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       OME is the accumulation of non-inflammatory exudate in the middle ear cavity following a series of pathological changes in the mucous membrane of the middle ear.

                                            Otitis media with effusion

ETIOPATHOLOGY:

  1. Tubal Occlusion: The causes are-
  • Adenoid hyperplasia.
  • Chronic rhinitis & sinusitis.
  • Chronic tonsillitis.
  • Benign & malignant tumour of nasopharynx.
  • Palatal defects- cleft palate, palatal paralysis.

                                                              Tubal Occlusion 

                                                                         ↓

                                            Negative pressure in middle ear cavity

                                                                         ↓

                                                             Retraction of TM

                                                                         ↓

                                 Formatting of sterile effusion in the middle ear cavity.

  1. Allergy:

                                   Seasonal or allergic particles inhalation or food stuff

                                                                        ↓

    Obstruct ET by oedema & also lead to increase secretory activity as middle ear mucosa acts as a shock organ.

  1. UNRESOLVED OTITIS MEDIA:

                                                Inadequate antibiotic therapy in ASOM

                                                                            ↓

                                                    Low grade infection lingers on

                                                                            ↓

                                     Increase number of Goblet cells & mucous glands

                                                                            ↓

                                                       Mucosa secrets more fluid

  1. VIRAL INFECTION:

                                                         Adeno & Rhino virus of URT

                                                                             ↓

                                                         Invade middle ear mucosa

                                                                             ↓

                                                         Increase secretory activity

  1. HYPOGAMMA GLOBULINAEMIA: Predispose to inflammatory response because of low immune status.

CLINICAL FEATURES:

  1. SYMPTOMS:
  • Hearing loss- conductive (Bilateral- child, unilateral- adult)
  • Delayed & defective speech.
  • Mild ear ache.
  • Blocking sensation of the ear.
  • Auto phony.
  • Nasal discharge.
  • Nasal obstruction.

    2. OTOSCOPY:

  • TM- Dull & opaque with loss of reflex. Thin leash of blood vessels seen at the handle of malleus or at the periphery of TM. Varying degree of retraction. Decreased mobility.
  • Middle ear- Fluid level may be seen as air bubble.

MANAGEMENT:

AIM: 1. Removal of fluid. 2. Prevention of recurrence.

MEDICAL:

  1. Decongestants- nasal drops, sprays or systemic decongestant relief oedema of ET.
  2. Antiallergic measures- Antihistaminics & sometimes steroids.
  3. Antibiotics- Useful in URTI or unresolved ASOM.
  4. Middle ear aeration-
  •   Patient should repeat daily perform valsalva manoeuvere.
  •   Sometimes politzeration or ET catheterization is done.
  •   Children can be given chewing gum to encourage repeated swallowing which opens the tube.

SURGICAL:

     1. Myringotomy & aspiration fluid: 

     Incision made in TM & fluid aspirated with suction.

 

                                                                    Thick mucous

                                                                               ↓

                                         Saline or mucolytic agent (chymotrypsin solution)

                                                                               ↓

                                                                   Liquify mucous

                                                                               ↓

                                                                        Aspiration

     2. Grommet insertion: Provide continued aeration of middle ear.

     3. Tympanotomy or cortical mastoidectomy: For removal of loculated thick fluid or other pathology (cholesterol granuloma).

     4. Surgical treatment of causative factor: Adenoidectomy, tonsillectomy, wash out of maxillary antrum.

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