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BRIG ANWAR UL HAQ03018513303
Otitis MediaWith
Effusion
INTRODUCTION
BRIG ANWAR UL HAQGRADUATION - 1985ARMY MEDICAL COLLEGEFCPS - 1997WORKED
ALL ACROSS PAKISTAN UN UK SAUDI ARABIA
CPSP SUPERVISOR - 2004DIRECTOR OF MEDICAL EDUCATION
QUETTA INSTITUTE OF MEDICAL SCIENCES
BRIG ANWAR UL HAQ
Otitis MediaWith
Effusion
PAKISTAN ZINDABAD
PUNJAB
PUNJABPUNJABAYE
LAHORELAHOREAYE
OMEChronic accumulation of mucus/non
purulent effusion within the middle ear and in mastoid air cell system (Middle Ear Cleft).
Duration >12 weeks
SynonymsGlue earSerous otitis media Chronic nonpurulent otitis media
Etio-PathologyPreceded by an episode of AOM with
Otalgia and fever.
Inflammation of eustachian tube epithelium
Flat cuboidal mucosa Partially replaced by thickened Pseudo Stratified Mucus secreting epithelium.
Goblet cells are usually presentMucus secreting cells are formed.
Etio-PathologyCharacteristics of effusionmixture of the secretions of the
epithelial cells goblet cells mucus glands along inflammatory transudate/exudate
Viscous Goblet Cells Mucous glands
Etio-PathologyBacteriologyStreptococcus Pneumonia Haemophilus Influenzae Branhamella Catarrhalis
The incidence of pathogens was higher in the younger children
Etio-PathologyEustachian tube dysfunction Viral upper respiratory tract infection, allergic reaction,
Pollutents Cigarette smoke. Adenoids GERD
Craniofacial Abnormalitiescleft palate Poor ET function.bifid uvulaDown and turner syndromes are prone to have
OME.
Down and Turner Syndrome
Bottle Feeding
Etio-PathologyAllergyAllergy – Swelling - Infection
GERDIts common in childrenPepsin is found in the effusion.Investigations are required to clarify
the role.
Etio-PathologyPrevalanceAge
Bimodal - infancy - primary schoolPeak - one year of age.
SeasonWinter>SummerRespiratory Tract InfectionsEar Infections
Etio-PathologyAOM EpisodeLargest single factorAntibiotics - No effectsContact with other childrenHereditabilityGreater concordance
monozygotic - Higher Incidence
dizygotic - Lesser Incidence
Etio-PathologyRacePrevalence is different in different races
GenderNo difference in male or females
Smoking No effect of parenteral smoking detected.
LAHORELAHOREAYE
Symptoms
No symptoms
Deafness
Tinnitus
Pain Ear
Symptoms
Associated Symptoms
Nasal Blockage
Nasal Discharge
Pain Throat
Fever
Examination GPESystemic Examination
Repiratoty SystemENT Examination
NoseNasopharynxEars
Pneumatic Otoscopy Tunning Fork Tests
OtoscopyDifferent Combinations of
Retraction of the pars tensa Variations in its colour.
OtoscopyColour
yellow Bluefluid levels air bubbles
PositionRetractedFull
MobilityReduced
Retraction
Bubbles
Air Fluid Level
Bulging
TYMPANOMETERY
PURE TONE AUDIOMETERY
X RAY NECK LAT VIEW FOR ADENOIDS
LAHORE
TreatmentNo Treatment
Spontaneous Recovery
Medical Management-AIMS
Speed up the resolutionAntibiotics
Benefits in first two weeks long term (>6 weeks) - not recommended
Nasal Decongestants No Significant effect.
Mucolytics No Significant result.
Medical Management-AIMS
Speed up the resolutionAntibiotics
Benefits in first two weeks long term (>6 weeks) - not recommended
Nasal Decongestants No Significant effect.
Mucolytics No Significant result.
ManagementNasal topical Steroids
No difference in resolution.Systemic Steroids
Not Recommended.Counseling and hearing tactics.
Disabilities can be minimized by hearing tactics.
Other Approach Auto Inflation-3.5 times more likely to improve. Higher efficacy found in older children.
ManagementNasal topical Steroids
No difference in resolution.Systemic Steroids
Not Recommended.Counseling and hearing tactics.
Disabilities can be minimized by hearing tactics.
Other Approach Auto Inflation-3.5 times more likely to improve. Higher efficacy found in older children.
ManagementNasal topical Steroids
No difference in resolution.Systemic Steroids
Not Recommended.Counseling and hearing tactics.
Disabilities can be minimized by hearing tactics.
Other Approach Auto Inflation-3.5 times more likely to improve.
Higher efficacy found in older children.
ManagementSurgical Management.Ventilation Tubes Insertion.
Posterosuperior insertion is not recommended –damages the Ossicular Chain
No difference in radial or circumferential inscion or anterosuperior and anteroinferior position.
To maximize the duration-insertion in anteroinferior is recommended . Made with Teflon,Silicone,Titanium,Gold. Aspirate as much of the middle ear fluid as possible through the
myringotomy before inserting VT, there is no evidence that is required. Topical preparations are used to prevent tube block with blood or infection.
Myringotomy with aspiration. Not shown to be effective.
Ventilation tubes
ManagementVentilation TubesSynonyms Myringotomy tube, Tympanostomy tube Pressure equalization (PE) tube.
Types1. Grommets (dumbbell shaped)
Short stay tubes that gets extruded within 6 months
Shephard’s grommet Armstrong’s grommet Donaldson’s grommet Shah’s grommet
2. T-tube (‘T’ shaped) For long term purposes that stays at least 1-2 years.
Management
AdenoidectomyMechanism - Unclear.Removes a chronic source of infection Nasopharynx.
E:\PRESENTATIONS\Animations\EAR\Glue Ear.flv
OutcomesHearingVT alone - 12 dB.Adenoidectomy - additional 3-4dB.
ComplicationsDisplacement of tube to middle ear
Perforation of TM.Scarring and weakening of the TM.
Early extrusion or blockage.Cholesteatoma formation.
Recommended