otitis media with effusion. what is ome? presence of fluid without signs or symptoms of ear...

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.