Otits Media with Effusion

Otits Media with Effusion

Q. 1 In chronic secretory otitis media, the treatment of choice is:
 A Cortical mastoidectomy
 B Radical mastoidectomy
 C Grommet tube insertion
 D Antibiotics and antihistaminic for 6 weeks
Q. 1 In chronic secretory otitis media, the treatment of choice is:
 A Cortical mastoidectomy
 B Radical mastoidectomy
 C Grommet tube insertion
 D Antibiotics and antihistaminic for 6 weeks
Ans. C

Explanation:

Otitis media with effusion (glue ear) or non-suppurative otitis media or sero mucinous otitis media or exudative otitis media is a very common condition in children and majority of children experience at least one episode in their life. Primary cause is poor Eustachian tube function in children. As the O2 is continuously absorbed by the middle ear mucosa it results in negative middle ear pressure unless the Eustachian tube opens to replenish the ear. Negative pressure leads to transudation of fluid into the middle ear and if the hypoxia continues a mucoid exudate is produced by the glands of middle ear mucosa (glue ear). Majority of children need no treatment. but, if required, surgery is the only effective way of curing glue ear and both ventilation tube (grommet) and adenoidectomy are effective. Myringotomy should be followed by grommet insertion to maintain the aeration of middle ear. It should be left in situ for weeks or months or until it is spontaneously extruded.


Q. 2

Weber Fechner Law is:

 A

Magnitude of stimulus strength perceived is approximately proportionate to the log of the intensity of stimulus strength

 B

Magnitude of stimulus strength perceived is directly proportional to the intensity of stimulus strength

 C

Threshold of receptor is directly proportional to stimulus strength

 D

Threshold of receptor is inversely proportional to stimulus strength

Q. 2

Weber Fechner Law is:

 A

Magnitude of stimulus strength perceived is approximately proportionate to the log of the intensity of stimulus strength

 B

Magnitude of stimulus strength perceived is directly proportional to the intensity of stimulus strength

 C

Threshold of receptor is directly proportional to stimulus strength

 D

Threshold of receptor is inversely proportional to stimulus strength

Ans. A

Explanation:

Magnitude of stimulus strength perceived is approximately proportionate to the log of the intensity of stimulus strength [Ref: Guyton 11/e p594; Ganong 22/e 126]

Weber – Fechner law

  • It states that the magnitude of the sensation felt in proportionate to the log of intensity of the stimulus.
  • Example – A person holding 30 grams weight in his hand can barely detect a I gm rise in weight (a rise than 1 gm would not be detectable). But when he holds 300 gm of weight. he can rarely detect a 10 gm increase in weight (a rise less than 10 gm would not be detectable to him. So a 300 gm wt. and (Say) 307 gm of weights would appear same to him.)
  • This is expressed mathematically as

Interpreted signal strength = Log x stimulus intensity + constant

 

 


Q. 3

Treatment of choice for glue ear is

 A

Myringotomy with cold knife

 B

Myringotomy with diode laser

 C

Myringotomy with ventilation tube insertion

 D

Conservative treatment with analgesics & antibiotics

Q. 3

Treatment of choice for glue ear is

 A

Myringotomy with cold knife

 B

Myringotomy with diode laser

 C

Myringotomy with ventilation tube insertion

 D

Conservative treatment with analgesics & antibiotics

Ans. C

Explanation:

 

(also k/a Serous otitis media, secretory otitis media, Mucoid otitis media)

  • OME is characterized by a non-purulent effusion of the middle ear that may be either mucoid or serous.
  • Symptoms usually involve hearing loss or aural fullness but typically do not involve pain or fever. In children hearing loss is generally mild and is often detected only with an audiogram.
  • The fluid is nearly sterile.
  • The condition is commonly seen in school-going children. It is the leading cause of hearing loss in children. Pathogenesis
  • Two main mechanisms are thought to be responsible.
  1. Eustachian tube dysfunction
  2. Increased secretory activity of middle ear mucosa

Treatment

  • Treatment may be medical or surgical
  • Medical measures are controversial and involve
  1. Decongestants
  2. Antiallergic measures
  3. Antibiotics
  4. Middle ear aeration

– Valsalva manoeuvre

– politzerisation or eustachian tube catheterization

– chewing gum

  • Surgical

1.Myringotomy and aspiration of fluid

2. Grommet or ventilation tube insertion

3. Surgical t/t of causative factor – adenoidectomy, tonsillectomy, and/or wash out of maxillary antra.


Q. 4

Treatment of choice for glue ear is:

