By Dr. Muaid I.

Aziz FICMS

AOM
CATARRHAL

COM
EFFUSION

EFFUSION

SUPPOARATIVE

SUPPURATIVE

TUBOTYMPANIC

ATTICOANTRAL

 Its a viral or bacterial infection of mucosal lining of the ME+

AOM

MAC More commoner in children than adult ?

1. adenoid 2. URTI 3. ET

ET disorders
ET dysfunction
Patulous ET

AOM
Types
Catarrhal Effusion

Suppurative

Acute catarrhal otitis media

URTI

Deafness ? No pain
Examination Nose

Pharynx
Ear Audiometry

Treatment
Treating underlying cause

Nasal decongestant
Inflation of the Eustachian tube

Acute middle ear effusion

More sever variety of catarrhal OM
Cause : URTI , Allergy , Barotrauma

More marked sx ( deafness, tinnitus ,vertigo)

Examination Congested , dark orange hue to it , may be retracted ,

little or no movement of the TM, splitted cone of light, fluid level Medical or surgical

ACUTE SUPPURATIVE OTITIS MEDIA

more commoner in children than in adults.
it can follow URTI which is often viral initially or it

can be secondary to the introduction of water through a perforation . Viral or bacterial adenovirus , rhinovirus streptococcus pneumonia , haemophilus influenza, branhamella catarrhalis.

 sudden onset dull ache in the ear which may become more

sever hearing loss fever ( common in children ) examination will show the drum very red & marked bulging outwards of the TM with loss of surface anatomy if the TM perforated or if there is preexisting perforation a copious mucopurulent & occasionally blood stained discharge coming from the ear once the drum rupture the pain will decrease to a dull ache

Treatment
URTI should be treated .

a 5 day course AB given as amoxillin _ clavelinic acid

analgesia for pain if present nasal decongestant

antihistamine drugs
myringotomy needed for reliving the sever pain

which is due to accumulated pus in the middle ear which is not resolved by AB if there is long standing perforation with recurrent attacks of AOM so myringoplasty is prepared for.

CHRONIC OTITIS MEDIA

Deafness main sx
Discharge ? Otalgia ? Other pathology ?

CX malignacy

? ?

CHRONIC MIDDLE EAR EFFUSION :

serous or secretory otitis media
In children & adults ? aetiology

chronic Eustachian tube dysfunction or obstruction due to blockage of the tube in the middle Ear or nasopharynx URTI as sinusitis , nasopharyngitis , allergic rhinitis unexplained chronic middle ear effusion specially in older person? suspicion of nasopharyngeal carcinoma.

Clinical features
blocked feeling in the ear occasionally tinnitus or mild vertigo the patient is unable to clear the ear by autoinflation . On examination

retraction of the TM in whole or part , retraction of pars tensa is seen &

the handle of malleus appears shortened & to lie in more horizontal position. The lateral process of the malleus may thus appear more prominent . the drum often have a dark or orange hue to it & occasionally a fluid level may be seen . Examination of the nose may reveal signs of the sinusitis or allergic rhinitis , occasionally a nasopharyngeal tumor detected on examination of the nasopharynx . Investigation : audiometry will reveal a CHL diminished or absent TM mobility on tympanogram will show flat curve which indicate ve middle ear pressure

Treatment
Treating of underlying cause
myringotomy +/- grommet Hearing aids

Chronic suppurative otitis media

Tubo - tympainc CSOM

Attico - antral

CSOM ( tympanomastoid )

Tubo-tympanic CSOM

AETIOLOGY PATHOLOGY C/F Mucopurulent discharge Deafness ( mild to moderate sever ?) Examination Central perforation ( ant. ,posterior , kidney shaped or subtotal) Otitis externa Nose , nasopharynx , pharynx should examined (tonsil ,adenoid, sinus infection) Hearing test X-R ( PNS , postnasal space , mastoid ) Mastoid X-R ( cellular, sclerotic),erosion? Swab for c/s

 CX is rare & are not serious

Polyp OE

More sever HL

TREATMENT
Treating URTI
Local treatment Thorough cleaning of ear canal (mopping , or suction

clearance) AB + steroid ( 5 days) local +/- systemic Preventive measures Surgery ( myringoplasty)( recurrent , deafness with disabilities)

Atticoantral CSOM
TYMPANOMASTOID ?
Serious cx ? Granulation tissue or polyp ?meaning?

pathology
Cholesteatoma
Granulation tissue with osteitis Cholesterol granuloma

Cholesteatoma
DEFINITION ( fat or keratin)
TYPES

Congenital cholesteatoma

THEORIES
Congenital cholesteatoma .

Metaplasia
Ingrowth of squamous epithelium Retraction pocket

Granulation tissue

Cholesterol granuloma
Dark brown gelatinous material with bone

destruction In combination of previous pathology Dark blue TM Cholesterol crystals

Clinical features
Discharge
Deafness Bleeding

Otoscopy
Foul smell dicharge Perforation Polyp , GT , cholesteatoma

Investigations
Hearing assessment
Radiology

Treatment
EUM + suction clearance
Polyp or GT ? Medical or surgical ? Mastoidectomy

COMPLICATIONS OF OM
Extracranial
Intracranial

EC COMPLICATIONS
Mastoiditis ( acute, masked, chronic) Petrositis

Labyrinthitis
Facial nerve pulsy

mastoiditis

presentation
Increasing Pain , tenderness behind the ear
Ear discharge ,no discharge(masked) Fever (child)

Increasing pulse
Deafness

Examination
Downwards ,outwards protruded auricle
Fluctuant swelling Sagging of posterior meatal wall

Perforated TM with pulsating discharge

Intact TM

 Investigation ( XR) , hearing assessment

Treatment AB

SURGERY

INTRACRANIAL COMPLICATIONS
meningitis Extradural abscess

Subdural abscess
Brain abscess Lateral sinus thrombosis

thanks