Non-Suppurative Otitis Media Dr. Vishal Sharma
Types • Otitis Media with effusion (O.M.E.) • Adhesive otitis media • Tympanosclerosis • Baro-traumatic otitis media
Otitis Media with effusion Presence of serous or mucoid effusion in middle ear cleft with no frank pus. Synonyms: • Secretory / Serous otitis media • Seromucinous / exudative otitis media • Catarrhal otitis media • Glue ear
Etiology 1. Eustachian tube dysfunction Vacuum in M.E. extravasation of fluid Lack of drainage of M.E. secretions 2. Upper respiratory tract allergy / viral infection Increase M.E. secretions 3. Low grade middle ear infection Inadequate treatment of A.S.O.M.
Causes for E.T. dysfunction 1. Eustachian Tube obstruction • Intrinsic edema = infection / allergy / trauma • Extrinsic= adenoid / nasopharyngeal tumour / post – Radiotherapy scarring • Functional = floppy Eustachian tube 2. Patulous Eustachian tube:reflux of secretions
Causes for E.T. dysfunction 3. Palatal abnormality: cleft palate / palatal palsy 4. Muco-ciliary pathology: Infection / allergy / smoking Kartagener’s syndrome / Young’s syndrome Surfactant deficiency / Immune deficiency
Predisposing conditions • Child going to a nursery • Early weaning with formula milk • Parents who smoke • Recurrent respiratory infections • Crowded living condition • Poor nutrition • Cleft palate
Clinical Symptoms • Mild deafness in a young child • Deafness increases during U.R.T.I. • Mild otalgia • Blocking sensation in ear • Delayed & defective speech due to deafness
Clinical signs 1. Otoscopy: • Blue eardrum with restricted mobility • Retraction of T.M. in early stage • Bulging of T.M. in later stages • Fluid level + air bubbles seen behind T.M. 2. Tuning Fork Tests: conductive deafness
Pure Tone Audiometry P.T.A.: low frequency conductive deafness
Impedance Audiometry C curve in ear drum retraction
Impedance Audiometry B curve in middle ear effusion
X-ray mastoid & Nasopharynx clouding of mastoid air cells + adenoid mass
Medical treatment • Antibiotic (Co-amoxyclav) for 2-4 weeks • Nasal decongestants (systemic + topical) • H1 anti-histamines • Auto-inflation of Eustachian tube by Valsalva maneuver • Analgesic for acute earache
Non-medical, Non-surgical treatment • Politzerization • Otovent balloon • Ear popper device • Eardoc device
Politzerization Rubber tube attached to Politzer bag is put into one nostril & both nostrils pinched. Pt is asked to swallow repeatedly & Politzer bag is squeezed simultaneously.
Otovent balloon device Balloon is inflated by blowing air out of nose. When fully inflated, balloon neck is pinched off and nasal occluder is inserted into one nostril. Child is instructed to swallow as balloon is deflated into nasal cavity. Portion of air from balloon enters Eustachian tube & ventilates middle ear.
Ear Popper Device Based on Politzer Maneuver, EarPopper ™ Device delivers a safe, constant, regulated stream of air into nasal cavity. During swallowing, air is diverted to Eustachian tube clearing & ventilating middle ear.
EARDOC device EARDOC ™ generates & transmits special vibration waves which travel through temporal bone to reach middle ear & Eustachian tube. The waves ease middle ear pressure & drain trapped fluids. As a result edema & pain are reduced.
Surgical treatment • Myringotomy (Tympanocentesis) + grommet (Pressure Equalization tube) insertion: Radial incision made in antero-inferior quadrant. For thick fluid, 2 incisions made in antero-inferior quadrant & antero-superior quadrant (Beer can principle).
Surgical treatment • Laser or radio-frequency assisted myringotomy: grommet insertion not required • Cortical mastoidectomy: for refractory cases with loculated fluid in mastoid • Treatment for predisposing factors:adeno-tonsillectomy / antral wash / polypectomy