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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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.