OTITIS MEDIA WITH EFFUSION
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Transcript 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.