ENT Lecture 2: Otitis Media

Dr. Tanveer Raza

Department of Ear, Nose and Throat
Department of Medical Education
Faculty of Medicine
University of Tabuk Three Gorges
Dam, Yichang
Dr. Tanveer Raza
traza@ut.edu.sa
Otitis Media with Effusion (OME)
 Synonyms
 Secretory Otitis Media
 Glue Ear
 Serous Otitis Media

Dr. Tanveer Raza

traza@ut.edu.sa
Otitis Media with Effusion (OME)
 Accumulation of non-purulent effusion in
middle ear cleft
 Effusion is
 Thick and viscid (Glue)
 May be thin and serous
 Nearly sterile
 Common in school going children

Dr. Tanveer Raza

traza@ut.edu.sa
OME: Aetiology
1. Malfunctioning of eustachian tube
 Example
 Adenoid
 Chronic tonsilitis
 Chronic rhinosinusitis (CRS)
 Nasopharyngeal tumors
 Cleft palate

2. Allergy
3. Unresolved Otitis Media
4. Viral infections
Dr. Tanveer Raza
traza@ut.edu.sa
OME: Clinical Feature
 Deafness
 Conductive
 Often unnoticed
 Delayed and defective speech
 Otalgia
 MIld

Dr. Tanveer Raza

traza@ut.edu.sa
 OME: Clinical Feature
 Otoscopy
 TM intact but dull and opaque
 Loss of light reflex
 Varying degrees of retraction
 May be full or slightly bulging
 Fluid level and air bubbles may be seen
 Hearing Test
 Tuning fork test
 Audiometry

Dr. Tanveer Raza

traza@ut.edu.sa
Dr. Tanveer Raza
traza@ut.edu.sa
Dr. Tanveer Raza
traza@ut.edu.sa
OME: Treatment
 Medical
 Decongestants
 Antiallergic measures
 Antihistamines
 Steroids
 Antibiotics
 May be given (if URTI_
 Middle ear aeration
 Valsalva manoeuvre
 Eustachian tube catheterization

Dr. Tanveer Raza

traza@ut.edu.sa
OME: Treatment
 Surgical
When medical treatment not working, fluid is
removed surgically
 Myringotomy and aspiration of fluid
 Grommet insertion
 Treatment of cause
 Tympanotomy or cortical mastoidectomy
 Long standing cases

Dr. Tanveer Raza

traza@ut.edu.sa
OME: Treatment

Dr. Tanveer Raza

traza@ut.edu.sa
Chronic Suppurative Otitis Media (CSOM)

 Chronic inflammatory process involving

middle ear cleft producing irreversible
pathological changes
 Characterstics
 Ear discharge
 Permanent perforation of tympanic membrane
 Type
 Tubotympanic
 Atticoantral

Dr. Tanveer Raza

traza@ut.edu.sa
CSOM: Type
1. Tubotympanic
 “Safe” or “Benign” type
 No risk of serious complication
 Starts in childhood
 Usually complication of Acute Otitis media
 Central perforation

Dr. Tanveer Raza

traza@ut.edu.sa
Tubotympanic Type: Aetiopathology
 Predisposing factor
 Recurrent URTI ,nasal allergy, CRS etc
 Enlarged adenoid, Chr. Tonsilitis
 Entry of water into ear
 Bathing, swimming, diving
 Malnutrition

Dr. Tanveer Raza

traza@ut.edu.sa
Tubotympanic Type: Clinical feature
 4Ds
 Discharge
 Deafness
 Defect
 TM perforation
 Duration

Dr. Tanveer Raza

traza@ut.edu.sa
Tubotympanic Type: Clinical feature
 Discharge- Otorrhoea
 Mucoid or muco-purulent
 Non-offensive
 Constant or intermmitent
 Appears following URTI or entry of water
into ear
 Dry in between infection

Dr. Tanveer Raza

traza@ut.edu.sa
Tubotympanic Type: Clinical feature
 Deafness
 Conductive type
 Long standing cases mixed type
 Progressive unless treated
 Mild to moderate
 Rarely above 50dB

 Defect-Perforation
 Central

Dr. Tanveer Raza

traza@ut.edu.sa
Tubotympanic Type: Investigations
 Otoscopy
 Hearing test
 Tuning fork test
 Audiogram
 Culture and sensitivity
 Mastoid X-ray

