AsmatullahMBBS,DLO,MCPS,FCPS

ENT Department.

Sandemen Provincial Hospital

Quetta.

Diseases of the Middle ear

Otitis Media

Definition:It is the inflammation of the mucous membrane of the middle ear cleft.

Classification

1)Acute otitis mediaa) Non Suppurative

b) Suppurative

2)Chronic Otitis mediaa) Suppurative

b) Non-Suppurative

3)Specific type of otitis media (tuberculosis syphilis, diphtheria).

4)Adhesive otitis Media.

Non-Suppurative Otitis Media

Synonyms :

• Secretory otitis Media

• Serous otitis Media

• Otitis media with effusion

• Glue ear

Definition : It is the accumulation of non-inflammatory exudate in the middle ear cavity following a series of Pathological changes in the mucous membrane of the middle ear . Commonly seen in Children.

Non-Suppurative Otitis Media

Etiology

1.Tubal Occlusion

2.Allergy

3.Hypogammaglobulinemia

Symptoms :

• Blocking sensation of the ears

• Deafness – conductive type. It is usually Bilateral in Children and

unilateral in Adults.

• The Child’s performance in school will be Low

• Wooly feelings in the Ear

• Autophony

Associated symptoms:1.Nasal discharge

2.Nasal Obstruction

Signs: • Tympanic membrane appears dull and lusterless but may

occasionally appears congested in the initial Stage.

• Retraction of the tympanic membrane

• Evidence of fluid in the middle ear in which the fluid level may be seen as an air Bubble

• Mobility of the tympanic membrane is decreased

• Tuning Fork test

Investigations :

• Plane X-Rays • PNS

• X-Ray Nasopharynx

• Audiometry

• PTA

• Impedance audiometry

Treatment :• Prevention of the secretory otitis media.

• Removal of the possible cause, e.g. adenoid- ctomy.

• Anti allergy

• Advice the child to sit in the Front Row at School.

• Myringotomy with grommet insertion.

Acute Suppurative Otitis Media

Definition :

It is an Acute suppurative inflammation of the periosteal layer of the middle ear Cleft by suppurative Organisms.

Incidence :It is Commonly seen in children but adults may also get affected.

Etiology

Routes of Infection :1.Eustachian tube

2.Traumatic perforation

3.Hematological

Common Organisms:

• Streptococcus

• Pneumococcus

• H. Influenza

• Moraxella catarrhalis

• Pseudomonas

Clinical Features

1.Stage I – Stage of hyperemia

2.Stage II – Stage of exudation

3.Stage III – Stage of Suppuration

4.Stage IV – Stage of coalescent mastoiditis

5.Stage V – Stage of Complications

6.Stage VI – Stage o resolution.

Chronic Suppurative otitis Media

Definition:

It is defined as Chronic inflammation of mucoperiosteal lining of the middle ear Cleft.

Classification

• Tubotympanic type (Safe type)

• Attico-antral type (Dangerous type)

TubotympanicEtiology

• Predisposing factors

• Inadequate Treatment

• Infection from surrounding areas

• some disease like tuberculosis are chronic from Beginning

• Pneumatization of mastoid

• Exciting Factors

• Gram negative organisms like pseudomonas, proteus. E.coli

• Streptococcus

• Staphylococcus

Symptoms :

• Discharge

• Active

• Quiescent

• Inactive

• Healed

Signs :• Non-foul smelling Discharge.

• Tympanic membrane (Central perforation)• Small , pinpoint perforation (less then 25%)

• Medium size (25-50%)

• Large Perforation (50-75%)

• Complete or Total.

Investigations

• Culture and sensitivity

• Examination under microscope

• PTA (mild conductive loss between 20 to 30 dB)

• Patch Test

• X-ray of Mastoids

• X-ray PNS

• X-ray Soft tissue neck lateral View

• Diagnostic nasal endoscopy s

Attico-Antral Disease

Definition :

Attico-Antral disease is an unsafe disease because it associated with Cholesteatoma formation.

Cholesteatoma :

is Defined as a sac in the middle ear which lined by keratinizing stratified squamous epithelium as keratin debris

Classification of Cholesteatoma

Cholesteatoma

Congenital Acquired

PrimaryAcquired

SecondaryAcquired

Theories

1.Retraction pocket theory

2.Theory of migration

3.Metaplasia theory

4.Implantation theory

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