Lec 3 Flashcards
ME develops from ?
1st branchial pouch
Classification of ME diseases
1- congenital
• hypoplasia
• aplasia
• ossiclar fixation ( treacher collins syndrome)
• congenital cholestetoma
2- traumatic
• traumatic rupture of drum
• ottic barotrauma
• bone fracture of temporal bone ( middle cranial fossa )
3- inflammatory
• AOM
• Chronic ( suppurtive or non )
• complications
4- neoplastic
• glomus tumour
• squamous cell carcinoma.
5- miscellaneous
Otosclerosis
Talk about AOM
(6)
1- acute inflammation of mucosal ME ( mastoid air cell - ME cavity - ET )
2- caustive organism
• streptococcus pneumanie
• hemophilus influenza
• moraxella catarilis
3- route if infection
• ET
- extension of infection from
Nose : rhinnits
Sinus : sinustis
Skin : exanthemata
Nasopharynx : adenoid
- passage of infected material
Vomitus
Infected milk
Infected water
Packing nose
• blood borne ( rare)
• by EAC when the drum is perforated
4- pathology
1- tubal catarrh : congestion , oedema in ET thus is closed ~> -ve ME pressure ~> retracted drum
2- catarrhl OM : congestion , oedema spreads to ME ~> serous exudate
3- suppuration : (accumalation of pus in ME ) كأنها abscessوساعاتها الحرارة بترتفع اكتر
4- perforation : due to necrosis of drum by the pus ~> discharge
5- recovery : healing of drum and resolution of pathological changes
5- clinical picture
• corresponding to the stages of pathology
• recovery can happen in any stage
1- tubal catarrh
Symptoms : deafness , tinnitus ( not marked )
Signs :
Otoscope
The drum is retracted and it has this characters
• disturbed or absent cone of light
• shortage of handle of malleus
• prominent lateral process
• exaggerated ant , post malleular folds
• limited mobility in seiglization
Tuning fork : CHL
2- catarrhl OM
Symptoms: deafness , tinnitus , pain
Signs :
Otoscope
The drum is congested especially at the periphery, handle of malleus ( cart wheel appearance ).
Tuning fork : CHL
3- suppuration
Symptoms: deafness , tinnitus , pain ( throbbing ) , fever
Signs
Otoscope
Drum is bulging
Tuning fork : CHL
4- perforation
Symptoms: deafness , tinnitus, discharge , (fever and pain but less )
Signs
Otoscope
Discharge : mucopurulent , pulsating
Perforation : anteroinferior ( near opening of ET )
ME mucosa : oedema , congestion
Tuning fork : CHL
6- treatment
General
Systemic antibiotic
Analgesic antipyretic
Local
According to stage
1- tubal catarrh
Decongestant nasal drop as xylometazoline
2- catarrhl OM
Glycerin phenol warm ear drop ( glycerin is hygroscopic , phenol is anathestic , warm to + vasclarity for more ig , suction of fluid )
3- suppuration
Myringotomy , then suction with local antibiotic ear drop
4- perforation
Myringotomy ( if perforation is small or high up i:e inadequate drainage )
Then suction with local antibiotic ear drop
Talk about AOM in children & infants
(4)
1- caustive organism :
Streptococcus pneumonie
Hemophilus inflenza
Moraxella catarhlis
2- predisposing factors
ARTER
-ADENOID : can cause infection , obstruction to ET
-RESPIRATORY TRACT INFECTION : common cold , exanthemata more common
- TEETHING : ~> low immunity
- ET is shorter , wider , more horizontal
- REGURGITATION: of either milk or vomitus
Vomitus as in gastroentritis that then passes to ET
Artifical milk is more liable to cause AOM than breast milk as
- it is more liable to be contaminated
- it has no ig ( no immunity)
- the flat position in artificial fed facilities the entrance of milk to ET
3- clinical picture (6)
Symptoms
General
- fever and rigors ( heat regulating center is not well developed)
- vomiting and diahrrea that is misdiagnosed as gastroenteritis
- baby is crying cant sleep from otalgia
Local
- pulling ears
- movement of head from side to side
Signs
Otoscope : cone of light may be absent , drum is congested ( rare perforation, discharge as children drum is thick )
4- treatment
General
- systemic antibiotcs
- analgesic antipyretic
Local
- decongestant nasal drop as xylometazoline
- glycerin phenol warm ear drops
- myrigotomy ( if medical treatment failed for 48 h or there is complications) then EAC suction and local antibiotcs ear drop
Complications of AOM is more common in children ?
