Download OTITIS MEDIA WITH EFFUSION

OTITIS MEDIA WITH
EFFUSION
What is OME?
 Presence
of fluid without signs or
symptoms of ear infection
 Decreased TM mobility
 Mild hearing loss generally
 90% of children suffer from OME before
school age (usually 6 months to 4 years)
 30-40% of children with recurrent OME
 5-10% last greater than 1 year
ETIOLOGY
1. Poor Eustachian Tube Function
anatomic blockade like adenoid
,congenital ,traumatic ,tumour…
2. Inflammatory response following AOM
45% have persistent effusion after 1 month,
but this number decreases to 10% after 3
months.
history
 Hearing
loss: TV too loud, “what?”
 Pain ,ear itching(rubbing) mainly at night
with sleep disturbances
 Problems with school performance
 Recurrent AOM
 In adults aural fullness and/or pressure, an
ear being plugged, or decreased hearing
 Speech and language delay
PHYSICAL EXAM
 Poorly
mobile TM
 Yellow(serous) or grey(mucoid)
 Neutral,bulging or retracted
 Air bubbles or fluid level
 Nasal ,oral and neck exam
 audiologic examination
Investigations

Audiogram :mild –
mod conductive
hearing loss

Tympanometery :type
B
management

Medical treatment
 Surgical treatment
Medical treatment
1.
2.
3.
4.
Antimicrobials: have benefit for treatment
Steroids: have no benefit alone but thy
are beneficial in combination with
antibiotics(short term improvment
Antihistamines and decongestants :no
benefit
Mucolytics,topical steroids ,autoinflation :
no benefit
Surgical treatment

Myringotomy with
ventilation tube: the
best treatment for
OME
 Adenoidectomy alone
or combined with
myringotomy.
 Tonsillectomy: no
benefit
Surgical Complications
Anesthesia – mortality reported as 1:50,000 for
ambulatory surgery
 Tympanostomy tube sequelae




Perforations in 2% after short-term tubes, 17% after
long-term tubes
Usually transient (otorrhea) or do not affect function
(tympanosclerosis, atrophy, shallow retraction)
Adenoidectomy


0.2-0.5% incidence hemorrhage
2% incidence of transient VPI
Surgery
 OME



relapse
20-50% of children with prior tubes relapse
after extrusion.
Adenoidectomy confers 50% reduction in
need for future operations.
Benefit of adenoidectomy apparent at age 2
years, greatest for children >3 years,
independent of adenoid size.