Dr. Abdussalam M jahan ENT depart, Misurata university, faculty of medicine Otitis media.
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Transcript of Dr. Abdussalam M jahan ENT depart, Misurata university, faculty of medicine Otitis media.
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Dr. Abdussalam M jahan Dr. Abdussalam M jahan ENT depart, Misurata university, ENT depart, Misurata university,
faculty of medicinefaculty of medicine
Otitis media
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Anatomy of the Ear
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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
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Acute inflammation of mucoperiosteal lining of middle ear
cleft.
Acute OM
It is common disease especially in children.. Why.
(ET, URTI, AdT, bottle feeding. )
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Bacteriology::
Streptococcus Hemolyticus
Streptococcus pnumoniae
Homophiles influenza
Route Perforated
TMET
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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
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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
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Signs of AOM
• Congested TM.• Pulging of TM.• Deafness.• Purulent discharge.• Perforated TM.
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Treatment of AOM
• Ear cleaning.• Systemic AB.• Local Ear drops.• analgesia.• Myringotomy +/-.
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Chronic OM
Chronic supp. OM Chronic non Supp.OM
Safe ( ( Tubotympanic)) Unsafe (Attico antral)
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Chronic inflammation of middle ear cleft (ME cavity, ET, Mastoid).
CSOM
It is common disease in low socioeconomic
classes.
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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).
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Tubotympanic (safe)
Chronic inflammation Involve the ant part of ME
( tympanic cavity + ET)
Microbiology: Grame +ve
bacteria
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S/S of CSOM safe
• otorrhea. - profuse - mucopurulent. - odorless. - on / off.• Deafness ( -ve Rinne test).• TM perforation.. central.
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Treatment of safe CSOM
• Cleaning ( suction or mopping).• Systemic AB.• Local ear drops.• Surgical intervention: myringoplasty
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Attico antral (unsafe)
Chronic inflammation Involve the post part of ME
( attic, antrum, mastoid)
Microbiology: Grame -ve bacteria & anaerobic
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Attico antral (unsafe)
Cholesteatoma
Definition: it is an epithelial cyst that contains keratin presented in middle ear ( presence of skin
in a wrong place).
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Cholesteatoma
CongenitalAcquired
secondaryprimary
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S/S of CSOM unsafe• otorrhea. - scanty. - purulent. - offensive. - continuous.• Deafness ( -ve Rinne test).• TM perforation, marginal.• Polypi or granulation tissues.
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Treatment of unsafe CSOM
• Only Surgical intervention: Mastoidectomy- Ct scan is important in management of
CSOM with Cholesteatoma.
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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
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Complications of CSOM
Cranial
Intracranial
Extracranial
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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.
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ET dysfunction
Functional Mechanical
Increase compliance as in children
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NP tumours
Tubal oedema as post RT
Tubal scaring as post Ad
Secretional
Abnormal opening mechanism as in Cleft
palate.
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So causes of SOM
• Adenoid hypertrophy.• NP carcinoma.• Post AOM.• Abnormal viscid sec.• Abnormal ciliary function.• Post op scaring
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symptoms of SOM
• Hearing loss.• Feeling of blockage.• tinnitus.• Symptoms of
cause.
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Signs of SOM
• Retracted TM.• Fluid level ( hair line).• Air bubbles.• TFT → CHL.
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Investigations of SOM
• Tympanometry.• PTA.• X- ray NP.• CT scan if
needed.
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Treatment of SOM
• mucolytic.• Steroids.• Decongestant N drop.• Valsalva.
medical
• Ventilation tube ( Grommet).
• Adenoidectomy
surgical
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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.
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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.
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