BY : GAUTAM DALSANIYA

SYNONYMS
SECRETORY OTITIS MEDIA
 SEROUS OTITIS MEDIA
 MUCOID OTITIS MEDIA
 “GLUE EAR”
INTRODUCTION
 INSIDIOUS CONDITION
CHARACTERISED BY ACCUMULATION
OF STERILE NONPURULENT EFFUSION
OF MIDDLE EAR CLEFT . THE FLUID MAY
BE THICK OR THIN AND VISCID.
INCIDENCES
 MOST COMMON IN CHILDREN
 SCHOOL GOING CHILDREN (5-10 AGE)
 BOTH SEXES ARE EQUALLY AFFECTED
 MORE COMMON IN WINTER SEASON
 INCREASED IN CHILDREN HAVING DOWN
SYNDROME , PALATAL DEFECT
IMMUNODEFICIENCY STATE , NOT
BREASTFEEDED , ETC.
PATHOGENESIS
 EUSTACHIAN TUBE DYSFUNCTION
1. FAILURE OF AREATION
2. FAILURE OF DRAINAGE
 INCREASED SECRETION OF MIDDLE EAR
INCREASE IN NUMBER OF MUCUS OR
SEROUS SECRETING GLANDS.
AETIOLOGY
MALFUNCTIONING OF EUSTACIAN TUBE d/t
1. OBSTRUCTION :
ADENOID HYPERPLASIA
PALATAL DEFECTS AND BIFID UVULA
TUMORS (NASOPHARYNGEAL CARCINOMA)
OEDEMA DURING RADIOTHERAPY
2. SPREAD OF INFECTION
CHRONIC RHINO-SINUSITIS
CHRONIC ADENOIDITIS
CHRONIC TONSILLITIS
 ALLERGY
SEASONAL ALLERGY TO INHALANT AND
FOODSTUFF IS COMMON IN CHILDREN.
 INFECTION
1. UNRESOLVED AOM
2. VIRAL INFECTION
RESPIRATORY SYNCITIAL VIRUS
ADENOVIRUS
 BAROTRAUMA USUALLY IN FLYERS
CLINICAL FEATURES
 SYMPTOMS
1. FLUCTUATING DEAFNESS
2. EARACHE USUALLY MILD
3. DELAYED AND DEFECTIVE SPEECH
4. TINNITUS

 ASSOCIATED SYMPTOMS
1. NASAL DISCHARGE
2. NASAL BLOCKAGE
3. PAIN IN THROAT AND FEVER
 ENT EXAMINATION
 EAR
1. OTOSCOPIC FINDING
USUALLY INTACT NORMAL TM IS SEEN.
1.TM COLOUR MAY BE YELLOW , GREY , OR BLUISH
2. THIN LEASH OF BLOOOD VESSEL SEEN ALONG
HANDLE OF MALLEUS OR AT PERIPHERY OF TM
3. IN EARLY STAGE TM AY BE NORMAL OR
RETRACTED
IN LATER STAGE TM IS BULGED IN POSTERIOR
PART DUE TO EFFUSION
4. IN CHILDREN FLUID LEVEL AND AIR BUBBLE
MAY BE SEEN WHEN TM IS TRANPARENT & THIN
5. LIGHT REFLEX IS LOST OR DISTORT
BULGING TM WITH BLOOD VESSELS AT
HANDLE OF MALLEUS AND PERIPHERY
FLUID AND AIR BUBBLES
IN MIDDLE EAR
2. PNEUMATIC OTOSCOPY
USED TO ASSESS THE MOBILITY AND POSITION
OF TYMPANIC MEMBRANE
OBSERVE THE TM MOVEMENT BY INCREASING
PRESSURE IN
1. EAC BY SIEGEL’S PNEUMATIC SPECULUM
2. MIDDLE EAR BY VALSALVA MANEUARE
FINDING : USUALLY THE MOBILITY OF TM IN SOM
IS RESTRICTED.

