Dr. Abdussalam M jahan Dr. Abdussalam M jahan ENT depart, Misurata ENT depart, Misurata university, faculty of medicine university, faculty of medicine Otitis media
Dr. Abdussalam M jahan Dr. Abdussalam M jahan ENT depart, Misurata university, ENT depart, Misurata university,
faculty of medicinefaculty of medicine
Otitis media
Anatomy of the Ear
Inflammation of Middle ear
Chronic OMChronic OM
Acute OMAcute OM
Chronic supp. OM Chronic non Supp.OM
A non supp OM A supp. OM A necrotizing
OM
Acute inflammation of mucoperiosteal lining of middle ear
cleft.
Acute OM
It is common disease especially in children.. Why.
(ET, URTI, AdT, bottle feeding. )
Bacteriology::
Streptococcus Hemolyticus
Streptococcus pnumoniae
Homophiles influenza
Route Perforated
TMET
Stages of AOM
Tubal occlusion
Catarrhal stage
Suppuration stage
Stage of resolution
ET obstruction. → –ve pr. → ME mucosa swollen and hyperaemic .
ME full of secretion
ME retained Normal
rupture of TM → pus come out
C/P of AOM
Tubal occlusion
Catarrhal stage
Suppuration stage
Fullness of ear + mild otalgia
increase pain + fever
discharge, pain disappear, decrease fever
sever pain, high fever, deafness
Signs of AOM
• Congested TM.• Pulging of TM.• Deafness.• Purulent discharge.• Perforated TM.
Treatment of AOM
• Ear cleaning.• Systemic AB.• Local Ear drops.• analgesia.• Myringotomy +/-.
Chronic OM
Chronic supp. OM Chronic non Supp.OM
Safe ( ( Tubotympanic)) Unsafe (Attico antral)
Chronic inflammation of middle ear cleft (ME cavity, ET, Mastoid).
CSOM
It is common disease in low socioeconomic
classes.
Safe ( ( Tubotympanic)) Unsafe (Attico antral)
cholesteatoma
Definition: it is an epithelial cyst that contains keratin
presented in middle ear ( presence of skin in a
wrong place).
Tubotympanic (safe)
Chronic inflammation Involve the ant part of ME
( tympanic cavity + ET)
Microbiology: Grame +ve
bacteria
S/S of CSOM safe
• otorrhea. - profuse - mucopurulent. - odorless. - on / off.• Deafness ( -ve Rinne test).• TM perforation.. central.
Treatment of safe CSOM
• Cleaning ( suction or mopping).• Systemic AB.• Local ear drops.• Surgical intervention: myringoplasty
Attico antral (unsafe)
Chronic inflammation Involve the post part of ME
( attic, antrum, mastoid)
Microbiology: Grame -ve bacteria & anaerobic
Attico antral (unsafe)
Cholesteatoma
Definition: it is an epithelial cyst that contains keratin presented in middle ear ( presence of skin
in a wrong place).
Cholesteatoma
CongenitalAcquired
secondaryprimary
S/S of CSOM unsafe• otorrhea. - scanty. - purulent. - offensive. - continuous.• Deafness ( -ve Rinne test).• TM perforation, marginal.• Polypi or granulation tissues.
Treatment of unsafe CSOM
• Only Surgical intervention: Mastoidectomy- Ct scan is important in management of
CSOM with Cholesteatoma.
Difference between safe and unsafe OM
cholesteatoma
discharge
perforation
Site of infection
Treatment
Yes No
Profuse
scanty, offensive
attic , Antrum
peripheral central
tympanic cavity, ET
medical or surgical
always surgical
Complications of CSOM
Cranial
Intracranial
Extracranial
Chronic non Supp.OM
Secretory OM or OM with effusion ( glue ear)
definition: Collection of fluids behind intact TM with out s/s of inflammation.Common in children under 9 yr.
etiology: -ET dysfunction.
-post unresolved AOM.
ET dysfunction
Functional Mechanical
Increase compliance as in children
Adenoid -De
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iliary
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Abno
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NP tumours
Tubal oedema as post RT
Tubal scaring as post Ad
Secretional
Abnormal opening mechanism as in Cleft
palate.
So causes of SOM
• Adenoid hypertrophy.• NP carcinoma.• Post AOM.• Abnormal viscid sec.• Abnormal ciliary function.• Post op scaring
symptoms of SOM
• Hearing loss.• Feeling of blockage.• tinnitus.• Symptoms of
cause.
Signs of SOM
• Retracted TM.• Fluid level ( hair line).• Air bubbles.• TFT → CHL.
Investigations of SOM
• Tympanometry.• PTA.• X- ray NP.• CT scan if
needed.
Treatment of SOM
• mucolytic.• Steroids.• Decongestant N drop.• Valsalva.
medical
• Ventilation tube ( Grommet).
• Adenoidectomy
surgical
Chronic non Supp.OM
Adhesive OM
definition: It is a complication of SOM, in which the TM become thin, atrophic, and adherent to the middle ear structures.
treatment: -grommet.
-tympanoplasty.
clinical case:
5 yrs old child presented with: Nasal obstruction + night snoringChronic nasal discharge.Decrease hearing.
On examination:-Retracted TM
-Fluid behind TM-TM not perforated.
What is Dx and how to confirm.