 A

Myringotomy with cold knife

 B

Myringotomy with diode laser

 C

Myringotomy with ventilation tube insertion

 D

Conservative treatment with analgesics and antibiotics

Q. 4

Treatment of choice for glue ear is:

 A

Myringotomy with cold knife

 B

Myringotomy with diode laser

 C

Myringotomy with ventilation tube insertion

 D

Conservative treatment with analgesics and antibiotics

Ans. C

Explanation:

Q. 5

Glue ear:

 A

Is painful

 B

Is painless

 C

Radical mastoidectomy is required

 D

NaF is useful

Q. 5

Glue ear:

 A

Is painful

 B

Is painless

 C

Radical mastoidectomy is required

 D

NaF is useful

Ans. B

Explanation:

Ans:B.)Is painless.

OTITIS MEDIA WITH EFFUSION

  • SynonymsSerous 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:
  • 1. 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)
  • 2. 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
  • 3. Tympanotomy (or) cortical mastoidectomy-very limted role
  • 4. 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

Q. 6

A mother brought her child with glue ear. Child had otitis media two weeks before. What is the treatment of choice for glue ear?

 A

Myringotomy with cold knife

 B

Myringotomy with diode laser

 C

Myringotomy with ventilation tube insertion

 D

Conservative treatment with analgesics & antibiotics

Q. 6

A mother brought her child with glue ear. Child had otitis media two weeks before. What is the treatment of choice for glue ear?

 A

Myringotomy with cold knife

 B

Myringotomy with diode laser

 C

Myringotomy with ventilation tube insertion

 D

Conservative treatment with analgesics & antibiotics

Ans. C

Explanation:

Otitis media with effusion (OME or glue ear) is defined as fluid in the middle ear space without clinical signs of inflammation or acute symptoms of illness. Otitis media with effusion usually follows an episode of acute otitis media. 

The guideline recommendation for the management of OME is that ventilating tubes should be placed after an effusion has persisted for 4 months and is accompanied by a bilateral hearing impairment of 20 dB or greater.
 

Q. 7

Glue ear is also known as:

 A

Acute suppurative otitis media

 B

Chronic suppurative otitis media

 C

Chronic secretory otitis media

 D

None of the above

Q. 7

Glue ear is also known as:

 A

Acute suppurative otitis media

 B

Chronic suppurative otitis media

 C

Chronic secretory otitis media

 D

None of the above

Ans. C

Explanation:

Q. 8

What is the treatment of choice for glue ear?

 A

Myringotomy with cold knife

 B

Myringotomy with diode laser

 C

Myringotomy with ventilation tube insertion

 D

Conservative treatment with analgesics & antibiotics

Q. 8

What is the treatment of choice for glue ear?

 A

Myringotomy with cold knife

 B

Myringotomy with diode laser

 C

Myringotomy with ventilation tube insertion

 D

Conservative treatment with analgesics & antibiotics

Ans. C

Explanation:

 
 

Q. 9

During follow up of a case of acute otitis media, a 6 year old child found to have glue ear with no symptoms. Next step of management is:

 A

Wait and watch

 B

Antibiotics

 C

Corticosteroids

 D

Antihistamines

Q. 9

During follow up of a case of acute otitis media, a 6 year old child found to have glue ear with no symptoms. Next step of management is:

 A

Wait and watch

 B

Antibiotics

 C

Corticosteroids

 D

Antihistamines

Ans. A

Explanation:

Close to 90% of episodes of otitis media with effusion (glue ear) resolve spontaneously after an acute otitis media episode is diagnosed. 
 
The American Academy of Pediatrics 2004 consensus guideline recommends watchful waiting without immediate use of antibiotics for children with uncomplicated otitis media with effusion.


