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OTITIS MEDIA (OM)

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  1. OTITIS MEDIA (OM) Dr. Lamia AlMaghrabi Consultant ENT King Saud Medical City

  2. Otitis media • Otitis media:is inflammation of the middle ear, or a middle ear infection.

  3. Otitis Media • It is the most common disease of childhood, next to viral URTI. • It is acute bacterial infection in 80% (1-6 years) • The most frequent disease treated with antibiotics. • Infectious &non inf. OM result in significant morbidity.

  4. Otitis Media 1-Acute Otitis Media • Acute bacterial infection with purulent exudate in ME. • Characterized by : rapid sign and symptoms.

  5. Otitis Media • Incdence: • 1-7 years of age with peak incidence in 1 year-old. • Finland study ( 75 % of children under 10 y.at least 1 /OM) • 6- 11 month-old 75.5% one attack OM. • 30% of children below 5 y. had multiple OM. • 4 time higher in winter than in summer.

  6. Normal Ear Drum

  7. Pathogenesis • Adenoid hypertrophy • immature ET Tube • Nasopharyngeal Ca • Ciliary dysfunction • Cleft palate • a-tensor tympani muscle • b- levatorpalati muscle • c- tensor palati muscle • d- Salpingopharyngeus muscle

  8. Pathogenesis • Middle ear contamination

  9. OTITIS MEDIA Presentation: • Acute onset of otalgia ( T ). • Fever • Sleeplessness • Irritability • Pulling of the ear by the child • Some degree of hearing loss • Ear discharge. • Tinnitus. • Ear fullness. • Dizziness.

  10. OTITIS MEDIA

  11. OTITIS MEDIA Treatment

  12. OTITIS MEDIA • Proper ; antibiotic / dose / compliance / duration • 1st line: • Amoxicillin 500 mg p.o.tid x 7-10 days (beta lactam resistant bacteria ) • 2nd line: • Augmentin 875 mg p.o. bid x 7-10 days • Ceftin 500 mg p.o.bic x 7-10 days • Penicillin allergic patients • SeptraDS ip.o bid x 7-10 days ii. Erythromycin

  13. 2- OTITIS MEDIA WITH EFFUSION • Most common disease treated by pediatricians • Myringotmy &tube insertion is the most common surgery in children.

  14. OTITIS MEDIA WITH EFFUSION • Chronic , asymptomatic. • 20 to 35% no history of AOM. • Fluid in the ME could be: serous mucoid (glue ear) mucopurulent

  15. Serous Otitis Media

  16. OTITIS MEDIA WITH EFFUSION Etiology

  17. OTITIS MEDIA

  18. OTITIS MEDIA WITH EFFUSION

  19. OTITIS MEDIA WITH EFFUSION • Diagnosis AUDIOMETRY PLAY AUDIOMETRY TYMPANOMETRY

  20. OTITIS MEDIA WITH EFFUSIONTreatment • Adeno – Tonsellectomy&Myringotomy tube insertion (T&A &TUBES)

  21. Complication Brain abscess Extradural abscess Meningitis Sub dural abscess labrynthitis Lateral sinus thrombosis Acute mastoiditis Petrositis Facial N paralysis

  22. Acute mastoiditis

  23. Labrynthitis

  24. Facial nerve paralysis

  25. Meningitis

  26. Brain abscess

  27. OTITIS MEDIA • COMPLICATION 2ndry cholesteatoma

  28. Post op mastiod cavity

  29. Tympanosclerosis

  30. Retraction of The Eardrum

  31. Retraction Pocket Formation

  32. Tympanic membrane perforation Tympanoplasty (video)

  33. TYMPANOPLASTY

  34. Chronic Otitis Media • Persistant disease, Severe destruction • It is characterized by: • Deafness • Ear discharge • T.m. perforation

  35. TYPES OF C.S.O.M. • Tubo tympanic s.o.m. Safe • Attico antral Unsafe

  36. Chronic Otitis Media • Causes: 1 Late treatment of acute otitis media. 2 Inadequate or inappropriate antibiotic therapy. 3 Upper airway sepsis. 4 Lowered resistance, e.g. malnutrition, anaemia,immunological impairment. 5 Particularly virulent infection, e.g. measles.

  37. ATTICO ANTRAL C.S.O.M. • Cholesteatoma Keratinizing Squamous Epithelium. A small sac May involve whole middle ear cleft

  38. TUBO TYMPANIC C.S.O.M • Deafness • Discharge • Central perforation

  39. TUBO TYMPANIC C.S.O.M • Patency of Eustachian tube • Nidus of infection in U.R.T.I. • Immune status of patient • Aerobic and Anaerobic

  40. TYPES OF TUBO TYMPANIC C.S.O.M. • Active Tubo Tympanic C.S.O.M. • Inactive Tubo Tympanic C.S.O.M.

  41. Audiological assessment • Voice test • Tuning fork test Rinne, Webers , A.B.C. • Pure tone audiogram

  42. RADIOLOGICAL ASSESSMENT • CT-scan temporal bone

  43. treatment • Aural toilet • Cotton buds • Suction and cleaning • Antibiotics • Topical antibiotics • Systemic antibiotics

  44. Surgical treatment • Precipitating disease • Adenoid • DNS • Nasal polyps • Aural polypectomy • Functional reconstruction tympanoplasty

  45. THANK YOU