Transcript Non-Suppurative Otitis Media Dr. Vishal Sharma Types 1. Otitis Media with effusion (O.M.E.) 2. Adhesive otitis media 3.

Non-Suppurative
Otitis Media
Dr. Vishal Sharma
Types
1. Otitis Media with effusion (O.M.E.)
2. Adhesive otitis media
3. Tympanosclerosis
4. Baro-traumatic otitis media
Otitis Media with effusion
Presence of serous or mucoid effusion in middle
ear cleft with no frank pus.
Synonyms:
1. Secretory / Serous otitis media
2. Seromucinous / exudative otitis media
3. Catarrhal otitis media
4. Glue ear
Etiology
1. Eustachian tube dysfunction
 Vacuum in M.E.  extravasation of fluid
 Lack of drainage of M.E. secretions
2. Upper respiratory tract allergy / viral infection
 Increase M.E. secretions
3. Low grade middle ear infection
 Inadequate treatment of A.S.O.M.
Causes for E.T. dysfunction
1. Eustachian Tube obstruction
• Intrinsic edema = infection / allergy / trauma
• Extrinsic = adenoid / nasopharyngeal tumour /
post – Radiotherapy scarring
• Functional = floppy Eustachian tube
2. Patulous Eustachian tube: reflux of secretions
Causes for E.T. dysfunction
3. Palatal abnormality:
 cleft palate / palatal palsy
4. Muco-ciliary pathology:
 Infection / allergy / smoking
 Kartagener’s syndrome / Young’s syndrome
 Surfactant deficiency / Immune deficiency
Causes of E.T. dysfunction
Predisposing conditions
• Child going to a nursery
• Early weaning with formula milk
• Parents who smoke
• Recurrent respiratory infections
• Crowded living condition
• Poor nutrition
• Cleft palate
Clinical Symptoms
• Mild deafness in a young child
• Deafness increases during U.R.T.I.
• Mild otalgia
• Blocking sensation in ear
• Delayed & defective speech due to deafness
Clinical signs
1. Otoscopy:
• Blue eardrum with restricted mobility
• Retraction of T.M. in early stage
• Bulging of T.M. in later stages
• Fluid level + air bubbles seen behind T.M.
2. Tuning Fork Tests: conductive deafness
Otoscopy
Blue ear drum
Left retracted ear drum
Right air-fluid level
Left air-fluid level
Right air bubbles
Left air bubbles
Investigations
Pure Tone Audiometry
P.T.A.: low frequency conductive deafness
Impedance Audiometry
C curve in ear drum retraction
Impedance Audiometry
B curve in middle ear effusion
X-ray mastoid & Nasopharynx
clouding of mastoid air cells + adenoid mass
Medical treatment
1. Antibiotic (Co-amoxyclav) for 2-4 weeks
2. Nasal decongestants (systemic + topical)
3. H1 anti-histamines
4. Auto-inflation of Eustachian tube by Valsalva
maneuver
5. Analgesic for acute earache
Non-medical, Non-surgical
treatment
• Politzerization
• Otovent balloon
• Ear popper device
• Eardoc device
Politzerization
Rubber tube attached to
Politzer bag is put into
one nostril & both
nostrils pinched. Pt is
asked to swallow
repeatedly & Politzer bag
is squeezed
simultaneously.
Otovent balloon device
Technique of inflation
Otovent balloon device
Balloon is inflated by blowing air out of nose.
When fully inflated, balloon neck is pinched off
and nasal occluder is inserted into one nostril.
Child is instructed to swallow as balloon is
deflated into nasal cavity. Portion of air from
balloon enters Eustachian tube & ventilates
middle ear.
Ear Popper Device
Ear Popper Device
Based on Politzer Maneuver, EarPopper ™
Device delivers a safe, constant, regulated
stream of air into nasal cavity. During
swallowing, air is diverted to Eustachian tube
clearing & ventilating middle ear.
EARDOC device
EARDOC device
EARDOC ™ generates & transmits special
vibration waves which travel through temporal
bone to reach middle ear & Eustachian tube. The
waves ease middle ear pressure & drain trapped
fluids. As a result edema & pain are reduced.