Q. 10

A 18-month-old boy is brought by parents to his family physician with a 2-day history of fever, irritability, and frequent tugging of his left ear. The physician diagnoses acute otitis media and treated with antibiotics. In follow-up 2 months later, otoscopic examination, air-fluid levels are seen in the left ear. Medical management is failed to resolve the effusion. Treatment of choice in this child is:

 A

Conservative

 B

Tympanoplasty

 C

Myringotomy with ventilation tube insertion

 D

Myringotomy with diode laser

Q. 10

A 18-month-old boy is brought by parents to his family physician with a 2-day history of fever, irritability, and frequent tugging of his left ear. The physician diagnoses acute otitis media and treated with antibiotics. In follow-up 2 months later, otoscopic examination, air-fluid levels are seen in the left ear. Medical management is failed to resolve the effusion. Treatment of choice in this child is:

 A

Conservative

 B

Tympanoplasty

 C

Myringotomy with ventilation tube insertion

 D

Myringotomy with diode laser

Ans. C

Explanation:

Surgical measures of serous otitis media:
  • Myringotomy and aspiration of fluids
  • Grommet insertion
  • Tympanotomy or cortical mastoidectomy
  • Surgical treatment of causative factor
 

Q. 11

Commonest cause of hearing loss in children is:

 A

CSOM

 B

ASOM

 C

Acoustic – neuroma

 D

Chronic secretory otitis media

Q. 11

Commonest cause of hearing loss in children is:

 A

CSOM

 B

ASOM

 C

Acoustic – neuroma

 D

Chronic secretory otitis media

Ans. D

Explanation:

Q. 12

Cause of U/L secretory otitis media in an adult is:

 A

CSOM

 B

Nasopharyngeal carcinoma

 C

Mastoiditis

 D

Foreign body of external ear

Q. 12

Cause of U/L secretory otitis media in an adult is:

 A

CSOM

 B

Nasopharyngeal carcinoma

 C

Mastoiditis

 D

Foreign body of external ear

Ans. B

Explanation:

 


 


Q. 13

Acute non suppurative otitis media in adults is due to:

 A

Allergic rhinitis

 B

URTI

 C

Trauma

 D

Malignancy

Q. 13

Acute non suppurative otitis media in adults is due to:

 A

Allergic rhinitis

 B

URTI

 C

Trauma

 D

Malignancy

Ans. D

Explanation:

Q. 14

Glue ear:

 A

Is painful

 B

Is painless

 C

Radical mastoidectomy is required

 D

NaF is useful

Q. 14

Glue ear:

 A

Is painful

 B

Is painless

 C

Radical mastoidectomy is required

 D

NaF is useful

Ans. B

Explanation:

 

Glue Ear/serous Otitis Media is a painless condition


Q. 15

Secretory otitis media is diagnosed by:

 A

Impedance audiometry

 B

Pure tone audiometry

 C

X-ray

 D

a and c

Q. 15

Secretory otitis media is diagnosed by:

 A

Impedance audiometry

 B

Pure tone audiometry

 C

X-ray

 D

a and c

Ans. A

Explanation:

 

Pure tone audiometry gives information about the quantity and quality of hearing loss.

In secretory otitis media: conductive deafness of 20-40 dB is seen (which is not a specific finding as conductive deafness can be seen in many other conditions). Therefore, pure tone audiometry is not diagnostic of serous otitis media but provides an assessment of the hearing loss and is therefore important in monitoring the progress of the condition and provides information useful for management decisions

On otoscopy: Tympanic membrane appears dull, opaque with loss of light reflex

X-ray mastoid: Shows clouding of air cells. (not diagnostic)

Impedance audiometry is an accurate way of diagnosing serous otitis media. It shows type B tympanogram which is diagnostic of fluid in ear.


Q. 16

Bluish tympanic membrane is seen in:

 A

Early ASOM

 B

Glue ear

 C

Cholesteatoma

 D

Cholesterol granuloma

Q. 16

Bluish tympanic membrane is seen in:

 A

Early ASOM

 B

Glue ear

 C

Cholesteatoma

 D

Cholesterol granuloma

Ans. B

Explanation:

 

In glue ear (serous otitis media) Tympanic membrane is dull opaque with loss of light reflex and appears yellow / grey / blue in colour.

  • Normal colour of tympanic membrane is pearly grey.
  • Congested membrane with prominent blood vessels (cartwheel sign) is seen in early stages of acute otitis media.
  • Bluish discoloration is seen in haemotympanum.
  • Flamingo pink color is seen in otosclerosis.



Q. 17

Treatment of choice for glue ear is:

 A

Myringotomy with cold knife

 B

Myringotomy with diode laser

 C

Myringotomy with ventilation tube insertion

 D

Conservative treatment with analgesics and antibiotics

Q. 17

Treatment of choice for glue ear is:

 A

Myringotomy with cold knife

 B

Myringotomy with diode laser

 C

Myringotomy with ventilation tube insertion

 D

Conservative treatment with analgesics and antibiotics

Ans. C

Explanation:

 

Treatment of choice for glue ear is insertion of grommet (i.e., ventilation tube insertion).

