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Definition Inflammation of the mucoperiosteal lining of the middle ear cleft (Eustachian tube, tympanic cavity, mastoid antrum and mastoid air cell).
Mastoid
Middle Ear
Classification
Acute otitis media: Acute viral (non suppurative) otitis media. Acute suppurative otitis media. Acute Necrotizing otitis media. Chronic otitis media:
Nonspecific:
Chronic suppurative otitis media: Chronic non-suppurative otitis media Otitis media with effusion.
Chronic adhesive otitis media Tympanosclerosis Cholesterol granuloma Specific e.g. Tuberculous otitis media.
Incidence
Acute otitis media is primarily a disease of children. Its peak incidence is during the first 6 years of life.
Several factors contribute to the prevalence of acute otitis media media in early childhood. These include: Anatomical features of Eustachian tube : The Eustachian tube is
shorter, wider and more horizontal than in adults
The orifices of the tube are surrounded by lymphoid tissues. Frequent exposure to upper respiratory infections Immature immune system
Predisposing factors
poor socioeconomic conditions Crowding Bottle feeding malnutrition, immunodeficiency Passive Smoking Pollution Mucociliary disorders
Bacteriology
The common organisms include: Streptococcus pneumoniae, Moraxilla catarrhalis H. influenzae is more frequent during infancy and early childhood. Viral infection commonly precedes secondary bacterial invasion
Routes of infection
Through the Eustachian tubes: This is the commonest route. Through a drum perforation.
Pathophysiology ET blockage
2.
-ve pressure in ME
1.
ET blockage
Clinical picture Acute otitis media is frequently preceded by upper respiratory infection. Stage of tubal occlusion:
May be mild fever. Sense of fullness in the ear Earache. mild conductive hearing loss The tympanic membrane appears retracted, congested, and lusterless.
Stage of resolution:
Resolution may occur with treatment or after perforation of the drum membrane.
Differential diagnosis
Other causes of otalgia Red tympanic membrane
Treatment:
Frequent aural toilets (cleaning). Culture and sensitivity of the discharge. Systemic and local antibiotics. Treatment of sequels and complications e.g. tympanoplasty
Definition: It is the accumulation of fluid( non infectious , non suppurative) behind an intact tympanic membrane without symptoms and signs of inflammation
It is the most common cause of hearing loss in children. Age: Any, most frequently under 9 years. Laterality: Usually bilateral
Etiology:
Eustachian tube dysfunction (Most important cause). post otitis : non resolved acute otitis media due inadequate medical treatment
2) Chronic (mucoid) middle ear effusion'. Occurs due to chronic ET dysfunction which can be: a) Mechanical obstruction:
i) Adenoids. ii) Nasopharyngeal Tumors
In the adults
Hearing loss
2- otoscopy:
a) Tympanic membrane:
i) Is retracted as evidenced by:
(1) Handle of the malleus becomes more horizontal. (2) Lateral process of the malleus becomes more prominent. ii) Looks dull and opaque.
4-Investigations:
A) Tympanometry: Flat tympanogram (Type B) B) Stapedial reflex: Absent C) PTA: CHL
Complications:
1. Recurrent ASOM. 2. Atelectasis - retraction pockets (usually posterosuperior) 3-Cholesteatoma. 4. Adhesive OM. 4. Tympanosclerosis 5- SNHL 6- Ossicular erosion
Treatment:
1} Medical treatment:
a) Antibiotics b) Steroids c) Mucolytic drugs d) Systemic decongestants. 2) ET inflation. Medical treatment should be at least for 3 months
2- Surgical treatment
a) Myringotomy with aspiration of fluid and insertion of ventilation tube b) adenoidectomy. c) Both Myringotomy with adenoidectomy( best) d) Cortical mastoidectomy to exenterate mastoid air cells( recurrent)
Etiology:
Proteolytic enzymes in middle ear effusion destroy the middle fibrous layer of the tympanic membrane > retraction of the TM by the negative middle ear pressure created by the Eustachian tube obstruction
Pathology:
Four stages are described as follows: 1) Stage I: Mild retraction of the tympanic membrane. 2) Stage //.-Tympanic membrane is more retracted to be in contact with incudostapedial joint.
3) Tympanosclerosis
Definition: It is deposition of calcified hyalinized collagen in the tympanic mucosa and / or in the tympanic membrane.
2) Otoscopy :
Chalky white patches in the TM (myringosclerosis) or in the middle ear (Tympanosclerosis
Treatment:
Myringosclerosis: No treatment if asymptomatic Tympanosclerosis:
Surgical removal or Hearing aid