Otits Media with Effusion
OTITIS MEDIA WITH EFFUSION
- Synonyms: Serous Otitis Media / Secretory Otitis Media / Mucoid Otitis Media/ Glue Ear/Non-Suppurative Otitis Media/Silent Otits Media.
- Non purulent sterile effusion accumulates in the middle ear cavity.
- Painless condition
- MCC of conductive deafness in school-going children
ETIOLOGY OF OTITS MEDIA WITH EFFUSION
- Malfunctioning of Eustachian tube (adenoid hyperplasia, chronic rhinitis, sinusitis & tonsillitis, tumors of nasopharynx, cleft palate)
- Cause of U/L secretory otitis media in an adult is Nasopharyngeal Carcinoma.
- Patients with Wegener’s Granulomatosis may present with Secretory Otitis Media
- Characteristic triad of Wegener’s granutomatosis is vasculitis of the upper respiratory tract (serious otitis media and epistaxis), vasculitis of the lower respiratory tract (hemoptysis) and vasculitis of the kidney (proteinuria).
- Allergy
- Unresolved otitis media
- Viral infection – adeno and rhinoviruses.
CLINCAL FEATURES OF OTITS MEDIA WITH EFFUSION
Symptoms:
- Hearing loss (<40DB)
- Delayed and defective speech
- Mild ear ache.
Otoscopy :
- Dull and opaque tympanic membrane.
- Intact tympanic membrane.Colour may be Yellow/Grey/Blue.
- Loss of light reflex
- Thin leash of blood vessels seen along the handle of malleus (less marked than ASOM)
- Retracted TM
- Bulging of the posterior part of TM
- Fluid level and air bubbles seen
- Mobility restricted
Tuning fork tests :Conductive deafness of 20-40 dB
Impedance Audiometry:confirmatory test for Secretory Otits Media,Shows Type -B curve.
X-ray Mastoid: Clouding of air cells.
MANAGEMENT OF OTITS MEDIA WITH EFFUSION
Medical Treatment:
- Decongestant , Anti allergic, Antibiotics , Middle ear aeration (Valsalva maneuver)
- Watchful waiting is recommended without immediate use of antibiotics for children with uncomplicated otitis media with effusion.
Surgical Treatment:
- Myringotomy and fluid aspiration: 2 incisions one in the antero inferior and other antero superior quadrant of the TM to aspirate thick glue like secretions.(Beer can principle)
- Grommet insertion: left in place till spontaneously extruded
- In chronic secretory otitis media(also known as Glue ear), the treatment of choice is Myringotomy with ventilation tube insertion
- Tympanotomy (or) cortical mastoidectomy-very limted role
- Surgical t/t of causative factor – adenoidectomy, tonsillectomy, and/or wash out of maxillary antra.
- Treatment of choice in a patient presenting with mouth breathing, recurrent serous otitis media and adenoid facies is Adenoidectomy.
SEQUELAE OF SOM
- Atrophic tympanic membrane and atelectasis of middle ear
- Ossicular necrosis
- Tympanosclerosis
- Retraction pockets and cholesteatoma
- Cholesterol granuloma
Exam Question
- In chronic secretory otitis media(also known as Glue ear), the treatment of choice is Myringotomy with ventilation tube insertion
- Glue ear is a painless condition.
- Glue ear is also known as Chronic Secretory Otits Media.
- During follow up of a case of acute otitis media, a 6 year old child found to have glue ear with no symptoms.
- Commonest cause of hearing loss in children is Chronic secretory otitis media.
- Cause of U/L secretory otitis media in an adult is Nasopharyngeal Carcinoma.
- Acute non suppurative otitis media in adults is due to Malignancy.
- Secretory otitis media is diagnosed by Impedance Audiometry.
- Bluish tympanic membrane is seen in Glue ear.
- Effusion is sterile in Otits media with effusion.
- Type-B Tympanogram is seen in Otits media with effusion.
- Otitis media with effusion is also known as Serous Otitis Media or Mucoid Otitis Media.
- Patients with Wegener’s Granulomatosis may present with Secretory Otitis Media
- Characteristic triad of Wegener’s granutomatosis is vasculitis of the upper respiratory tract (serious otitis media and epistaxis), vasculitis of the lower respiratory tract (hemoptysis) and vasculitis of the kidney (proteinuria).
- Watchful waiting is recommended without immediate use of antibiotics for children with uncomplicated otitis media with effusion.
- Conducting hearing loss with intact tympanic membrane occurs in Glue Ear.
- Treatment of choice in a patient presenting with mouth breathing, recurrent serous otitis media and adenoid facies is Adenoidectomy.
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