OTITIS MEDIA WITH EFFUSION

Heba Hudifa
20M067
• This is an insidious condition characterized by
accumulation of nonpurulent effusion in the
middle ear cleft.
• Effusion maybeThick and viscid/Thin and serous
• INCIDENCE:Commenly seen in children (5-8yrs)
 Pathogenesis
• Two mechanisms

1. Malfunctioning of ET: Pressure change occur in

middle ear thereby fails to aerate the middle ear
and drain the fluid leading to accumulation of
fluid.

2. Increased Secretory activity of Middle Ear:

Biopsies of middle ear mucosa in these cases
have confirmed increase in number of mucus or
serous secreting cells.
 AETIOLOGY
1. Malfunctioning of ET:
Causes include;
• Adenoid hyperplasia
• Chronic rhinitis and sinusitis
• Chronic tonsillitis
• Benign and malignant
tumours of nasopharynx
• Palatal defects, e.g. cleft
palate, palatal paralysis.
• Down’s syndrome
2. Allergy:
Seasonal or perennial allergy to inhalants or
foodstuff is common in children. This not only
obstructs eustachian tube by oedema but may
also lead to increased secretory activity as
middle ear mucosa acts as a shock organ in
such cases
3. Unresolved Otitis media:
Inadequate antibiotic therapy in acute
suppurative otitis media may inactivate infection
but fail to resolve it completely. Low-grade
infection lingers on. This acts as stimulus for
mucosa to secrete more fluid. The number of
goblet cells and mucous glands also increase
4. Viral Infection:
Adenovirus and rhinoviruses of upper
respiratory tract may invade middle ear
mucosa and stimulate it to increased secretory
activity
 Clinical Features
SYMPTOMS:
• Hearing loss - Insidious in onset and rarely
exceeds 40 Db. Accidentally discovered during
audiometric screening tests.
• Delayed and defective speech- Because of
hearing loss, development of speech is delayed
or defective
• Mild earaches- There may be history of upper
respiratory tract infections with mild earache
OTOSCOPIC FINDINGS:
▪Tympanic membrane is dull and
opaque with loss of light reflex
▪Thin leash of blood vessels seen
along handle of malleus or at
periphery of TM
▪TM show varying degree of
retraction(full/slightly bulged in
posterior part)
▪When TM is transparent fluid level
and air bubbles seen
▪Valsalva manoeuvre produce
crackling sound
▪Mobility of TM reduced
▪Appear yellow/grey/bluish color
 HEARING TESTS
1. Tuning fork tests- show conductive hearing loss

2. Audiometry- There is conductive hearing loss of

20– 40 Db maybe associated with SNHL

3. Impedence audiometry- Presence of fluid is

indicated by reduced compliance and flat curve
with a shift to negative side

4. X-ray mastoids or CT temporal bone- There is

clouding of air cells due to fluid.
MEDICAL: TREATMENT
• Topical Decongestants(nasal drops,sprays,systemic)
helps to relieve oedema of ET.
• Antiallergic measures(antihistamnes/steroids) used
in cases allergy
• Antibiotics useful in URTI or unresolved acute
suppurative otitis media

• Middle ear Aeration-Perform Valsalva

manoeuvre.Sometimes, politzerization or eustachian
tube catheterization has to be done that helps to
ventilate middle ear and promote drainage of fluid.
Children can be given chewing gum to encourage
repeated swallowing which opens the tube
 SURGICAL:
1. Myringotomy:
▪ An incision is made in
tympanic membrane and
fluid aspirated with suction
▪ Thick mucus require
mucolytic
agents(chymotrypsin) to
liquify before aspirating
▪ In case of thick glue like
secretions based on beer can
principle 2 incisions is made
one at anteroinferior another
at anterosuperior quadrent
of TM
o Grommet insertion:
If myringotomy and aspiration combined with
medical measures have not helped a grommet is
inserted to provide continued aeration of middle
ear
o Tympanotomy/cortical mastoidectomy:
It is sometimes required for removal of loculated
thick fluid or other associated pathology such as
cholesterol granuloma
o Surgical treatment of Causative factor:
At the time of myringotomy, adenoidectomy,
tonsillectomy and/or wash-out of maxillary antra
may be required
COMPLICATIONS:
• Atrophic Tympanic Membrane and Atelectasis of
The Middle Ear
• Ossicular Necrosis
• Tympanosclerosis
• Retraction Pockets and Cholesteatoma
• Cholesterol Granuloma
 REFERENCES
• Diseases of Ear,Nose,Throat and head and
neck surgery Dhingra ,8th edition
• Google image
THANK YOU