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Otitis Media with Effusion Causes Cures Complications

Otitis Media with Effusion Causes Cures Complications. J.H.Black 2013. Otitis media with Effusion. Introduction Non purulent fluid > 3 months 20-50% of all children 90% resolve spontaneously Precise diagnosis still problem. Otitis media with Effusion. Aetiology: Acute otitis media

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Otitis Media with Effusion Causes Cures Complications

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  1. Otitis Media with EffusionCauses CuresComplications J.H.Black 2013

  2. Otitis media with Effusion • Introduction • Non purulent fluid > 3 months • 20-50% of all children • 90% resolve spontaneously • Precise diagnosis still problem

  3. Otitis media with Effusion • Aetiology: • Acute otitis media • E.T. obstruction • Cleft palate • Adenoid hypertrophy • Nasal allergy • Chronic rhinosinusitis • Barotrauma • Radiotherapy

  4. Otitis media with Effusion • Aetiology • Acute Otitis Media • Commonest < 5 years • Increased in: • Boys • Winter • Passive smoking • Day care • Non breast fed

  5. Otitis media with Effusion • Aetiology • Acute Otitis Media • Most common cause M.E.E. • Variable resolution rate • Small % have M.E.E. > 3 months • Minimal resolution > 3 months • ??? Delay Grommets for 3 months

  6. Otitis media with Effusion • Aetiology: • Acute otitis media • E.T. obstruction • Cleft palate • Adenoid hypertrophy • Nasal allergy • Chronic rhinosinusitis • Barotrauma • Radiotherapy

  7. Otitis media with Effusion • Aetiology • E.T. Obstruction • Causes negative M.E. pressure • Resultant serous transudate • E.g. Nasopharynx CA • BUT unusual in children – mucoid!

  8. Otitis media with Effusion • Aetiology: • Acute otitis media • E.T. obstruction • Cleft palate • Adenoid hypertrophy • Nasal allergy • Chronic rhinosinusitis • Barotrauma • Radiotherapy

  9. Otitis media with Effusion • Aetiology • Cleft palate • Classic example of aeration failure • All clefts will have: • Episodes of M.E.E. • Persistent negative pressure effects • Retraction of T.M. • Early repair decreases M.E.E. • Large % need repeated Grommets

  10. Otitis media with Effusion • Aetiology: • Acute otitis media • E.T. obstruction • Cleft palate • Adenoid hypertrophy • Nasal allergy • Chronic rhinosinusitis • Barotrauma • Radiotherapy

  11. Otitis media with Effusion • Aetiology • Adenoid Hypertrophy • Contentious relationship • ? Displacement of E.T. orifice • ? Obstruction • ? Reservoir of infection

  12. Otitis media with Effusion • Aetiology • Adenoid Hypertrophy • Not all enlarged A’s have M.E.E.’s • Not all M.E.E.’s have enlarged A’s • A’s with Grommets: • Less M.E.E. once Grommet extruded • ? A’s routine with Grommets

  13. Otitis media with Effusion • Aetiology: • Acute otitis media • E.T. obstruction • Cleft palate • Adenoid hypertrophy • Nasal allergy • Chronic rhinosinusitis • Barotrauma • Radiotherapy

  14. Otitis media with Effusion • Aetiology • Nasal allergy • Weak association • Large A’s with allergy • Chronic rhinosinusitis • Ascending infection • Barotrauma • Radiotherapy • Fibrosis around E.T.

  15. Otitis media with Effusion • Effects of M.E.E. • Hearing loss • Pre-lingual • Delayed onset • Infants • Slow progress • Incorrect pronunciation

  16. Otitis media with Effusion • Effects of M.E.E. • Hearing loss • Pre-school • Delay vocab/ lang acquis/ comm skills • School • Retarded • Word recognition • Reading skill • Intellectual develoment

  17. Otitis media with Effusion • Effects of M.E.E. • Otalgia • Result of secondary infection • Clumsiness • Irritability • Behavioural problems

  18. Otitis media with Effusion • Sequelae M.E. negative pressure • Persistent retraction • Causes atrophy T.M. fibrous layer • Irreversible • Central translucent area • Necrose with AOM - perforation

  19. Otitis media with Effusion • Sequelae M.E.negative pressure • Extensive atrophy • T.M. drapes M.E. structures • Poor sound conduction • Results: • Marked H.L. • Ossicular erosion – amplified H.L.

  20. Otitis media with Effusion • Sequelae M.E. negative pressure • Retraction pockets • Part of T.M. retracts into attic • Postero-superior • Squamous epith.accumulation • CHOLESTEATOMA !!!

  21. Otitis media with Effusion • Sequelae M.E. negative pressure • Cholesteatoma • Destroys ossicles • Obstructs drainage • With infection: • Mastoiditis • Intracranial spread

  22. Otitis media with Effusion • Diagnosis and screening OME • T.M. appearance • Extremely variable • Retraction is N.B. • Very limited • Miss subtle: • Changes • Abnormalities

  23. Otitis media with Effusion • Diagnosis and screening OME • T.M. Mobility • Pneumatic Otoscopy • Tympanometry • Effective screen • Otologist • 94% sensitivity • 75% specificity • Otologist AND Tympanometry • 97% sensitivity • 90% specificity

  24. Otitis media with Effusion • Diagnosis and screening OME • P.T. Audiology / H.L. • Poor relationship • H.L. often absent • OME and AOM often in very young

  25. Otitis media with Effusion • Management of OME • Medical • NO effective medical cure • No help • Antihist / sympathomimetic comb • Mucolytics • Antibiotics

  26. Otitis media with Effusion • Management of OME • Medical • Antibiotics with systemic steroids • Very slight better cure rate (>5yrs) • Steroid nasal sprays • Reduced need for Grommets • Increased general health • No effect on child’s growth

  27. Otitis media with Effusion • Management of OME • Surgical • Myringotomy • Immediate improved hearing • High recurrence rate

  28. Otitis media with Effusion • Management of OME • Surgical • Myringotomy AND Grommets • Ventilate M.E. with neg. M.E.Pressure • Prevent sequelae of TM retraction • Ameliorate otalgia in “grumbling” OM • Prevent recurrent OM in “prone” Pt’s

  29. Otitis media with Effusion • Management of OME • Surgical • Myringotomy AND Grommets • Grommets effective: • Permit aeration of M.E. • Relieve negative M.E. pressure . Increased mucous drainage . Mucosal metaplasia to normal

  30. Otitis media with Effusion • Grommets in Otitis Prone children • Most OME’s return to normal • In persistent MEE’s – logical • How does normal ear benefit ??? • Trade-off – otorrhoea!!! with AOM • Immunodeficiency to Pneumococ • Specific Immunotherapy • Prophylactic AB for 6 months??

  31. Take Home Messages • OME extremely common < 10 yrs • 90% resolve spontaneously • AOM most common cause of OME • Clefts all have MEE – repair early

  32. Take Home Messages • Excision A’s – less reinsertion G’s • Hearing loss – negative at all ages • Persistent retraction destructive • T.M. appearance poor indicator

  33. Take Home Messages • T.M. mobility sensitive indicator • Tympanometry adds to accuracy

  34. Take Home Messages • P.T hearing loss poor indicator • No effective medical cure • Grommets effective: • Aerate M.E. • Relieve negative M.E. pressure

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