Dr. Tanveer Raza

traza@ut.edu.sa
Tubotympanic Type: Investigations
 Otoscopy
 Examination under microscope
 Tympanic membrane
 Central perforation
 Middle ear mucosa
 Normally pale, pink and moist
 Disease mainly confined to mucosa of
anterior and inferior part of tympanic cavity
 Polyp

Dr. Tanveer Raza

traza@ut.edu.sa
Tubotympanic Type: Investigations
 Otoscopy
 Polyp
 Occasionally a pale looking polyp

Dr. Tanveer Raza

traza@ut.edu.sa
Tubotympanic Type: Investigations
 Culture sensitivity
 Common organisms are
 Ps. aeruginosa
 Proteus
 E. coli
 S. aureus
 Bacteroides fragilis

Dr. Tanveer Raza

traza@ut.edu.sa
Tubotympanic Type: Treatment
 Aural toileting
 Dry mopping
 Suction clearance under microscope
 Local disinfection
 Antibiotics ear drops often combined with
steroids
 Neomycin, polymyxin, gentamycin
 In case of persistent discharge
 Following C/S systemic antibiotics

Dr. Tanveer Raza

traza@ut.edu.sa
Tubotympanic Type: Treatment
 Precautions
 Avoid water entry into ear
 Rubber inserts
 Avoid swimming, diving
 Avoid hard-nose blowing
 Tetanus immunization

Dr. Tanveer Raza

traza@ut.edu.sa
Tubotympanic Type: Treatment
 Treatment of contributory cause
 Surgery
 Myringoplasty with or without ossicular
reconstruction
 Aural polypectomy
 If polyp present

Dr. Tanveer Raza

traza@ut.edu.sa
Atticoantral Type
 “Attic” or “Marginal” perforation
 “Unsafe” or “Dangerous” type
 High risk of complications
 Associated with “Cholesteatoma”

Dr. Tanveer Raza

traza@ut.edu.sa
Atticoantral: Pathology
1. Cholesteatoma
2. Osteitis and granulation tissue
 Flashy red polypus may be seen
3. Ossicular necrosis
 Common
 Conductive deafness
4. Cholesterol granuloma

Dr. Tanveer Raza

traza@ut.edu.sa
Atticoantral: Clinical Features
 Discharge
 Deafness
 Bleeding
 Perforation
 Retraction pocket
 Cholesteatoma

Dr. Tanveer Raza

traza@ut.edu.sa
Atticoantral: Clinical Features
 Discharge
 Usually scanty and foul smelling
 Deafness
 Mainly conductive
 More severe than tubotympanic
 Sensorineural may be added
 Bleeding
 May occur from granulation or polyp

Dr. Tanveer Raza

traza@ut.edu.sa
Atticoantral: Clinical Features
 Perforation
 Attic pr posterosuperior marginal type
 Retraction pocket
 Invagination of tympanic membrane
 Cholesteatoma
 Pearly white flakes

Dr. Tanveer Raza

traza@ut.edu.sa
Atticoantral: Investigations
1. Hearing tests
 Tuning fork test
 Audiometry
2. Xray mastoid
3. CT Scan of temporal bone
4. C/S of ear discharge

Dr. Tanveer Raza

traza@ut.edu.sa
Atticoantral: Bacteriology
 Aerobic
 Ps. Aeruginosa
 Proteus
 E. coli
 S. aureus
 Anaerobes
 Bacteroides fragilis
 Anerobic Streptococci

Dr. Tanveer Raza

traza@ut.edu.sa
 Atticoantral: Treatment
 Surgical (Main treatment)
 Conservative
 Limited role
 Suction clearance

Dr. Tanveer Raza

traza@ut.edu.sa
 CSOM: COMPLICATIONS
A. Intratemporal
 Mastoiditis
 Petrositis
 Facial paralysis
 Labyrinthitis

Dr. Tanveer Raza

traza@ut.edu.sa
 CSOM: COMPLICATIONS
B. Intracranial
 Extradural abscess
 Subdural abscess
 Meningitis
 Brain abscess
 Lateral sinus thrombophlebitis
 Otitic hydrocephalus

Dr. Tanveer Raza

traza@ut.edu.sa
Thank You

Three Gorges
Dam, Yichang