of TM with possible retraction
 However, in adults T-tubes are justified routinely, as
in them OME is likely to be persistent over years
rather than months


Types
23
 Grommet Stay upto 6 mths
 T tubes stay upto 1-2 yrs
 Materials for tubes
 Silicone
 Teflon
 Stainless steel
 Titanium
 Gold

 Few names (see photographs on next slide)
 Shepard
 Armstrong
 Reuter Bobbin
 Goodle

 Can be inserted AI or PI quad
 Stay longer in AI quadrant
 Guttenplan et al. (scott brown)  no difference in radial vs
circumferential incision

Complications of ventilation tubes
26

 Intra op
 Displacement into middle ear
 Damage to ossicles
 Early post op
 Blockage of tube by blood
 Granulation around tube
 Ear infection
 Otorrhoea
 Late post op
 Permanent perforation
 Tympanosclerosis
 TM atrophy & retraction


Sequelae of OME
27

 Adhesive Otitis Media / TM atelectasis
 TM atrophy  Retraction Pockests 
Cholesteatoma
 Ossicular Necrosis
 Tympanosclerosis


28

Thank You


Otitis media with effusion ome

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Similar to Otitis media with effusion ome

Similar to Otitis media with effusion ome (20)

More from Supreet Sn

More from Supreet Sn (6)

Recently uploaded

Recently uploaded (20)

Otitis media with effusion ome