Non-suppurative Otitis Media

Non-suppurative Otitis Media

It is an inflammatory condition of the middle ear and mastoid air cell system characterized by accumulation of fluid in the middle ear cavity Also known as Secretory Otitis Media, Serous Otitis Media, Glue ear, Non-purulent Otitis Media, Otitis Media with effusion or Catarrhal Otitis Media

Epidemiology
Young children are usually affected More frequent in boys 90% children affected before age 6 Occurs more frequently in winter months

Aetiopathogenesis
Vacuum theory (Eustachian tube blockage) Allergy (Oedema & Effusion of middle ear mucosa) Inflammatory reaction due to Low-grade infection (Viral/Bacterial)

Risk Factors
Upper respiratory tract infections Craniofacial abnormalities (cleft palate) Downs syndrome Passive smoking

Pathogenesis
Dysfunction of eustachian tube
Obstruction
Mechanical Obstruction Enlarged adenoid, Tumour, Enlarged inferior turbinate Non-mechanical obstruction Weakness of related muscle

Pathogenesis
Dysfunction of eustachian tube
Infection
PCR detects middle ear fluid, +ve findings was 70% Strep. pneumoniae, H. influenza, Hemolytic streptococci

Pathogenesis
Dysfunction of eustachian tube
Clearance & Defense
Immotile Cilia syndrome

Pathogenesis
Dysfunction of eustachian tube
Adenoids Nasopharyngeal carcinoma Sinusitis Cleft palate Deflected Nasal Septum Polyp Inadequately treated AOM Hypogammaglobulinemia Post radiotherapy

Symptoms
Deafness Earache Tinnitus

Symptoms
Associated symptoms
Ear popping, fullness Ear rubbing, irritability, sleep disturbances Failure to respond appropriately to voices or sounds Recurrent Acute otitis media Problems with school performance Balance problems, motor delay Delayed speech, language

Signs
Tympanic membrane is dull, lustreless, retracted, restricted in mobility, fluid level is seen, air bubble Tuning fork test Conductive deafness

Diagnosis
Usually asymptomatic Hearing loss
Kid cannot concentrate himself Turn on TV in loudness If one ear is normal, above symptoms will ignored

Fullness Otalgia Tinnitus

Diagnosis
Diagnosis made at physical examination
Tympanic membrane may be retracted, dull and opaque The color of tympanic membrane may range from light pink to amber and even dark blue The presence of air bubbles or air fluid levels makes the diagnosis more evident

Investigations
Pure Tone Audiometry: Conductive Deafness Impedance: Flat curve X-ray Post nasal space X-ray PNS Allergic Test

Treatment
Medical Treatment
Nasal Decongestants Anti-histamines Mucolytic agents Valsalva manoeuvre Antimicrobial agents with or without inflation Steroids may be considered
10 14 day course Unlikely to provide long term benefit Multiple courses not recommended

Treatment
Surgical Management
Myringotomy & Grommet Insertion Treat the cause

Complications
Hearing loss Conductive, Sensorineural, Mixed Tympanosclerosis Cholesteatoma Cholesterol Granuloma: Blue Drum Syndrome

Complications
Atelectatic Otitis Media
Sequela of otitis media with effusion Conductive Hearing Loss Tympanic membrane contacts with ossicular chain, promontory

Differential Diagnosis
Nasopharyngeal Carcinoma
Unilateral otitis media with effusion EBV VCA IgA +ve Nasoendoscope CT or MRI Biopsy

CSF leakage
Head Trauma Meningitis CT or MRI