basic understanding of glue ear

1. SEROUS OTITIS MEDIA
Dr Chandra Bhan
Assistant professor
MRAMC

2. SYNONYMS
Serous Otitis Media
Secretory Otitis Media
Glue Ear
Mucoid otitis media
otitis media with effusion
Exudative otitis media
Tubotympanic catarrh

3. DEFINITION
 Chronic accumulation of non purulent serous or
mucoid fluid within middle ear cleft.
 Time that fluid has to be present for the condition to be
chronic is usually taken as 12 weeks.
 Mostly affects children
 Insidious onset
 Sterile in nature.
 Behind an intact and retracted TM.
 With conductive hearing loss

4.  50% of all children- before the first birthday, 80% of all
children - before the third birthday – have OME
 Prevalence bimodal at 2 & 5 yrs when child first
attends play group school & when goes to primary
school
 More during winters
 Each episode of ASOM increases odd ratio of
developing OME by 12
 M > F

5. AETIOLOGY
ET Malfunctioning.
 Obstruction
 Adenoid hyperplasia
 Tumours (nasopharyngeal carcinoma)
 Palatal defects
 Palatal paralysis
 Hyperbaric oxygen therapy
 Oedema during radiation therapy
 Spread of Infection
 Chronic adenoiditis
 Chronic rhino-sinusitis
 Chronic tonsillitis
 High prevalence in HIV patients

6. Increased Secretions
 Allergy
 Milk
 Cigarette smoke (specially mother smoking)
 Obstruct the ET by oedema and increases the secretion
as mucosa act as shock organ in such cases.
 Infections
 Unresolved AOM
 Viral Infections

7. PATHOGENESIS
 Eustachian tube dysfunction
 Failure of aeration
 Failure of drainage
 Increased secretion in ME
 Due to Increase in secretory glands
 Spontaneous resolution if
 Drainage via ET restablished
 Perforation of the tympanic membrane ocure
 If both continue  OME

8. CLINICAL FEATURES
 Hearing loss- up to 40 db
 Mild otalgia
 Ear fullness
 Tinnitus
 Children
 Delayed Speech and defective speech
 PoorAcademics
SYMPTOMS

9. Clinical Features: Signs
 Conductive hearing Loss - TFT
 Otoscopy
-Signs of TM retraction.
-Loss of light reflex
-Colour – Yellow/Grey/ Blue
-Thin blood vessel along handle of malleus ant periphery of tm
 Signs of Effusion
Air Bubbles
Fluid Levels

10.  Pneumatic Otoscopy
 Used to assess the mobility and position of TM
 Observe TM movement by
Increasing Pressure in EAM – Siegel’s speculum
Increasing pressure in ME - Valsalva namoeuver
 TM may be Mobile/ Partially Mobile/ Immobile

11. Evaluation
 TFT-
Rinne - negative
Weber- lateralized towards more diseased ear.
ABC –normal both ear
 Audiometry
 Pure ToneAudiometry
Bilateral Conductive Hearng Loss
20 – 40dB
Sometimes SNHL due to fluid pressing round window

12.  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
 Reduced compliance with flat curve with a shift to
negative side.

13. Tympanogram
2012

14.  Radiology
Xray Skull Lateral view
Adenoid Hyperplasia
 Xray Mastoid Schuller’s View
Clouding of air cell
 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)
 Nasal and nasopharyngeal examination.

15. TREATMENT
 Medical Treatment
 Nasal decongestants
Systemic
 Triaminic Syr 5-10 ml 8 hrly
• Phenylpropanolamine 12.5 mg/5ml
• Chlorpheniramine 2 mg/5ml
 Pseudoephedrine 25 mg
Local
 Nasivion – Oxymetazoline 0.05% drops.
 Otrivin – Xylometazoline 0.1% drops.

16.  Anti-allergy measures
 Antihistamines
 Nasal Steroids spray
 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)
 Middle Ear Aeration
 Valsalva Maneuver

17.  Surgical Treatment
 Myringotomy
 Myringotomy with ventillation tubes (improves hearing by 12
dB)
 Adenoidectomy (improves hearing by 8 dB)
 Tonsillectomy
 Cortical Matoidectomy (in failure of ventilation tube cases)

18. Ventilation tubes
 Also known as grommet
 Inserted through radial incision in AS or AI quadrant of
TM.
 Longer a tube stays in situ longer it can be potentially
benefit
 On other hand, longer a tube is in situ the greater the
chance of complications like-
 Infection
 Granulation tissue
 Permanent perforation
 Thinning of TM with possible retraction

19. TYPES
 Shepard Armstrong
 Reuter Bobbin
 Goodie t tube
 Silicone T tube
 Shah tube
FUNCTION
 Ventilate the middle ear
 Drain the middle ear
 Improve the hearing
 Epithelium will revert back to normal

20. Complications of ventilation tubes
 Intra op


Displacement into middle ear
Damage to ossicles
 Early post op




Blockage
Granulation around tube
Ear infection
Otorrhoea
 Late post op



Permanent perforation
Tympanosclerosis
TM atrophy & retraction

21. SEQUELAE OF OME
 Adhesive Otitis Media / TM atelectasis
 TM atrophy  Retraction Pockests Cholesteatoma
 Ossicular Necrosis
 Tympanosclerosis
 Cholesterol grannuloma