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Otitis Media With Effusion (O.M.E.)

 

=Glue ear, SOM (Secretory otitis media)== mucous otitis media

  1. Definition:
    OME: Is accumulation of non purulent fluid in the middle ear.
    The condition is called chronic if the fluid remains
    for >12 wks.
    1. Incidence: School going children
    2. Associations: in children
      1. Environmental factors (nurseries,  creches, playgroups etc)
      2. Sex: Male > female
      3. Eustachian tube malfunction.
      4. Adenoid hypertrophy
      5. Unresolved OM
      6. Allergy
      7. Viral infections
      8. Cleft plate
      9. Incompletely t/t som
  2. ​​Pathology:
    1. EU tube dysinfection
    2. Secretion of m/ear
    3. Allergy
  3. In adults
    1. Idiopathic
    2. Barotrauma during descent
    3. Nasopharyngeal carcinoma
    4. Radiotherapy

Fig. Flow chart of treatment of ASOM

  1. Feature
    1. Hearing loss
    2. Delayed speech development
    3. Mild earaches
  2. Otoscopy: Tympanic membrane: dull
    1. Yellow, grey blue
    2. Retraction/ ¯mobility of TM
    3. Air fluid level behind/bubbles
    4. Thin leash of vessles along handle of malleus
  3. Investigations
    1. Pure tone audiometry: Hearing loss: 20-40 dB
    2. Impedance audiometry: Type B curve. 60-65%
    3. Myringotomy and aspiration
      A curve: 20-25%
      C curve: 10-15%
    4. X-ray: Mastoids: clouding of air cells
  4. Treatment (i.e. adenoidectomy is an important part of Treatment.)

A. Conservative

B. Surgical

1. Antibiotic

Myringotomy with/without grommets

2.  Antiallergic

Cortical mastoidectomy

3.  Nasal decongestants

Surgical treatment of the causative factor (adenoids, tonsils etc.)

  1. Sequelae:
    1. TM atrophy
    2. Ossicular necrosis
    3. Tympanosclerosis
    4. Cholesteatoma
    5. Cholesterol granuloma
    6. Effect on development of hearing
    7. Toxic effect on inner ear
  2. PS. Grommets
    1. Materials used:
      1. Stainless steel
      2. Gold
      3. Teflon
      4. Silicone
    2. Position
      1. Antero-inferior quadrant of the tympanic membrane
      2. For long term : anterosuperior quadrant
    3. Types:
      1. Short term tubes: Shepard, Donaldson
      2. Long term: Per lee tube. Goode ↑­-tube (both are made up of silicone)
  3. ​​Indications of grommet insertion
    1. Glue ear (serous/secretory otitis media)
    2. Recurrent otitis media with otalgia
    3. Eustachian tube dysfunction.​




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