Otitis media with effusion ome

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Acute Otitis Media with Effusion

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Otitis media with effusion ome

  1. 1. OTITIS MEDIA WITH EFFUSION (OME) 1 DR. SUPREET SINGH NAYYAR, AFMCwww.nayyarENT.com 2012
  2. 2. Synonyms 2Serous Otitis MediaSecretory Otitis Media“Glue Ear”www.nayyarENT.com 2012
  3. 3. 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 losswww.nayyarENT.com 2012
  4. 4. 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>Fwww.nayyarENT.com 2012
  5. 5. Aetiology 5ET 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 patientswww.nayyarENT.com 2012
  6. 6. Aetiology contd. 6Increased Secretions Allergy  Milk  Cigarette smoke (specially mother smoking)  GERD Infections  Unresolved AOM  Viral Infectionswww.nayyarENT.com 2012
  7. 7. 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  OMEwww.nayyarENT.com 2012
  8. 8. 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 fibrosiswww.nayyarENT.com 2012
  9. 9. 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 pacifierswww.nayyarENT.com 2012
  10. 10. Clinical Features: Symptoms 10 Hearing loss Mild otalgia Ear fullness Tinnitus Children  Delayed Speech  Poor Academicswww.nayyarENT.com 2012
  11. 11. 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 Levelswww.nayyarENT.com 2012
  12. 12. 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/ Immobilewww.nayyarENT.com 2012
  13. 13. Evaluation 13 Audiometry (sensitivity 92 %)  Pure Tone Audiometry  Bilateral Conductive Hearng Loss  Air-Bone Gap  20 – 40 dBwww.nayyarENT.com 2012
  14. 14. 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 patencywww.nayyarENT.com 2012
  15. 15. Tympanogram 15www.nayyarENT.com 2012
  16. 16. Newer methods 16 Sonotubometry Acoustic reflectometrywww.nayyarENT.com 2012
  17. 17. 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)www.nayyarENT.com 2012
  18. 18. Nasopharynx evaluation 18 Post rhinoscopy Nasopharyngoscopy EBV titres (in adults)  EBV IgA anti VCA  EBV IgA anti EAwww.nayyarENT.com 2012
  19. 19. 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% dropswww.nayyarENT.com 2012
  20. 20. 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  Politzerisationwww.nayyarENT.com 2012
  21. 21. 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 OMEwww.nayyarENT.com 2012
  22. 22. 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 monthswww.nayyarENT.com 2012
  23. 23. 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 incisionwww.nayyarENT.com 2012
  24. 24. www.nayyarENT.com 24 2012
  25. 25. www.nayyarENT.com 25 2012
  26. 26. 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 & retractionwww.nayyarENT.com 2012
  27. 27. Sequelae of OME 27 Adhesive Otitis Media / TM atelectasis TM atrophy  Retraction Pockests  Cholesteatoma Ossicular Necrosis Tympanosclerosiswww.nayyarENT.com 2012
  28. 28. 28 Thank Youwww.nayyarENT.com 2012

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