The lecture has been given on Nov. 1st, 2010 by Dr. Muaid.

1. By
Dr. Muaid I. Aziz
FICMS

2. AOM
CATARRHAL
EFFUSION
SUPPURATIVE
COM
EFFUSION
SUPPOARATIVE
TUBOTYMPANIC
ATTICOANTRAL

3. AOM
 Its a viral or bacterial infection of mucosal lining of the ME+
MAC
 More commoner in children than adult ? 1. adenoid
2. URTI
3. ET

4. ET disorders
 ET dysfunction
 Patulous ET

5. AOM
Types
 Catarrhal
 Effusion
 Suppurative

6. Acute catarrhal otitis media
 URTI
 Deafness ? No pain
 Examination
Nose
Pharynx
Ear
Audiometry

7. Treatment
 Treating underlying cause
 Nasal decongestant
 Inflation of the Eustachian tube

8. Acute middle ear effusion
More sever variety of catarrhal OM
Cause :
 URTI , Allergy , Barotrauma
More marked sx ( deafness, tinnitus ,vertigo)
Examination
 Congested , dark orange hue to it , may be retracted ,
little or no movement of the TM, splitted cone of light,
fluid level
 Medical or surgical

10. ACUTE SUPPURATIVE OTITIS
MEDIA more commoner in children than in adults.
 it can follow URTI which is often viral initially or it
can be secondary to the introduction of water through
a perforation .
 Viral or bacterial
adenovirus , rhinovirus
streptococcus pneumonia , haemophilus influenza,
branhamella catarrhalis.

11.  sudden onset dull ache in the ear which may become more
sever
 hearing loss
 fever ( common in children )
 examination will show the drum very red & marked
bulging outwards of the TM with loss of surface anatomy
 if the TM perforated or if there is preexisting perforation a
copious mucopurulent & occasionally blood stained
discharge coming from the ear
 once the drum rupture the pain will decrease to a dull ache

12. Treatment
 URTI should be treated .
 a 5 day course AB given as amoxillin _ clavelinic acid
 analgesia for pain if present
 nasal decongestant
 antihistamine drugs
 myringotomy needed for reliving the sever pain
which is due to accumulated pus in the middle ear
which is not resolved by AB
 if there is long standing perforation with recurrent
attacks of AOM so myringoplasty is prepared for.

13. CHRONIC OTITIS MEDIA
 Deafness main sx
 Discharge ?
 Otalgia ? Other pathology ?
CX ?
malignacy ?

14. CHRONIC MIDDLE EAR EFFUSION :
 serous or secretory otitis media
 In children & adults ?
 aetiology
 chronic Eustachian tube dysfunction or obstruction
due to blockage of the tube in the middle Ear or
nasopharynx
 URTI as sinusitis , nasopharyngitis , allergic rhinitis
unexplained chronic middle ear effusion specially in
older person? suspicion of nasopharyngeal carcinoma.

15. Clinical features
 blocked feeling in the ear
 occasionally tinnitus or mild vertigo
 the patient is unable to clear the ear by autoinflation .
 On examination
 retraction of the TM in whole or part , retraction of pars tensa is seen &
the handle of malleus appears shortened & to lie in more horizontal
position. The lateral process of the malleus may thus appear more
prominent . the drum often have a dark or orange hue to it &
occasionally a fluid level may be seen .
 Examination of the nose may reveal signs of the sinusitis or allergic
rhinitis , occasionally a nasopharyngeal tumor detected on
examination of the nasopharynx .
 Investigation : audiometry will reveal a CHL
diminished or absent TM mobility on tympanogram
will
show flat curve which indicate –ve middle ear pressure

16. Treatment
 Treating of underlying cause
 myringotomy +/- grommet
 Hearing aids

17. Chronic suppurative otitis media
 Tubo - tympainc CSOM
 Attico - antral CSOM ( tympanomastoid )

18. Tubo-tympanic CSOM
 AETIOLOGY
 PATHOLOGY
 C/F
 Mucopurulent discharge
 Deafness ( mild to moderate sever ?)
 Examination
 Central perforation ( ant. ,posterior , kidney shaped or subtotal)
 Otitis externa
 Nose , nasopharynx , pharynx should examined (tonsil ,adenoid, sinus
infection)
 Hearing test
 X-R ( PNS , postnasal space , mastoid )
 Mastoid X-R ( cellular, sclerotic),erosion?
 Swab for c/s

19.  CX is rare & are not serious
Polyp
OE
More sever HL

20. TREATMENT
 Treating URTI
 Local treatment
Thorough cleaning of ear canal (mopping , or suction
clearance)
AB + steroid ( 5 days) local +/- systemic
Preventive measures
Surgery ( myringoplasty)( recurrent , deafness with
disabilities)

21. Atticoantral CSOM
 TYMPANOMASTOID ?
 Serious cx ?
 Granulation tissue or polyp ?meaning?

22. pathology
 Cholesteatoma
 Granulation tissue with osteitis
 Cholesterol granuloma

23. Cholesteatoma
DEFINITION ( fat or keratin)
TYPES

24. Congenital cholesteatoma

25. THEORIES
Congenital cholesteatoma .
Metaplasia
Ingrowth of squamous epithelium
Retraction pocket

27. Granulation tissue

28. Cholesterol granuloma
 Dark brown gelatinous material with bone
destruction
 In combination of previous pathology
 Dark blue TM
 Cholesterol crystals

29. Clinical features
 Discharge
 Deafness
 Bleeding
 Otoscopy
Foul smell dicharge
Perforation
Polyp , GT , cholesteatoma

30. Investigations
 Hearing assessment
 Radiology

31. Treatment
 EUM + suction clearance
 Polyp or GT ?
 Medical or surgical ? Mastoidectomy

32. COMPLICATIONS OF OM
 Extracranial
 Intracranial

33. EC COMPLICATIONS
 Mastoiditis ( acute, masked, chronic)
 Petrositis
 Labyrinthitis
 Facial nerve pulsy

34. mastoiditis

35. presentation
 Increasing Pain , tenderness behind the ear
 Ear discharge ,no discharge(masked)
 Fever (child)
 Increasing pulse
 Deafness

36. Examination
 Downwards ,outwards protruded auricle
 Fluctuant swelling
 Sagging of posterior meatal wall
 Perforated TM with pulsating discharge
 Intact TM

37.  Investigation ( XR) , hearing assessment
 Treatment
 AB
SURGERY

38. INTRACRANIAL COMPLICATIONS
 meningitis
 Extradural abscess
 Subdural abscess
 Brain abscess
 Lateral sinus thrombosis

39. thanks