3. TUNNING FORK TEST

RINNE’S TEST : NEGATIVE
WEBER TEST : LATERALISED TO WORST EAR
ABC TEST : SAME AS EXAMINER
EVALUATION
1. PURE TONE AUDIMETRY
1. IT SHOWS THE B/L OR U/L CONDUCTIVE
HEARING LOSS OF 20-40 dB
2. AIR BONE GAP OF > 15 dB PRESENT
2. IMPEDENCE AUDIOMETRY
(TYMPANOMETRY)
IN CASE OF SEROUS OTITIS MEDIA WE GET
“B AND C “ PATTERN.
TYPE B IS MOST COMMONLY ASSOCIATED
3. RADIOLOGY
1. X-RAY MASTOID SCHULLER’S VIEW
CLOUDING IN THE MASTOID AIR CELLS

2. X-RAY SKULL AND NECK LATERAL VIEW

WE MAY GET THE ADENOID HYPERPLASIA
TREATMENT
1. MEDICAL TREATMENT
1. NASAL DECONGESTANT
LOCAL : OXYMETAZOLIN , XYLOMETAZOLIN
SYSTEMIC: PSEUDOEPHDRINE 25 MG

2. ANTIHISTAMINICS

3. ANTIBIOTCS : CO-AMOXICLAV ( ONLY IN CASE OF

URTI OR UNRESOLVED ASOM)

4. MIDDLE EAR AREATION : BY

a) VALSALVA MANOEUVRE
b) EUSTACHIAN TUBE CATHETERIZATIN
c)CHILDREN TO BE GIVEN CHEWING GUMS
2. SURGICAL TREATMENT
1. REMOVAL OF CAUSES
ADENOIDECTOMY
TONSILLECTOMY
WASHOUT OF MAXILLARY ANTRA
2. MYRINGOTOMY
DONE TO ASPIRATE THE FLUID IN MIDDLE
EAR.
~ SMALL RADIAL INCISION IS MADE ON
POSTEROINFERIOR OR ANTEROINFERIOR
~TWO INCISION ARE MADE ON ANTERO-
-INFERIOR AND ON ANTEROSUPERIOR TO
ASPIRATE THICK GLUE LIKE FLUID. IT IS
KNOWN AS “BEER-CAN” PRINCIPLE.
INCISION GIVEN IN MYRINGOTOMY IN SOM
3. VENTILATION TUBES/ TYMPANOSTOMY
TUBE ( GROMMETS OR T-TUBE)
FOR CONTINOUS AREATION GROMMETS OR
T- TUBES CAN BE INSERTED FOR CONTINOUS
DRAIAGE.
 TYPES OF TUBE
1. SHEPARDS GROMMET
2. SILICONE –TUBE
3. SHAH TUBE
4. GOODIE’S T-TUBE
5. METAL TUBE LIKE TITANIUM,GOLD
 COMPLICATION OF VENTILATION TUBE
1. BLOCKAGE DUE TO BLOOD OR SECRETION
2. MIDDLE EAR INFECTION
3. EXTRUSION
4. PERSISTENT PERFORATION
5. TYMPANOSCLEROSIS
6. GRANULOMA FORMATION.

FOR LONG TERM (1-2 yr) T-TUBE CAN BE USED OR

WHEN GROMMETS ARE EXTRUDED.
GROMMETS CAN BE USED FOR 2-6 MONTHS .
SEQUELE OF CHRONIC SOM.
1. ATELECTASIS OF MIDDLE EAR AND ATROPHIC TM
2. OSSICUAR NECROSIS – MOST COMMONLY LONG
PROCESS OF INCUS GET NECROSED
3. TYMPANOSCLEROSIS(CHALKY DEPOSITE ON TM)
4. RETACTION POCKETS AND CHOLESTEATOMA
5. CHOLESTEROL GRANULATION- DUE TO STASIS OF
SECRETION IN MIDDLE EAR .
AERO- OTITIS MEDIA
DEFINITION
IT IS A NON-SUPPURATIVE ONDITION RESULTING
FROM FAILURE IF EUSTACHIAN TUBE TO MAINTAIN
MIDDLE EAR PRESSURE AT AMBIENT ATMOSPHERIC
LEVEL.
MECHANISM
WHEN ATM. PRESSURE IS HIGHER THAN THE
MIDDLE EAR PRESSURE BY A CRITICAL OF 90 mmHg
AND EUSTACIAN TUBE GET BLOCKED.
SUDDEN NEGATIVE PRSSURE CAUSE RETRACTION OF
TYMPANIC MEMBRANE , HYPERAEMIA , ENGORGED
VESSEL , HAEMORRHAGE AND TRANSUDATION.
CLINICAL FEATURE
1.SYMPTOMS : SEVERE EARACHE
HEARING LOSS
TINNITUS
2.SIGN : TM RETRACTED
CONGSTED TM
MAY SHOW FLUID OR HAEMORRHAGIC
EFFUSION.

TREATMENT
1.RESTORE MIDDLE EAR AREATION
2. DECONGESTANT NASAL DROP
3. MYRINGOTOMY IF REQUIRED
THANK
YOU