1 / 34

Otitis Media with Effusion Causes Cures Complications

Otitis Media with Effusion Causes Cures Complications. J.H.Black 2013. Otitis media with Effusion. Introduction Non purulent fluid > 3 months 20-50% of all children 90% resolve spontaneously Precise diagnosis still problem. Otitis media with Effusion. Aetiology: Acute otitis media

bebe
Download Presentation

Otitis Media with Effusion Causes Cures Complications

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Otitis Media with EffusionCauses CuresComplications J.H.Black 2013

  2. Otitis media with Effusion • Introduction • Non purulent fluid > 3 months • 20-50% of all children • 90% resolve spontaneously • Precise diagnosis still problem

  3. Otitis media with Effusion • Aetiology: • Acute otitis media • E.T. obstruction • Cleft palate • Adenoid hypertrophy • Nasal allergy • Chronic rhinosinusitis • Barotrauma • Radiotherapy

  4. Otitis media with Effusion • Aetiology • Acute Otitis Media • Commonest < 5 years • Increased in: • Boys • Winter • Passive smoking • Day care • Non breast fed

  5. Otitis media with Effusion • Aetiology • Acute Otitis Media • Most common cause M.E.E. • Variable resolution rate • Small % have M.E.E. > 3 months • Minimal resolution > 3 months • ??? Delay Grommets for 3 months

  6. Otitis media with Effusion • Aetiology: • Acute otitis media • E.T. obstruction • Cleft palate • Adenoid hypertrophy • Nasal allergy • Chronic rhinosinusitis • Barotrauma • Radiotherapy

  7. Otitis media with Effusion • Aetiology • E.T. Obstruction • Causes negative M.E. pressure • Resultant serous transudate • E.g. Nasopharynx CA • BUT unusual in children – mucoid!

  8. Otitis media with Effusion • Aetiology: • Acute otitis media • E.T. obstruction • Cleft palate • Adenoid hypertrophy • Nasal allergy • Chronic rhinosinusitis • Barotrauma • Radiotherapy

  9. Otitis media with Effusion • Aetiology • Cleft palate • Classic example of aeration failure • All clefts will have: • Episodes of M.E.E. • Persistent negative pressure effects • Retraction of T.M. • Early repair decreases M.E.E. • Large % need repeated Grommets

  10. Otitis media with Effusion • Aetiology: • Acute otitis media • E.T. obstruction • Cleft palate • Adenoid hypertrophy • Nasal allergy • Chronic rhinosinusitis • Barotrauma • Radiotherapy

  11. Otitis media with Effusion • Aetiology • Adenoid Hypertrophy • Contentious relationship • ? Displacement of E.T. orifice • ? Obstruction • ? Reservoir of infection

  12. Otitis media with Effusion • Aetiology • Adenoid Hypertrophy • Not all enlarged A’s have M.E.E.’s • Not all M.E.E.’s have enlarged A’s • A’s with Grommets: • Less M.E.E. once Grommet extruded • ? A’s routine with Grommets

  13. Otitis media with Effusion • Aetiology: • Acute otitis media • E.T. obstruction • Cleft palate • Adenoid hypertrophy • Nasal allergy • Chronic rhinosinusitis • Barotrauma • Radiotherapy

  14. Otitis media with Effusion • Aetiology • Nasal allergy • Weak association • Large A’s with allergy • Chronic rhinosinusitis • Ascending infection • Barotrauma • Radiotherapy • Fibrosis around E.T.

  15. Otitis media with Effusion • Effects of M.E.E. • Hearing loss • Pre-lingual • Delayed onset • Infants • Slow progress • Incorrect pronunciation

  16. Otitis media with Effusion • Effects of M.E.E. • Hearing loss • Pre-school • Delay vocab/ lang acquis/ comm skills • School • Retarded • Word recognition • Reading skill • Intellectual develoment

  17. Otitis media with Effusion • Effects of M.E.E. • Otalgia • Result of secondary infection • Clumsiness • Irritability • Behavioural problems

  18. Otitis media with Effusion • Sequelae M.E. negative pressure • Persistent retraction • Causes atrophy T.M. fibrous layer • Irreversible • Central translucent area • Necrose with AOM - perforation

  19. Otitis media with Effusion • Sequelae M.E.negative pressure • Extensive atrophy • T.M. drapes M.E. structures • Poor sound conduction • Results: • Marked H.L. • Ossicular erosion – amplified H.L.

  20. Otitis media with Effusion • Sequelae M.E. negative pressure • Retraction pockets • Part of T.M. retracts into attic • Postero-superior • Squamous epith.accumulation • CHOLESTEATOMA !!!

  21. Otitis media with Effusion • Sequelae M.E. negative pressure • Cholesteatoma • Destroys ossicles • Obstructs drainage • With infection: • Mastoiditis • Intracranial spread

  22. Otitis media with Effusion • Diagnosis and screening OME • T.M. appearance • Extremely variable • Retraction is N.B. • Very limited • Miss subtle: • Changes • Abnormalities

  23. Otitis media with Effusion • Diagnosis and screening OME • T.M. Mobility • Pneumatic Otoscopy • Tympanometry • Effective screen • Otologist • 94% sensitivity • 75% specificity • Otologist AND Tympanometry • 97% sensitivity • 90% specificity

  24. Otitis media with Effusion • Diagnosis and screening OME • P.T. Audiology / H.L. • Poor relationship • H.L. often absent • OME and AOM often in very young

  25. Otitis media with Effusion • Management of OME • Medical • NO effective medical cure • No help • Antihist / sympathomimetic comb • Mucolytics • Antibiotics

  26. Otitis media with Effusion • Management of OME • Medical • Antibiotics with systemic steroids • Very slight better cure rate (>5yrs) • Steroid nasal sprays • Reduced need for Grommets • Increased general health • No effect on child’s growth

  27. Otitis media with Effusion • Management of OME • Surgical • Myringotomy • Immediate improved hearing • High recurrence rate

  28. Otitis media with Effusion • Management of OME • Surgical • Myringotomy AND Grommets • Ventilate M.E. with neg. M.E.Pressure • Prevent sequelae of TM retraction • Ameliorate otalgia in “grumbling” OM • Prevent recurrent OM in “prone” Pt’s

  29. Otitis media with Effusion • Management of OME • Surgical • Myringotomy AND Grommets • Grommets effective: • Permit aeration of M.E. • Relieve negative M.E. pressure . Increased mucous drainage . Mucosal metaplasia to normal

  30. Otitis media with Effusion • Grommets in Otitis Prone children • Most OME’s return to normal • In persistent MEE’s – logical • How does normal ear benefit ??? • Trade-off – otorrhoea!!! with AOM • Immunodeficiency to Pneumococ • Specific Immunotherapy • Prophylactic AB for 6 months??

  31. Take Home Messages • OME extremely common < 10 yrs • 90% resolve spontaneously • AOM most common cause of OME • Clefts all have MEE – repair early

  32. Take Home Messages • Excision A’s – less reinsertion G’s • Hearing loss – negative at all ages • Persistent retraction destructive • T.M. appearance poor indicator

  33. Take Home Messages • T.M. mobility sensitive indicator • Tympanometry adds to accuracy

  34. Take Home Messages • P.T hearing loss poor indicator • No effective medical cure • Grommets effective: • Aerate M.E. • Relieve negative M.E. pressure

More Related