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Non-Suppurative Otitis Media

Non-Suppurative Otitis Media. Dr. Vishal Sharma. Types. Otitis Media with effusion (O.M.E.) Adhesive otitis media Tympanosclerosis Baro-traumatic otitis media. Otitis Media with effusion. Presence of serous or mucoid effusion in middle ear cleft with no frank pus. Synonyms:

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Non-Suppurative Otitis Media

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  1. Non-Suppurative Otitis Media Dr. Vishal Sharma

  2. Types • Otitis Media with effusion (O.M.E.) • Adhesive otitis media • Tympanosclerosis • Baro-traumatic otitis media

  3. Otitis Media with effusion Presence of serous or mucoid effusion in middle ear cleft with no frank pus. Synonyms: • Secretory / Serous otitis media • Seromucinous / exudative otitis media • Catarrhal otitis media • Glue ear

  4. Etiology 1. Eustachian tube dysfunction  Vacuum in M.E.  extravasation of fluid  Lack of drainage of M.E. secretions 2. Upper respiratory tract allergy / viral infection  Increase M.E. secretions 3. Low grade middle ear infection  Inadequate treatment of A.S.O.M.

  5. Causes for E.T. dysfunction 1. Eustachian Tube obstruction • Intrinsic edema = infection / allergy / trauma • Extrinsic= adenoid / nasopharyngeal tumour / post – Radiotherapy scarring • Functional = floppy Eustachian tube 2. Patulous Eustachian tube:reflux of secretions

  6. Causes for E.T. dysfunction 3. Palatal abnormality:  cleft palate / palatal palsy 4. Muco-ciliary pathology:  Infection / allergy / smoking  Kartagener’s syndrome / Young’s syndrome  Surfactant deficiency / Immune deficiency

  7. Causes of E.T. dysfunction

  8. Predisposing conditions • Child going to a nursery • Early weaning with formula milk • Parents who smoke • Recurrent respiratory infections • Crowded living condition • Poor nutrition • Cleft palate

  9. Clinical Symptoms • Mild deafness in a young child • Deafness increases during U.R.T.I. • Mild otalgia • Blocking sensation in ear • Delayed & defective speech due to deafness

  10. Clinical signs 1. Otoscopy: • Blue eardrum with restricted mobility • Retraction of T.M. in early stage • Bulging of T.M. in later stages • Fluid level + air bubbles seen behind T.M. 2. Tuning Fork Tests: conductive deafness

  11. Otoscopy

  12. Blue ear drum

  13. Left retracted ear drum

  14. Right air-fluid level

  15. Left air-fluid level

  16. Right air bubbles

  17. Left air bubbles

  18. Investigations

  19. Pure Tone Audiometry P.T.A.: low frequency conductive deafness

  20. Impedance Audiometry C curve in ear drum retraction

  21. Impedance Audiometry B curve in middle ear effusion

  22. X-ray mastoid & Nasopharynx clouding of mastoid air cells + adenoid mass

  23. Medical treatment • Antibiotic (Co-amoxyclav) for 2-4 weeks • Nasal decongestants (systemic + topical) • H1 anti-histamines • Auto-inflation of Eustachian tube by Valsalva maneuver • Analgesic for acute earache

  24. Non-medical, Non-surgical treatment • Politzerization • Otovent balloon • Ear popper device • Eardoc device

  25. Politzerization Rubber tube attached to Politzer bag is put into one nostril & both nostrils pinched. Pt is asked to swallow repeatedly & Politzer bag is squeezed simultaneously.

  26. Otovent balloon device

  27. Technique of inflation

  28. Otovent balloon device Balloon is inflated by blowing air out of nose. When fully inflated, balloon neck is pinched off and nasal occluder is inserted into one nostril. Child is instructed to swallow as balloon is deflated into nasal cavity. Portion of air from balloon enters Eustachian tube & ventilates middle ear.

  29. Ear Popper Device

  30. Ear Popper Device Based on Politzer Maneuver, EarPopper ™ Device delivers a safe, constant, regulated stream of air into nasal cavity. During swallowing, air is diverted to Eustachian tube clearing & ventilating middle ear.

  31. EARDOC device

  32. EARDOC device EARDOC ™ generates & transmits special vibration waves which travel through temporal bone to reach middle ear & Eustachian tube. The waves ease middle ear pressure & drain trapped fluids. As a result edema & pain are reduced.

  33. Surgical treatment • Myringotomy (Tympanocentesis) + grommet (Pressure Equalization tube) insertion: Radial incision made in antero-inferior quadrant. For thick fluid, 2 incisions made in antero-inferior quadrant & antero-superior quadrant (Beer can principle).

  34. Surgical treatment • Laser or radio-frequency assisted myringotomy: grommet insertion not required • Cortical mastoidectomy: for refractory cases with loculated fluid in mastoid • Treatment for predisposing factors:adeno-tonsillectomy / antral wash / polypectomy

  35. Myringotomy & grommet insertion

  36. Myringotome

  37. Right Myringotomy incision

  38. Left Myringotomy incision

  39. Myringotomy performed

  40. Beer can principle

  41. Glue like fluid

  42. Shepard’s Grommet

  43. Armstrong’s grommet

  44. Donaldson grommet

  45. Shah’s grommet

  46. T-tube grommet

  47. Grommet insertion

  48. Right grommet in position

  49. Left grommet in position

  50. Grommet in ant-sup quadrant

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