Tympanotomy / cortical mastoidectomy has a very limited role. and is not done nowadays for serious otitis media.


Q. 18

Following statements are true about otitis media with effusion in a child:

 A

Immediate myringotomy is done

 B

Type B tympanogram

 C

The effusion of middle ear is sterile

 D

b and c

Q. 18

Following statements are true about otitis media with effusion in a child:

 A

Immediate myringotomy is done

 B

Type B tympanogram

 C

The effusion of middle ear is sterile

 D

b and c

Ans. D

Explanation:

 



Q. 19

In serous otitis media, which one of the following state­ments is true?

 A

Sensorineural deafness occurs as a complication in 80% of the cases

 B

Intracranial spread of the infection complicates the clini­cal courses

 C

Tympanostomy tubes are usually required for treatment

 D

Gram-positive organisms are grown routinely in culture in the aspirate

Q. 19

In serous otitis media, which one of the following state­ments is true?

 A

Sensorineural deafness occurs as a complication in 80% of the cases

 B

Intracranial spread of the infection complicates the clini­cal courses

 C

Tympanostomy tubes are usually required for treatment

 D

Gram-positive organisms are grown routinely in culture in the aspirate

Ans. C

Explanation:

 

 


Q. 20

Procedure for serous otitis media is:

 A

Tympanoplasty

 B

Mastoidectomy

 C

Myringotomy

 D

Medical treatment

Q. 20

Procedure for serous otitis media is:

 A

Tympanoplasty

 B

Mastoidectomy

 C

Myringotomy

 D

Medical treatment

Ans. C

Explanation:

 

In Children

TOC of serous otitis media – myringotomy + insertion of grommet (ventilation tube) along with adenoidectomy (if features of adenoid hyperplasia are present) or tonsillectomy

In Adults (Scotts Brown 7th ed )

In case of serous otitis media without nasopharyngeal carcinoma.

Myringotomy with ventilation tube insertion is done (In adults ventilation tube improves hearing for a very short term < 1 yr) 

Then there are two treatment options: (i) Hearing aid (ii) Myringotomy without ventilation tube insertion

Recently, CO, laser assisted tympanic membrane ventilation has been advocated for the treatment of adult OME.



Q. 21

Otitis media with effusion is also known as:

 A

Serous otitis media

 B

Suppurative otitis media

 C

Mucoid otitis media

 D

a and c

Q. 21

Otitis media with effusion is also known as:

 A

Serous otitis media

 B

Suppurative otitis media

 C

Mucoid otitis media

 D

a and c

Ans. D

Explanation:

Q. 22

A 25 years old female develops serous otitis media of left ear with cough and occasional hemoptysis and . hematuria and epistaxis for one and half months her. Hemoglobin is 7 gm. B.P. > 170/100, ptoreinuria +++, RA positive (+ve) and ANCA positive (+ve), the likely cause is-

 A

Wegener’s granulo matosis

 B

Rheumiatoid arthritis

 C

Rapidly proliferative glomerulonephritis

 D

Good pasteur’s syndrome

Q. 22

A 25 years old female develops serous otitis media of left ear with cough and occasional hemoptysis and . hematuria and epistaxis for one and half months her. Hemoglobin is 7 gm. B.P. > 170/100, ptoreinuria +++, RA positive (+ve) and ANCA positive (+ve), the likely cause is-

 A

Wegener’s granulo matosis

 B

Rheumiatoid arthritis

 C

Rapidly proliferative glomerulonephritis

 D

Good pasteur’s syndrome

Ans. A

Explanation:

Answer is A (Wegener’s granulomatosis):

The patient in question is presenting with the charachteristic triad of Wegener’s granutomatosis namely, vasculitis of the upper respiratory tract (serious otitis media and epistaxis), vasculitis of the lower respiratory tract (hemoptysis) and vasculitis of the kidney (proteinuria)

Presence of ANCA and Rheumatoid factor further support the diagnosis of Wegener’s granulomatosis which is the single best answer of choice.