- the drum is thick resisting bulging
- low immunity
Prognosis of AOM
C omplete recovery : with + immunity , - virulance , adequate treatment
C omplications : with - immunity, + virulance , inadequate treatment
C hronicity : suppurtive or non due inadequate treatment
Classification of chronic otitis media
Chronic non suppurtive - SECRETORY
- adhesive
CSOM - safe
- unsafe
Talk about secretory otits media ( SOM )
(10)
1- chronic nonsupputive otitis media
2- glue ear
3- ME with effusion
4- OME
5- def : collection of non purulent effusion in ME behind an intact drum
6-predisposing factors : if ET is closed by either (OVECTRA)
- otitis media if acute , recurrent with inadequate treatment
- viral infection
-ET is closed by adenoid or infection ( common cold )
- cleft palate ( defcent palatal muscles)
- tumour in nasopharynx if old male with unilateral SOM
- radiotherapy in head , neck ( fibrosis to ET )
- allergy in ME mucosa
7- types :
Serous : tranudate from bv due -ve pressure in ME
Mucoid : active mucus secretion by mucosal gland in ME without drainage
8- clinical picture
Symptoms (3)
- deafness and tinnitus (may be unilataeral or bilateral if itis adenoid and may be presented by school retardation )
- bubbling sensation ( fullness) in ear
- earache if there is recurrent AOM
Signs
Otoscope (3)
- opaque dull intact retracted drum ( if it is amber yellow then serous , if it is gray then it is mucoid )
- there may bubbles
- fluid level ( hair line )
Tuning fork : CHL
9- investigations (3)
- PTA ( pure tune audiometry ) CHL
- tympanometry : type b ( flat curve )
- x ray lateral position in nasopharynx to see adenoid
10 - treatment ( 7+3)
Medical
- treat the cause ( adenoid or common cold )
- systemic antibiotics to prevent recurrent infection
- steroid with withdrawal method
- mucolytics
- decongestant nasal drops
- chewing gum to open ET
- valsalva manuveur to open ET
Surgical
(If medical treatment failed)
- myringotomy
- with insertion of ventilation tube
( type of ventilation tube
* grommets tube : temporary ,for 6 months due to extrusion
* t tubes : permanent, prefered to adults )
- adenoidectomy if existed
Prognosis of SOM
R ecovery by adequate treatment
R solution : spontaneously sometimes
R current infection ( AOM)
R tention of glue in ME ~> adhesion , tympanosclerosis
Talk about adhesive otitis media
(6)
1- chronic non supportive otitis media
2- def : retracted drum which becomes in contact with the medial wall of ME ( promontry )
( atelectasis) , adehesion of structures in ME
3- artiology :
Long standing ET obstruction
Following SOM
FOLLOWING healed CSOM
4- clinical picture
Symptoms: deafness tinnitus
Signs : otoscope : retracted drum
1- disturbed or absent cone of light
2- shortege of handle of malleus
3- prominent lateral process
4- exaggerated ant, post malleular folds
5- limited mobility in seiglization
Tuning fork : CHL
5- investigations
PTA : CHL
Tympanometry : type c ( ET dysfunction)
6-treatment :
Prophylactic: treat the cause
Curative : cartilage tympanoplasty or hearing aid
Talk about Tympanosclerosis ?
(5)
1- white patches are seen through the drum ( fibrosis)
2- cause : previous trauma ( accidental- surgical)
Healed CSOM
IDIOPATHIC
3- pathology: hyaline degeneration in collagen bundles with calcification
4- clinical picture
Symptoms: deafness (CHL) and tinnitus
Signs : white patches seen through the drum by otoscope
5- treatment :
Surgery usually fails so hearing aid
Idealist place to insert ventilation tube in ?
Anterosuperior ( least in epithelial migration)
‼️DO NOT PUT IN POSTEROSUPERIOR ( important as it has the ossicles)
4 ( adenoid )
•The most Common conductive deafness/ cause in chlidren is SOM
•The most common cause for SOM in children is adenoid
• THE most common cause for snoring in children is adenoid
• The most common cause for nasal obstruction in children is adenoid
AOM ~> CSOM ~> complications
Mucosa ~> mucosa + periosteum ~> bone + other areas
When does necrotizing OM happen ?
Occurs in exanthemata leading to total necrosis of drum
