otitis media with effusion. what is ome? presence of fluid without signs or symptoms of ear...
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OTITIS MEDIA WITH OTITIS MEDIA WITH EFFUSIONEFFUSION
What is OMEWhat is OME??
Presence of fluid without signs or Presence of fluid without signs or symptoms of ear infectionsymptoms of ear infection
Decreased TM mobility Decreased TM mobility Mild hearing loss generallyMild hearing loss generally 90% of children suffer from OME before 90% of children suffer from OME before
school age (usually 6 months to 4 years)school age (usually 6 months to 4 years) 30-40% of children with recurrent OME30-40% of children with recurrent OME 5-10% last greater than 1 year5-10% last greater than 1 year
ETIOLOGYETIOLOGY
11 . .Poor Eustachian Tube FunctionPoor Eustachian Tube Function
anatomic blockade like anatomic blockade like adenoid ,congenital ,traumatic ,tumouradenoid ,congenital ,traumatic ,tumour……
2. Inflammatory response following AOM2. Inflammatory response following AOM
45% have persistent effusion after 1 45% have persistent effusion after 1 month, but this number decreases to 10% month, but this number decreases to 10% after 3 months. after 3 months.
historyhistory
Hearing loss: TV too loud, “what?”Hearing loss: TV too loud, “what?” Pain ,ear itching(rubbing) mainly at night Pain ,ear itching(rubbing) mainly at night
with sleep disturbances with sleep disturbances Problems with school performanceProblems with school performance Recurrent AOMRecurrent AOM In adults aural fullness and/or pressure, an In adults aural fullness and/or pressure, an
ear being plugged, or decreased hearing ear being plugged, or decreased hearing Speech and language delaySpeech and language delay
PHYSICAL EXAMPHYSICAL EXAM
Poorly mobile TMPoorly mobile TM Yellow(serous) or grey(mucoid)Yellow(serous) or grey(mucoid) Neutral,bulging or retractedNeutral,bulging or retracted Air bubbles or fluid levelAir bubbles or fluid level Nasal ,oral and neck examNasal ,oral and neck exam audiologic examinationaudiologic examination
InvestigationsInvestigations
Audiogram :mild –Audiogram :mild –mod conductive mod conductive hearing losshearing loss
Tympanometery :type Tympanometery :type BB
managementmanagement
Medical treatmentMedical treatment Surgical treatmentSurgical treatment
Medical treatment Medical treatment
1.1. Antimicrobials: have benefit for treatmentAntimicrobials: have benefit for treatment
2.2. Steroids: have no benefit alone but thy Steroids: have no benefit alone but thy are beneficial in combination with are beneficial in combination with antibiotics(short term improvmentantibiotics(short term improvment
3.3. Antihistamines and decongestants :no Antihistamines and decongestants :no benefitbenefit
4.4. Mucolytics,topical steroids ,autoinflation : Mucolytics,topical steroids ,autoinflation : no benefitno benefit
Surgical treatmentSurgical treatment
Myringotomy with Myringotomy with ventilation tube: the ventilation tube: the best treatment for best treatment for OMEOME
Adenoidectomy alone Adenoidectomy alone or combined with or combined with myringotomy.myringotomy.
Tonsillectomy: no Tonsillectomy: no benefitbenefit
Surgical ComplicationsSurgical Complications
Anesthesia – mortality reported as 1:50,000 for Anesthesia – mortality reported as 1:50,000 for ambulatory surgeryambulatory surgery
Tympanostomy tube sequelaeTympanostomy tube sequelae Perforations in 2% after short-term tubes, 17% after Perforations in 2% after short-term tubes, 17% after
long-term tubeslong-term tubes Usually transient (otorrhea) or do not affect function Usually transient (otorrhea) or do not affect function
(tympanosclerosis, atrophy, shallow retraction)(tympanosclerosis, atrophy, shallow retraction) AdenoidectomyAdenoidectomy
0.2-0.5% incidence hemorrhage0.2-0.5% incidence hemorrhage 2% incidence of transient VPI2% incidence of transient VPI
SurgerySurgery
OME relapseOME relapse 20-50% of children with prior tubes relapse 20-50% of children with prior tubes relapse
after extrusion.after extrusion. Adenoidectomy confers 50% reduction in Adenoidectomy confers 50% reduction in
need for future operations.need for future operations. Benefit of adenoidectomy apparent at age 2 Benefit of adenoidectomy apparent at age 2
years, greatest for children >3 years, years, greatest for children >3 years, independent of adenoid size.independent of adenoid size.