Q. 23

A 25 years old female develops serous otitis media of left ear with cough and occasional hemoptysis and hematuria and epistaxis for one and half months her hemoglobin is 7 gm. B.P is > 170/100, proteinuria +++, RA – ve and ANCA – ve, the likely cause is‑

 A

Wegener’s granulomatosis

 B

Rheumiatoid arthritis

 C

Rapidly proliferative glomerulonephritis

 D

Goodpasteur’s syndrome

Q. 23

A 25 years old female develops serous otitis media of left ear with cough and occasional hemoptysis and hematuria and epistaxis for one and half months her hemoglobin is 7 gm. B.P is > 170/100, proteinuria +++, RA – ve and ANCA – ve, the likely cause is‑

 A

Wegener’s granulomatosis

 B

Rheumiatoid arthritis

 C

Rapidly proliferative glomerulonephritis

 D

Goodpasteur’s syndrome

Ans. A

Explanation:

Answer is A>D (Wegener’s granulumatosis > Goodpasture’s Syndrome);

The patient in question is presenting with characteristic clinical triad of Wegener’s granulomatosis, namely, Vasculitis of upper respiratory tract (serous otitis media, epistaxis), Vasculitis of lower respiratory tract (cough and hemoptysis) and vasculitis of the kidney (proteinuria)

Although positive ANCA assays are often instrumental in suggesting the diagnosis of WG, Negative ANCA assays do not preclude the diagnosis, 10% of patients with disseminated WG and upto 30% of patients with limited WG may be negative for ANCA

The clinical picture is classical of Wegner’s Granulomatosis. However, the absence of ANCA confuses the diagnosis. Nevertheless the presence or absence of ANCA should be adjunctive and in the presence of a classical clinical picture of WG, tissue diagnosis (biopsy) should be performed to confirm the diagnosis.

Definitive diagnosis of WG is established by tissue biopsy and not by presence or absence of ANCA

Pulmonary + Renal Syndrome
Pulmonary (Hemoptysis) + Renal (Proteinuria) manifestations

Wegener’s granulomatosis

Classical Clinical presentation is one of a young Male/Female (male: female=1:1) presenting with upper respiratory tract features (Otitis media, Epistaxis) along with hemoptysis and acute glomerulonephritis+

ANCA is usually positive and suggests the diagnosis

Negative ANCA does not preclude the diagnosis. In the presence of classical clinical picture a provisional diagnosis of WG should be made on clinical ground and confirmed/ excluded by tissue biopsy

The patient in question is presenting with classical clinical triad of Wegener’s granulomatosis. Although ANCA is negative a negative ANCA does not preclude the diagnosis of WG. Based on the strong clinical suspicion, WG should the single best initial provisional diagnosis and tissue biopsy should be performed.

Goodpasture’s syndrome

 

Classical clinical presentation is one of a young male smoker (male female=3-4:1) presenting with hemoptysis and signs of acute glomerulonephritis

 

Although disease may be preceeded by an upper respiratory tract infection, upper respiratory tract involvement features like otitis media and epistaxis are not characterstic of good pasture’s syndrome

 

ANCA is usually negative

 

Diagnosis is made by detecting serum levels of Anti GBM antibodies

 

The patient in question is not presenting with classical clinical features of good pasture’s syndrome and serum levels of Anti GBM antibodies have not been provided in the question. These make a diagnosis of Good pasture’s syndrome less likely.




Q. 24

Conducting hearing loss with intact tympanic membrane ‑

 A

Presbycausis

 B

Meniere’s disease

 C

Glue ear

 D

Acoustic neuroma

Q. 24

Conducting hearing loss with intact tympanic membrane ‑

 A

Presbycausis

 B

Meniere’s disease

 C

Glue ear

 D

Acoustic neuroma

Ans. C

Explanation:

Ans. is ‘c’ i.e., Glue ear

Among the given options, only glue ear (serous otitis media) is a cause of conductive deafness.


Q. 25

Following is the preferred treatment of Serous Otitis Media –

 A

Grommet surgery

 B

Oral Amoxicillin for 5 – 10 days

 C

Modified radical mastoidectomy

 D

Bed rest, antipyretics and adequate fluid intake

Q. 25

Following is the preferred treatment of Serous Otitis Media –

 A

Grommet surgery

 B

Oral Amoxicillin for 5 – 10 days

 C

Modified radical mastoidectomy

 D

Bed rest, antipyretics and adequate fluid intake

Ans. A

Explanation:

Ans. is ‘a’ i.e., Grommet surgery

Treatment of otitis media

Following two treatments have been described : ‑

1) Watchful waiting

  • Watchful waiting is the active monitoring of the condition and hearing in anticipation of spontaneous resolution. Guidlines aimed at both primary care and specialist otolaryngologist broadly agree that a watch­ful waiting period for about three months is the initial management of children with serous otitis media. Therefore, unless there are also signs of an infection, most health care providers will not treat SOM at first Instead, they will recheck the problem in 2-3 months. This should be coupled with reassurance that doing nothing is as likely as doing something to result in resolution of the SOM and the associated symptoms.

