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

How Does The Ear Work?

EUSTACHIAN TUBE Connects nasopharynx

with tympanic cavity

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

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)

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

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

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.

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

CLINICAL FEATURES OF MEE SYMPTOMS: PRESENTATION Deafness-h/o aural fullness or an ear being

plugged or diminished hearingo Insidious onseto Rarely exceeds 40dB

Delayed and defective speech-most common morbidity encountered

Earaches are rare or mild

Tugging at ear or repeated inserting of finger

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

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

INVESTIGATIONS contd… 3)IMPEDENCE

AUDIOMETRY/TYMPANOMETRY:

Objective test useful in children and infants

Presence of fluid is indicated by reduced compliance and flat curve with a shift to negative side

Management (medical ) Decongestants Antiallergic measures Antibiotics Middle ear aeration

Surgical Myringotomy Grommet insertion Cortical mastoidectomy Surgical treatment of causative factor

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