Otits Media with Effusion

OTITIS MEDIA WITH EFFUSION
  • Synonyms: Serous Otitis Media / Secretory Otitis Media / Mucoid Otitis Media/ Glue Ear/Non-Suppurative Otitis Media/Silent Otits Media.
  • Non purulent sterile effusion accumulates in the middle ear cavity
  • . Painless condition
  • MCC of conductive deafness in school-going children
ETIOLOGY OF OTITS MEDIA WITH EFFUSION
  • Malfunctioning of Eustachian tube (adenoid hyperplasia, chronic rhinitis, sinusitis & tonsillitis, tumors of nasopharynx, cleft palate)
  • Cause of U/L secretory otitis media in an adult is Nasopharyngeal Carcinoma.
  • Patients with Wegener's Granulomatosis may present with Secretory Otitis Media
  1. Characteristic triad of Wegener's granutomatosis is vasculitis of the upper respiratory tract (serious otitis media and epistaxis), vasculitis of the lower respiratory tract (hemoptysis) and vasculitis of the kidney (proteinuria).
  • Allergy
  • Unresolved otitis media
  • Viral infection - adeno and rhinoviruses.
CLINCAL FEATURES OF OTITS MEDIA WITH EFFUSION
Symptoms:

  • Hearing loss (<40db br=""> Delayed and defective speech
  • Mild ear ache.
  • Otoscopy 
  • Dull and opaque tympanic membrane.
  • Intact tympanic membrane.Colour may be Yellow/Grey/Blue.
  • Loss of light reflex
  • Thin leash of blood vessels seen along the handle of malleus (less marked than ASOM)
  • Retracted TM
  • Bulging of the posterior part of TM
  • Fluid level and air bubbles seen
  • Mobility restricted
<40db br="">
  1. Tuning fork tests :Conductive deafness of 20-40 dB
  2. Impedance Audiometry:confirmatory test for Secretory Otits Media,Shows Type -B curve.
  3. X-ray Mastoid: Clouding of air cells.
MANAGEMENT OF OTITS MEDIA WITH EFFUSION
  • Medical Treatment:
  1. Decongestant , Anti allergic, Antibiotics , Middle ear aeration (Valsalva maneuver)
  2. Watchful waiting is recommended without immediate use of antibiotics for children with uncomplicated otitis media with effusion.
  • Surgical Treatment:
  1. Myringotomy and fluid aspiration: 2 incisions one in the antero inferior and other antero superior quadrant of the TM to aspirate thick glue like secretions.(Beer can principle)
  2. Grommet insertion: left in place till spontaneously extruded
  3. In chronic secretory otitis media(also known as Glue ear), the treatment of choice is Myringotomy with ventilation tube insertion
  4. Tympanotomy (or) cortical mastoidectomy-very limted role
  5. Surgical t/t of causative factor - adenoidectomy, tonsillectomy, and/or wash out of maxillary antra.
  6. Treatment of choice in a patient presenting with mouth breathing, recurrent serous otitis media and adenoid facies is

  •  Adenoidectomy.
<40db br=""> SEQUELAE OF SOM
  • Atrophic tympanic membrane and atelectasis of middle ear
  • Ossicular necrosis
  • Tympanosclerosis
  • Retraction pockets and cholesteatoma
  • Cholesterol granuloma
Exam Question
  • In chronic secretory otitis media(also known as Glue ear), the treatment of choice is Myringotomy with ventilation tube insertion
  • Glue ear is a painless condition.
  • Glue ear is also known as Chronic Secretory Otits Media.
  • During follow up of a case of acute otitis media, a 6 year old child found to have glue ear with no symptoms.
  • Commonest cause of hearing loss in children is Chronic secretory otitis media.
  • Cause of U/L secretory otitis media in an adult is Nasopharyngeal Carcinoma.
  • Acute non suppurative otitis media in adults is due to Malignancy.
  • Secretory otitis media is diagnosed by Impedance Audiometry.
  • Bluish tympanic membrane is seen in Glue ear.
  • Effusion is sterile in Otits media with effusion.
  • Type-B Tympanogram is seen in Otits media with effusion.
  • Otitis media with effusion is also known as Serous Otitis Media or Mucoid Otitis
  • Characteristic triad of Wegener's granutomatosis is vasculitis of the upper respiratory tract (serious otitis media and epistaxis), vasculitis of the lower respiratory tract (hemoptysis) and 
  • vasculitis of the kidney (proteinuria).
  • Watchful waiting is recommended without immediate use of antibiotics for children with uncomplicated otitis media with effusion.
  • Conducting hearing loss with intact tympanic membrane occurs in Glue Ear.
  • Treatment of choice in a patient presenting with mouth breathing, recurrent serous otitis media and adenoid facies is Adenoidectomy.

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