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Non suppurative otitis media
1. Non - suppurative
Otitis Media
Dr. Krishna
Koirala, MS
Associate
Professor
Dept. of ENT- HNS2016-04-26
2. Types
1. Otitis Media with effusion (O.M.E.)
2. Adhesive otitis media
3. Tympanosclerosis
4. Barotraumatic otitis media
3. Otitis Media with
Effusion
• Presence of serous or mucoid fluid in
the middle ear cleft without frank pus
• Synonyms
– Glue ear
– Serous otitis media
– Seromucinous otitis media
– Secretory otitis media
– Exudative otitis media
– Catarrhal otitis media
4. Etiology
1. Eustachian tube dysfunction
– Vacuum in middle ear→ extravasation
of fluid
– Lack of drainage of middle ear
secretions
2. Upper respiratory tract allergy / viral
infection
– Increase middle ear secretions
6. Symptoms
• Mild deafness in a young child that
increases during U.R.T.I.
• Mild otalgia
• Blocking sensation in ear
• Delayed & defective speech due to
7. Signs
1. Otoscopy
− Dull /pinkish/blue eardrum with
restricted mobility
− Retraction of T.M. in early stage
− Bulging of T.M. in later stages
− Fluid level and air bubbles seen behind
the T.M.
16. Politzerization
• Rubber tube attached
to Politzer bag is put
into one nostril & both
nostrils pinched
• Pt is asked to swallow
repeatedly & Politzer
bag is squeezed
simultaneously
18. • Balloon is inflated by blowing air out of
nose
• When fully inflated, balloon neck is
pinched off and nasal occluder is
inserted into one nostril
• Child is instructed to swallow as balloon
is deflated into the nasal cavity
• Portion of air from balloon enters
Eustachian tube & ventilates middle ear
20. • Based on Politzer Maneuver, Ear Popper
Device delivers a safe, constant,
regulated stream of air into nasal cavity
• During swallowing, air is diverted to
Eustachian tube clearing and ventilating
middle ear
22. EARDOC generates and transmits special
vibration waves which travel through
temporal bone to reach the middle ear &
Eustachian tube → the waves ease middle
ear pressure and drain trapped fluids →
edema & pain are reduced
23. Surgical treatment
1. Myringotomy (Tympanocentesis) +
grommet (Pressure Equalization /
Ventilation tube) Insertion
– Radial incision made in antero-inferior
quadrant
– For thick fluid, 2 incisions made in
24. 2. Cortical mastoidectomy for refractory
cases with loculated fluid in mastoid
3. Treatment for predisposing factors like
adeno-tonsillectomy ,antral wash
,polypectomy
38. Adhesive Otitis Media
• Pathology
– TM atrophy + atelectasis (due to
dissolution of fibrous layer) +
adhesions in middle ear cavity,
following chronic O.M.E.
• Clinical Features
– Conductive deafness
39. Treatment:
1. Hearing Aid
2. Surgery (long term results are poor)
a. Tympanotomy + release of adhesions
+ put silastic sheet b/w promontory &
TM
b. Grommet insertion
40. Tympanosclerosis
Deposition of hyaline
(acellular and avascular
collagen) and calcium
deposits in submucosal
tissue of T.M. & M.E.
cavity following long-
standing otitis media
during healing process
43. Role of Esutachian tube
• E.T. has collapsible cartilaginous and rigid
bony portion
• Allows expulsion of air from middle ear
into E.T. but not suction of air into middle
ear via ET
44. Etiology
• Failure of Eustachian tube to equalize
rapid increase in pressure difference b/w
middle ear & atmosphere, over a long
period
• During ascent
– Middle ear pressure > Atmospheric
Pressure → no barotrauma in normal
middle ear
• During descent
45. Pressure
Differen
ce
Pathology in
normal Middle
Ear
Symptom
s
- 60 mm
Hg
Hyperemia , edema ,
exudation , T.M.
retraction
Otalgia,
deafness,
tinnitus
- 90 mm
Hg
Locking of ET
(collapse of lumen),
microscopic
hemorrhage
Severe
otalgia
- 100 to
400 mm
Hg
T.M. rupture Frank
blood
otorrhea
47. Prevention
1. Avoid air travel during cold / nasal
allergy
2. During descent while flying
– Do repeated swallows (lozenges /
chewing gum)
– Do intermittent Valsalva maneuvre
– Avoid sleeping (as swallowing is