MIDDLE EAR

DISEASES
PRESENTER
MUHAMMAD ISMAIL DARS

OTITIS MEDIA
ACUTE OTITS MEDIA
OTITIS MEDIA WITH EFFUSION
CHRONIC SUPPURATIVE OTITIS MEDIA

ACUTE
SUPPURATIVE
OTITIS MEDIA
DEFINTION: INFLAMMATION OF MUCOSAL
LINING OF MIDDLE EAR CLEFT BY BACTERIAL
INFECTIONS.

Most common in children between ages of 3 to 7 years.

Eustachian tube is short ,wider and horizontal in children
allowing contamination from regurgitation of feed.Thus may
account for higher incidence of infection in this age group .

Risk factor that predispose middle ear infection in all age group could be :
URTI
INFECTION OF TONSILS AND ADENOID
CHRONIC RHINITUS AND SINUSITUS
WHOOPING COUGH

Common organism involved:

.Beta haemolytic streptococcus (40%)
.Haemophilus influenza (30%)
.Moraxella catarhalis (10%)

PATHOLOGY

THE DISEASE RUN THROUGH FOLLOWING STAGES.

STAGE OF TUBAL OCCLUSION: Edema and hyperaemia of
nasopharyngeal end of eustachian tube blocks the tube leading to
absorbing of air and developing the negative intratympanic pressure
with some degree of effusion in the middle
SYMPTOMS:
Block feeling in the ear
Impairment of hearing
Mild earache
SIGN : ON EXAMINTION WE SEE
Tympanic membrane with handle of malleus is retracted more
horizontally
Loss of lateral process of malleus and light reflex
Tunning fork test show conductive type of deafness

STAGE OF
PRESUPPURATION
IF TUBAL OCCLUSION IS PROLONGED,PYOGENIC

ORGANISM INVADE IN THE TYMPANI CAVITY

CAUSING INFLAMMATION OF ITS MUCOSAL LINING
WITH FORMATION OF INFLAMMATORY EXUDATESY

SYMPTOMS
PATIENT COMPLAIN OF MARKED EARACHE THROBBING IN

NATURE THAT MAY DISTURB SLEEP.

DEAFNESS
IN CHILDREN HIGH DEGRESS OF FEVER RUNS AND IS RESTLESS

SIGNS
CONGESTION OF PARS TENSA AND PARS FLACCIDA
WITH BLOOD VESSELS SEEN ALONG THE HANDLE OF

MALLEUS AND PERIPHERY TO EARDRUM

CONDUCTIVE TYPE OF DEAFNESS

STAGE OF
SUPPURATION
MARKED BY PUS FORMATION
TYMPANIC MEMBRANE START BULGING TO POINT OF

RUPTURE

SYMPTOMS
EARACHE BECOMES EXCRUCIATING (GREAT IN

PAIN)
DEAFNESS INCREASES
CHILD MAY RUN FEVER OF 102-103F

SIGN
TYMPANIC MEMBRANE APPEAR UNIFORMLY RED
BULGING
WITH LOSS LANDMARKS
YELLOW SPOT MAY SEEN WHERE RUPTURE IS IMNINENT OR

ABOUT HAPPEN

STAGE OF
RESOLUTION
TYMPANIC MEMBRANE RUPTURE WITH
RELEASE OF PUS

SYMPTOMS
EVACUATION OF PUS
EARACHE IS RELIEVED
FEVER COMES TO NORMAL IN CHILDREN

SIGN
EAC CONTAIN MUCOPURULENT DISCHARGE
SMALL PERFORATION SEEN IN ANTERIOR INFERIOIR

QUADRANT OF PARS TENSA

TYMPANIC MEMBRANE RECOVER ITS NORMAL
&LANDMARKS

STAGE OF
COMPLICATIONS
IF VIRULENCE OF BACTERIA HIGH
RESISTANCE OF PATIENT POOR
RESOLUTION MAY NOT TAKEPLACES
THE INFECTION MAY SPREAD BEYOND THE BORDERS OF

MIDDLE EAR

OTITIS MEDIA
WITH EFFUSION
OR GLUE EAR
Condition characterized by accumulation of nonpurulent
effusion behind the eardrum in the middle ear cleft
Effusion often thick and viscid and sometime its thin
and serous and nearly sterile
Commonly seen in school going children

AETIOLOGY
MALFUNCTIONING OF EUSTACHIAN TUBE

: THAT FAIL TO AERATE AND

DRAIN
CAUSES ARE ADENOID HYPERLASIA
TONSILLITUS
RHINITIS
SINUSITIS
INCREASED SECRETORY ACTIVITY OF MIDDLE EAR MUCOSA:
ALLERGY IS COMMON IN CHILDREN
UNRESOLVED OTITIS MEDIA
VIRAL INFECTON
THESE FACTORS ACT AS STIMULUS FOR MUSCOSA TO SECRRETE MORE FLUID

CLIINICAL
FEATURES
SYMPTOMS:
Hearing loss exceeds 40dB
Delayed & defective speech bcz of hearing
Mild earache

SIGNS

TYMPANIC MEMBRANE OFTEN DULL & OPAQUE WITH

LOSS OF LIGHT REFLEX

APPEAR YELLOW ,GREY OR BLUISH IN COLOUR
SHOW VARYING DEGRESS OF RETRACTION
MAY APPEAR SLIGHT OR FULL BULGING IN ITS
POSTERIOR PART DUE TO EFFUSION
FLUID LEVEL ANF AIR BUBBLES MAY BE SEEN
TUNING FORK SHOW CONDUCTIVE TYPE OF
DEAFNESS