Surgical treatment
1. Myringotomy (Tympanocentesis) + grommet
(Pressure Equalization tube) insertion:
Radial incision made in antero-inferior
quadrant. For thick fluid, 2 incisions made in
antero-inferior quadrant & antero-superior
quadrant (Beer can principle).
Surgical treatment
2. Laser or radio-frequency assisted myringotomy:
grommet insertion not required
3. Cortical mastoidectomy: for refractory cases
with loculated fluid in mastoid
4. Treatment for predisposing factors: adenotonsillectomy / antral wash / polypectomy
Myringotomy &
grommet insertion
Myringotome
Right Myringotomy incision
Left Myringotomy incision
Myringotomy performed
Beer can principle
Glue like fluid
Shepard’s Grommet
Armstrong’s grommet
Donaldson grommet
Shah’s grommet
T-tube grommet
Grommet insertion
Right grommet in position
Left grommet in position
Grommet in ant-sup quadrant
T-tube grommet in situ
Grommet extrusion
Grommet gets extruded
on its own due to
endothelium growing
on its inner surface.
Extrudes after 6 - 9
months.
Grommet extrusion
Healed tympanic membrane
Complications of
Grommet insertion
Tympanosclerosis
T.M. Perforation
T.M. Perforation
Granulation over grommet
Grommet lost inside
Radiofrequency assisted
myringotomy
Cortical Mastoidectomy
Sequelae of O.M.E.
1. T.M. atrophy & atelectasis
2. Adhesive otitis media
3. Tympanosclerosis
4. Cholesterol granuloma
5. Ossicular necrosis
6. Retraction pocket & cholesteatoma
Prevention of O.M.E.
• Avoid irritants like cigarette smoke
• Identify & avoid any allergens
• Consider a smaller day care centre (< 6 children)
• Wash hands & toys frequently
• Use air filters & provide fresh air at home
• Encourage breastfeeding
• Use of pneumococcal vaccine
Adhesive Otitis Media
Pathology: TM atrophy + atelectasis (due to
dissolution of fibrous layer) + adhesions in M.E.
cavity, following chronic O.M.E.
Clinical Features:
1. Conductive deafness
2. Thin retracted T.M. with no mobility
Adhesive Otitis Media
Adhesive Otitis Media
Treatment:
1. Hearing Aid
2. Surgery (long term results are poor)
a. Tympanotomy + release adhesions + put
silastic sheet b/w promontory & TM.
b. Grommet insertion
Left grommet in position
Tympanosclerosis
Deposition of hyaline
(acellular + avascular
collagen) + calcium
deposits in submucosal
tissue of T.M. & M.E.
cavity following longstanding otitis media
Tympanosclerosis
Treatment:
1. Hearing Aid
2. Surgery (long term results are poor)
Remove tymapnosclerotic plaque & perform
tympanoplasty
Barotrauma of
middle ear
Pathogenesis
E.T. has collapsible
cartilaginous part &
rigid bony part
Allows expulsion of air
from middle ear into E.T.
but not suction of air into
middle ear via ET.
Etiology
Failure of Eustachian tube to equalize rapid
increase in pressure difference b/w middle ear
& atmosphere, over a long period.
During ascent: middle ear pressure is more than
Atmospheric Pressure  no barotrauma in
normal middle ear
During descent: middle ear pressure is less than
Atmospheric Pressure  barotrauma occurs
Pressure
Difference
Pathology in normal
Middle Ear
- 60 mm Hg Hyperaemia + edema +
exudation + T.M.
retraction
- 90 mm Hg
(less in pt
with cold)
- 100 to 400
mm Hg
Locking of E.T.
(collapse of lumen),
microscopic
hemorrhage
T.M. rupture
Symptoms
Otalgia,
deafness,
tinnitus
Severe
otalgia
Frank blood
otorrhoea
Treatment
1. Nasal decongestants + H1 anti-histamines
2. Politzerization for middle ear aeration
3. Myringotomy + grommet insertion done for:
– refractory cases
– presence of haemotympanum
Prevention
1. Avoid air travel during cold / nasal allergy
2. During descent while flying:
 Do repeated swallows (lozenges / gum)
 Do intermittent Valsalva maneuvre
 Avoid sleeping (as swallowing is decreased)
3. Pt with previous episode: take nasal decongestant + antihistamine 30 min before descent.
Thank You