Deseases of middle ear asom,som - dr.madhu priya 15.02.16

1. OTITIS MEDIA WITH EFFUSION
 Also known as (syn. Secretory otitis
media,Mucoid otitis media,glue ear,middle
ear effusion)
by Dr.Madhu priya
(Asst.Prof)
Department of ENT
MGMC&RI

2. How Does The Ear Work?

3. EUSTACHIAN TUBE
 Connects nasopharynx
with tympanic cavity

4. FUNCTIONS OF ET
 Ventilation and regulation of middle ear
pressure
 Protection against a)nasopharangeal
sound pressure
b)reflux of
nasopharangeal
secretions
 Clearance of middle ear secretions

5. DISORDER OF EUSTACHIAN
TUBE
 Normally ET is closed
 It opens intermittently during swallowing,yawning and
sneezing through the active contraction of TVPM.
 Air, composed of oxygen,carbon dioxide,nitrogen and water
vapour,normally fills the middle ear and mastoid.
 When the tube is blocked,first oxy is absorbed,but later
other gases,carbon dioxide and nitrogen also diffuse out
into the bld---results in neg pressure in middle ear and
retraction of TM---”LOCKING” of the tube with collection of
transudate and later exudate and even haemorrhage
(Acute OME)

6. What is glue ear?
 Insidious condition
 Glue ear is defined as
inflammation of the middle
ear, accompanied by the
accumulation of fluid in the
middle-ear cleft (serous or
mucoid,not purulent),
without the symptoms and
signs of acute
inflammation
 Effusion is thick and
viscid,sometimes may be
thin and serous
 Commonly seen in school
going children

7. AETIOLOGY
 MALFUNCTIONING OF THE TUBE
 Mechanical obstruction-URI,allergy,sinusitis,nasal
polypi,DNS,hypertrophic
adenoids,nasopharangeal tm/mass
 Functional-Sniffling,abnormal ciliary function of
the tube(kartagener’s syndrome,situs
inversus,bronchiectasis,cystic fibrosis,chronic
sinusitis),palatal defects,Down
syndrome,barotrauma
 Both

8. Aetiology contd..
 Allergy-seasonal or perennial allergy to foodstuffs
 Unresolved otitis media
 Infections
 Viral-adeno and rhino viruses
 Bacterial-The same flora found in AOM can be
isolated in OME. With OME, the inflammatory process
clearly resolves, and the volume of bacteria
decreases.

9. AETIOLOGY contd…
 Other risk factors
More common in:
 Bottle feeding
 Feeding while supine
 Attending day-care
 Having a sibbling with OM
 Allergies to common environmental entities
 Low socio-economic status
 Low birth weight
 Parental history of OME
 Living in a home in which people smoke
 Recurrent URI

10. CLINICAL FEATURES OF MEE
 SYMPTOMS:
PRESENTATION
 Deafness-h/o aural fullness or an ear being
plugged or diminished hearing
o Insidious onset
o Rarely exceeds 40dB
 Delayed and defective speech-most common
morbidity encountered
 Earaches are rare or mild
 Tugging at ear or repeated inserting of finger

11. CLINICAL FEATURES cont…
 SIGNS
 Otoscopic findings:
 Opacification of the
drum (other than due to
scarring)
 Loss of the light reflex,
or a more diffused light
reflex
 Indrawn, retracted, or
concave drum
 Decreased or absent
mobility of the drum
 Presence of bubbles or
fluid level
 Yellow or amber colour
change to the drum
 Fullness or bulging of
the drum, though this is
not typical

13. INVESTIGATIONS contd…
 HEARING TESTS:
 1)TUNING FORK TESTS:
conductive deafnes
 2)PURE TONE
AUDIOMETRY:
 Best way to assess hearing
 Only suitable for children
who are 4 yrs and older
 There is C.H.L. of 20-40
dB,sometimes there is ass
S.N.H.L. d/t fluid present
on R.W. membrane

14. INVESTIGATIONS contd…
 3)IMPEDENCE
AUDIOMETRY/TYMPAN
OMETRY:
 Objective test useful
in children and infants
 Presence of fluid is
indicated by reduced
compliance and flat
curve with a shift to
negative side

15. Management (medical )
 Decongestants
 Antiallergic measures
 Antibiotics
 Middle ear aeration

16. Surgical
 Myringotomy
 Grommet insertion
 Cortical mastoidectomy
 Surgical treatment of causative factor

18. Sequeale of chronic SOM
 Atrophic TM & atelectasis of ME
 Ossicular necrosis
 Tympanosclerosis
 Retraction pockets
 Cholesterol granuloma