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بسم الله الرحمن الرحيم
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بسم الله الرحمن الرحيم

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  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

  15. DIAGNOSIS • Otoscopy • Tuning fork tests

  16. DIAGNOSIS • Otoscopy • Tuning fork tests • PTA

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

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

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

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

  21. Iatrogenic Cholesteatoma

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

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

  24. 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

  25. 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)

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

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

  28. Treatment • Observation • Surgical treatment • Hearing aid

  29. 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)

  30. CHRONIC SUPPURATIVE OTITIS MEDIA

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

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

  33. 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)

  34. CHOLESTEATOMA

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

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

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

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

  39. Clinical Features of CSOM