Otitis Media with Effusion and Acute Otitis Media - PowerPoint PPT Presentation

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Otitis Media with Effusion and Acute Otitis Media

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Adenoids disease. enlarged or chronic infection or malignancy. Anatomy ... Additional pathology (adenoid disease) Diagnosis. Oto(micro)scopy. aerated/fluid ... – PowerPoint PPT presentation

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Title: Otitis Media with Effusion and Acute Otitis Media


1
Otitis Media with Effusion and Acute Otitis
Media
  • Wouter-J.F. ten Cate
  • ORL Specialist

2
Anatomy
3
Normal Ear
4
Middle Ear Effusion
  • Fluid in the middle ear

Normal
5
Epidemiology
  • Middle ear effusion is the most common cause of
    acquired conductive hearing loss in children
  • 60 of all children will have a middle ear
    effusion in their first year
  • 90 of all children will develop a middle ear
    effusion

6
Epidemiology
  • The peak is between 3-6 years where 30 will have
    a a middle ear effusion
  • Incidence drops to 2 at age 11
  • Incidence relates positively to upper airway
    tract infections

7
Persistent Middle Ear EffusionSynonyms
  • Glue ear
  • Otitis media with effusion (OME)
  • Chronic seromucinous otitis media

8
OME
  • The diagnosis otitis media with effusion is made
    when fluid is present behind the ear drum for 12
    weeks or more

9

Factors involved in the Aetiology of OME
Anatomic/Physiological dysfunction 1. Eustachian
tube dysfunction 2. Cleft palate submucous
cleft 3. Craniofacial dysplasia (trisomie 21)
Infection
Host Factors 1.Immature/impaired immunology 2.
Familial predisposition 3. Method of feeding
(breast or bottle) 4. Sex 5. Race
OME
Environmental Factors 1. Day-care attendance 2.
Smoking in households
Allergy
10
Infection/Inflammation
Eustachian tube dysfunction
Hyperactive middle ear and tube mucosa
Negative middle ear pressure
OME
11
Eustachian Tube
  • Connects middle ear and nasopharynx
  • Lumen shaped like two cones with apex directed
    toward middle, isthmus
  • Mucosa has mucous producing cells and ciliated
    cells

12
Eustachian Tube
13
Eustachian Tube
14
Nasopharynx
15
Eustachian tube
  • Children
  • wide cartilaginous part
  • longer bony portion
  • 10 degree angle
  • isthmus larger
  • nasopharyngeal orifice 4-5 mm in infants
  • Adults
  • ant 2/3- cartilaginous
  • post 1/3- bony
  • 45 degree angle
  • isthmus 1-2 mm
  • nasopharyngeal orifice 8-9 mm

16
Eustachian Tube
  • Usually closed
  • Opening involves cartilaginous portion
  • Opens 1 x per minute in adult
  • Opens 5 x per minute in a baby
  • Duration of opening only a fraction of a second

17
Eustachian Tube Physiology
  • Pressure regulation (ventilation) of the middle
    ear
  • Clearance of middle ear secretions
  • Protection from nasopharyngeal sound, secretions,
    and pressure differences during breathing,
    swallowing etc.

18
Eustachian Tube and Middle Ear Pressure
  • Compensation the negative pressure changes due to
    of gas diffusion in the middle ear
  • Dynamic equilibrium lies around zero

19
The mastoid serves as
a pressure
buffer Small mastoids are correlated with
chronic middle ear disease
20
Tube opening Active and Passive
  • Active during swallowing, yawning, and sneezing
  • Tensor veli palatini responsible for active tubal
    opening
  • Passive From middle ear or nasopharynx through
    pressure difference (Valsalva, scuba diving)

21
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22
Tube Dysfunction
  • Upper airway infection
  • involves often Eustachian tube
  • Adenoids disease
  • enlarged or chronic infection or malignancy
  • Anatomy
  • Cleft palate
  • Craniofacial dysplasia (trisomie 21)
  • children
  • Trauma
  • adenoidectomy and temporal bone fracture
  • Ciliary dysfunction

23
Eustachian Tube Function Tests
  • Valsalva
  • Toynbee
  • Politzer
  • Tympanogram (indirect)

24
Valsalva and Toynbee
25
Valsalva Manoeuvre
26
Tympanometry
  • Compliance test of the tympanic membrane under
    different pressure levels in the outer ear canal

27
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28
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29
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30
Causes of Hyperactive Middle Ear Mucosa and Fluid
Exudate
  • Bacterial and viral infection
  • Allergy
  • Negative middle ear pressure

31
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32
Infection and OME
  • Previously thought sterile
  • 30-50 grow in culture
  • Over 75 PCR
  • Usual upper airway infection organisms

33

34
Clinic of Persistent Middle Ear Effusion
  • Oft asymptomatic
  • Hearing loss
  • Plugged, popping ears, otalgia
  • Delayed speech development
  • Unclear speech / loud speech
  • Additional pathology (adenoid disease)

35
Diagnosis
  • Oto(micro)scopy
  • aerated/fluid
  • position - bulging, retracted
  • mobility - normal, hypomobile, neg pressure
    (pneumatic otoscope)
  • associated pathology

36
Otoscope
37
Valsalva with MEE
38
Middle Ear Effusion with Air Bubbles
39
OME Typical
40
OME
41
Middle Ear Effusion?
42
Further Diagnostics
  • Audiogram
  • document CHL, SNHL, baseline, preop
  • sooner if high risk
  • Impedance tympanometry

43
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44
Treatment - OME
  • Antibiotics/nasal decongestants
  • If unresponsive
    Myringotomy tympanostomy combined with
    treatment of associated condition if possible
    (adenoidectomy, allergic rhinitis)
  • Valsalva training

45
Adenoid Face
46
Enlarged Adenoids
47
Myringotomy
48
After VT Placement
49
Complications of VTs
  • G/A complications.
  • Otorrhoea 12
  • TM perforation 0.5 -25
  • Scarring/ atrophy/ tympanosclerosis of TM
  • Cholesteatoma

50
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51
CAVE Middle Ear Effusion in Adults...
52
NPC
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