2) Surgery

  • Surgical intervention is recommended when watchful waiting and monitoring of hearing has confirmed failure of resolution of SOM. Following surgical intervention are used commonly : –
  1. Myringotomy and aspiration offluid : -An incision is made in tympanic membrane and fluid aspirated with suction.
  2. Grommet (ventilation tube) surgery : – If myringotomy and aspiration combined with medical measures has not helped and fluid recurs, a grommet is inserted to provide continued aeration of middle ear. This is the most common surgical intervention for SOM. Most prefered site of grommet insertion is antero-inferior through circumferential or radial incision.
  3. Surgical treatment of causative factor : – Adenoidectomy, tonsillectomy etc.

Medical measures are controversial and involve : ‑

  1. Decongestants
  2. Antiallergic measures
  3. Antibiotics
  4. Middle ear aeration :- Valsalva maneuver, Politzerisation or eustachian tube catheterization, Chewing gum.

Q. 26

Patient presents with mouth breathing, recurrent serous otitis media and adenoid facies. What is the best line of management ?

 A

Adenoidectomy

 B

Tonsillectomy

 C

Antibiotics

 D

Supportive therapy

Q. 26

Patient presents with mouth breathing, recurrent serous otitis media and adenoid facies. What is the best line of management ?

 A

Adenoidectomy

 B

Tonsillectomy

 C

Antibiotics

 D

Supportive therapy

Ans. A

Explanation:

Ans. is ‘a’ i.e., Adenoidectomy

The triad of nasal and aural symptoms with adenoid facies points to the diagnosis of enlarged adenoids.

For the treatment of enlarged adenoids when symptoms are not marked breathing excercise, decongenstant nasal drops and antihistaminics are used and when symptoms are marked, adenoidectomy is done.

We have a patient with marked and recurrent symptoms thus adenoidectomy is the treatment of choice.


Q. 27

All are true about serous otitis media except 

 A

Also called glue ear

 B

Affect school going children

 C

Type C tympanogram

 D

Fluid in middle ear

Q. 27

All are true about serous otitis media except 

 A

Also called glue ear

 B

Affect school going children

 C

Type C tympanogram

 D

Fluid in middle ear

Ans. C

Explanation:

 

Serous otitis media

  • Serous otitis media (SOM) has many synonyms : Serous otitis media, otitis media with effusion, glue ear, non-suppurative otitis media, mucoid otitis media, silent otitis media. SOM is an insidious condition in which there is thick or sticky non-purulent fluid behind the eardrum in the middle ear, but there is no ear infection, i.e., effusion of middle ear without infection. Fluid in the middle ear is sterile. SOM occurs most commonly in school going children and SOM is the commonest cause of childhood hearing loss.

Etiopathogenesis

1) Eustachian tube dysfunction

  • Eustachian tube dysfunction, coupled with recurrent upper respiratory tract infection is the most important factor in the development of SOM. Normally eustachian tube helps to drain fluids to prevent them from building up in the ear. In Eustachian tube dysfunction, it is unable to drain the fluid. Following can cause Eustachian tube block :-
  1. Respiratory tract infection :- Adenoid, rhinitis, tonsillitis, sinusitis.
  2. Allergies
  3. Benign and malignant tumor of nasophar-ynx.

2) Unresolved otitis media

  • Inadequate antibiotic therapy in acute suppurative otitis media may inactivate infection but fails to resolve it completely. Low grade infection lingers on and acts as stimulus for mucosa to secrete more fluid.

Clinical features

  • Unlike children with an ear infection (ASOM), children with SOM do not act sick. o The only presenting symptom may be hearing loss with fullness in ear.

Otoscopic finding of SOM

  • Air bubbles on the surface of ear drum
  • Fluid behind the eardrum.
  • Dullness of the eardrum when a light is used, with loss of light reflex. o Eardrum may appear yellow, grey or bluish in colour.
  • Retracted eardrum with decreased mobility
  • Tympanometry shows type B tympanogram.


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