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بسم الله الرحمن الرحيم

بسم الله الرحمن الرحيم. CHRONIC OTITIS MEDIA. 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).

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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

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