1. بسم الله الرحمن الرحيم

2. CHRONIC OTITIS MEDIA

3. Classification of Chronic Otitis Media • Chronic Non Suppurative Otitis Media • Otitis media with effusion “OME” • Adhesive otitis media • Chronic Suppurative Otitis Media “CSOM” • Tubotympanic (Safe) • Atticoantral (Unsafe)

4. OTITIS MEDIA WITH EFFUSION

5. DEFINITION Presence of non-purulent fluid within the middle ear cleft

6. SYNONYMS • Secretory otitis media • Middle ear effusion • Sero-mucinous otitis media • Catarrhal otitis media • Glue ear • Serous otitis media • Non-suppurative otitis media

7. PREVALENCE • Between 20% and 50% of children do have OME at some time between 3 and 10 years of age • Two peaks at 2 and 5 years of age

8. RISK FACTORS • Race • Age • Gender • Season • Nasopharyngeal anatomical abnormalities • Cleft palate • Smoking • ? Allergy

9. HISTOPATHOLOGY • Changes in the mucosa • Vasodilatation & mononuclear cell infiltration • Metaplasia of the epithelium to ciliated columnar • Mucus secreting gland formation • Formation of fluid in the middle ear • Transudate • Exudate • Secretion

10. ETIOPATHOLOGY • Eustachian tube dysfunction • Chronic inflammation

11. ETIOLOGY • Eustachian tube dysfunction • Poor muscular function • Adenoids • Barotrauma • Others • Infections • Unresolved AOM • Adenoiditis and other URTIs

12. SYMPTOMS • Hearing impairment • ± Otalgia • Fluid sensation

13. Diagnosis

14. DIAGNOSIS

16. DIAGNOSIS • Otoscopy • Tuning fork tests

17. DIAGNOSIS • Otoscopy • Tuning fork tests • PTA

19. DIAGNOSIS • Otoscopy • Tuning fork tests • PTA • Tympanometry

22. DIAGNOSIS • Otoscopy • Tuning fork tests • PTA • Tympanometry • Myringotomy

23. TREATMENT • Treatment of the cause if feasible • Observation • Medical treatment • Antibiotics • Decongestants, ?Auto-inflation • ?Steroids • Surgical • Myringotomy • Ventilation tubes (grommets)

29. COMPLICATIONS OF VENTILATION TUBES INSERTION • Infection • Blockage • Extrusion • Tympanosclerosis • Perforation

30. Iatrogenic Cholesteatoma

31. FACTORS AFFECTING TREATMENT • Age • Duration • Unilateral or bilateral • Degree of hearing impairment • Previous treatment • Associated conditions • Tympanic membrane changes • Others

32. SEQUELAE • Spontaneous resolution • 50% resolve within 3 months. Only 5% persists for more than 12 months • Tympanosclerosis • Scarring, retraction and atelectasis • Cholesteatoma

33. Conclusion • OME is very common in children • Etiology is associated with ET dysfunction and or chronic infection • In adults: Nasopharyngeal pathology should be considered • Most cases resolve spontaneously • Conservative treatment is of doubtful value • VT insertion restore hearing in the selected cases

34. Classification of Chronic Otitis Media • Chronic Non Suppurative Otitis Media • Otitis media with effusion “OME” • Adhesive otitis media • Chronic Suppurative Otitis Media “CSOM” • Tubo-tympanic (Safe) • Attico-antral (Unsafe)

35. Chronic Adhesive Otitis Media • Formation of adhesion in the middle ear after reactivation and subsequent healing of either CSOM or OME

36. Clinical Features • History of CSOM or OME • Deafness is usually the only symptoms • TM shows various structural changes

37. Treatment • Observation • Surgical treatment • Hearing aid

38. Classification of Chronic Otitis Media • Chronic Non Suppurative Otitis Media • Otitis media with effusion “OME” • Adhesive otitis media • Chronic Suppurative Otitis Media “CSOM” • Tubo-tympanic (Safe) • Attico-antral (Unsafe)

39. CHRONIC SUPPURATIVE OTITIS MEDIA

40. ETIOLOGY • Environmental • Genetic • Previous OM • Upper respiratory tract infections • Eustachian tube dysfunction

41. CLINICO-PATHOLOGICAL TYPES Tubo-tympanic Attico-antral

42. PATHOLOGY • Signs of suppurative infection • Discharge & perforation • Chronic inflammatory reaction in the mucosa and the bone (ostietis) • Signs of healing attempts • Granulation tissue & polyps • Fibrosis & tympanosclerosis • Cholesteatoma (attico-antral type)

43. CHOLESTEATOMA

44. DEFINITION • The presence of a desquamating stratified squamous epithelium in the middle ear

47. PATHOGENESIS OF CHOLESTEATOMA • Implantation (congenital or acquired) • Metaplasia • Epithelial migration

48. CLASSIFICATION OF CHOLESTEATOMA • Congenital • Acquired • Primary • Secondary

49. Effect of Cholesteatoma Keratin encourages persistence of the infection Matrix causes bone erosion

50. Clinical Features of CSOM