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Otitis Media Otolaryngology
Otitis Media Otolaryngology
Otitis Media Otolaryngology
Dr.Sherif Bugnah
ENT Resident | AFHSR
Supervised by Dr.Muslih
INTRODUCTION & DEFINITIONS
Otitis media (OM) is the most common
bacterial infection in children and the most
frequent indication for antimicrobial or
surgical therapy in this age group. It is also
the leading cause of hearing loss in children.
OM : any inflammatory process in the
middle-ear cleft behind an intact tympanic
membrane (TM).
CLASSIFICATIONS
Two Major Classes of OM are
èAcute Otitis Media
èChronic OM with effusion (OME).
A diagnosis of AOM requires the presence of a (MEE)
and the symptoms and signs of acute infection (Fever,
Pain,Red and Bulging TM).
OME indicates an MEE without signs of inflammation.
Equivalent terms are chronic secretory OM, chronic
serous OM, and "glue ear." MEE denotes a liquid in the
middle-ear cleft regardless of etiology.
CLINICAL AND FUNCTIONAL ANATOMY
OTOSCOPY
AOM Classic signs
èRedness
èBulging of the TM.
DIAGNOSIS.
OTOSCOPY
èEarly stages of AOM, TM
may bulge outward and it
often moves normally.
èIn effusion, drum mobility
is decreased. Severe cases
the usual landmarks may
not be visible.
DIAGNOSIS.
OTOSCOPY
If the process continues, necrosis of the
TM occurs and the effusion passes into the ear
canal through a typically pinpoint perforation.
Massive necrosis of the drumhead is rare,
although necrotizing streptococcal infection is
a known cause of permanent perforation.
DIAGNOSIS.
OTOSCOPY
Clinical variants of AOM
èMyringitis is an inflammation of the TM without MEE.
The etiology and pathogenesis of Myringitisare not well
documented. Treatment is the same for AOM.
èBullous Myringitis is seen in both adults and children.
Pain is an outstanding feature . Most cases bullae on
the TM are associated with the same pathogenic
bacteria as AOM and treated similarly.
DIAGNOSIS.
OTOSCOPY
The classic findings of OME are a retracted,
hypomobile or immobile TM and a dark, fluid-
filled tympanum that obscures visualization of
the long process of the incus.
DIAGNOSIS.
DIAGNOSIS.
TYMPANOMETRY
Acoustic energy reflected from the TM as the pressure
in the external auditory canal is varied from -400 daPa to
100 daPa, the shape of which provides considerable
information about the status of the middle ear.
In air-containing ears, the shape of the tympanogram is
usually peaked at -100 daPa (type A).
In MEA, compliance is low and the tympanogram is
labeled type B by
Negative middle-ear pressure below 150 daPa) with a
sharp peak is labeled type C.
TYMPANOMETRY
. Type A represents normal middle ear function. Type A curves have normal mobility and pressures |normal hearing
and sensorineural hearing loss with normally functioning middle ear systems. Type B represents restricted tympanic
membrane mobility. Type B curves have little or no point of maximum mobility and reduced compliance, typical of a
stiff middle ear system (Otitis media.) Type C represents significant negative pressure in the middle ear cavity. Type
C curves have normal mobility and negative pressure at the point of maximum mobility,(treatment when more
negative than -200 mm H2O). Type As represents normal middle ear pressure but reduced mobility suggesting
limited mobility of the tympanic membrane and middle ear structure, commonly seen in fixation of the ossicular
chain. Type Ad represents normal middle ear pressure but hypermobility. This pattern is indicative of a flaccid
DIAGNOSIS.
AUDIOMETRY
Guidelines for treatment of OME in young children
recommended that audiometry be used in the decision of
surgical drainage of the middle ear, and that surgery should
not be done if the pure-tone average is less than 20 dB
Limited Giudelines!
ØAudiometry is not always available, no
ØIt is not practical for 2-year-old children.
ØHearing levels may fluctuate frequently so that a normal
pure-tone average on one day does not exclude
abnormal thresholds on another
SEQUELAE AND COMPLICATIONS
ANTIHISTAMINES, DECONGESTANTS!
§ No evidence shows that antihistamines,
decongestants, vasoconstrictors, or any other
form of systemic or topical therapy aimed at
diminishing nasal symptoms result in shortened
duration of pain, fever, effusion, or hearing loss.
§ The combination of an antihistamine &
decongestant was found not affecting the
clearance of MEE
TREATMENT
TYMPANOCENTESIS
Ø Important for selection of therapy by
knowledge of the specific organism in specific
cases of AOM occurring in premature
newborns, immunocompromised patients,
patients with progression of symptoms and
signs while receiving an appropriate
antimicrobial, patients with intracranial
infection, and research subjects.
TREATMENT
MYRINGOTOMY
Ø Although severe AOM has many of the clinical
features of a closed-space abscess, incision and
drainage (myringotomy) has proven to be of limited
value. Myringotomy promptly relieves severe pain of
AOM in patients with severe pain but adds little to
either remission of infection or clearance of MEE in
cases of AOM treated with amoxicillin-clavulanate
TREATMENT
FOLLOW-UP
Infants, at greater risk of AOM and meningitis.
Therefore, a 3-day check is recommended.
Ø 2-week check is often performed in children of all
ages to determine whether the MEE has cleared.
Ø Initial follow-up at 4 weeks in routine cases of
AOM in older children.
Ø If TM has ruptured, indicating a severe episode, it
is better to continue the antimicrobial agent until
drainage stopped/TM sealed
TREATMENT
SURGICAL TREATMENT
Ø Surgical treatment is an option for children with
hearing loss and is recommended when the effusion
and hearing loss persist for 4 to 6 months.
Ø Type of procedure to be used. Myringotomy,
Adenoidectomy, Tympanostomy Tubes.
TREATMENT
Cholesteatoma Formation
Suppurative Complications of Otitis Media
THE END