Group 2 Presentation Emily Isabella Deborah Sheila Why may hearing be affected by cold or congestion The middle ear communicates with the nasopharynx via the Eustachian tube An upper respiratory infection causes ID: 286092
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Slide1
Otitis Media
Group 2 Presentation – Emily, Isabella, Deborah, SheilaSlide2
Why may hearing be affected by cold or congestion?
The middle ear communicates with the nasopharynx via the
Eustachian tube
.
An upper respiratory infection causes
inflammation and swelling
of the
tissues surrounding the Eustachian tube
, resulting in difficulty hearing as sound does not travel efficiently from the outer ear to the inner ear.
Infection that is spread via the Eustachian tube from the nasal cavity and pharynx (throat) to the middle ear, can cause
otitis media
.Slide3Slide4
What is otitis media?
Definition: Otitis media is inflammation of the middle ear, or middle ear infection.
Infection causes pressure to build up behind the tympanic membrane, causing intense pain. In severe cases, the membrane may rupture, leading to chronic conditions.
Location:
in the area between the tympanic membrane and the inner ear, including the Eustachian tube
Cause:
most commonly caused by infection with viral, bacterial, or fungal pathogens. Most common bacterial pathogen is
Streptococcus
pneumoniaeSlide5Slide6
Acute Otitis Media
Risk Factors:Developmental alterations of the auditory tubeImmature immune system
Frequent infections of the upper respiratory mucosaSlide7
Acute Otitis Media:
Signs and SymptomsOne or more of the following symptoms:
Otalgia
(earache)
Fever
Otorrhea
(discharge from the external ear)
Recent onset of anorexia
Irritability
Vomiting
Diarrhoea
Signs
Abnormal
otoscopic
findings of the tympanic membrane including:
Opacity
Bulging
Erythema
Middle ear effusion
Decreased mobility with pneumatic
otoscopySlide8Slide9
Acute Otitis Media:
Treatment OptionsPain present
treatment to reduce pain
E.g., ibuprofen
Medical treatment
Concern of antimicrobial resistance due to aggressive antibiotic use
Observation without antibiotic use in children with mild acute Otis media
Treatment with antibacterial agent
amoxicillin (80-90 mg/kg/day)
ENT referral if history of recurrent acute Otis media
Surgical interventionSlide10
Chronic Otitis Media
P
erforated tympanic membrane
with persistent drainage from the middle ear (i.e. persistent
otorrhea
)
major cause of acquired hearing impairment in children esp. in developing countries
WHO’s definition: >2 weeks of
otorrhea
Otolaryngologists: >3 months of active disease
R
ecurrent or persistent effusions in middle ear behind an
intact tympanic membrane
in which principal symptom (if present at all) is
deafness and not ear discharge
i.e. chronic non-
suppurative
/ secretory /
seromucous
/ serous /
mucoid
OM (glue ear)Slide11
Chronic Otitis Media: Contributing Risk Factors
Young age (children)(Developing nations) Overcrowding, malnutrition
Being a member of a large family
History of multiple episodes of acute OM
Nasopharyngeal
colonisation
by bacteria implicated in OM
Chronic sinus infection & allergies
Upper respiratory infections (certain viruses like RSV, influenza, adenovirus)
Altered
eustachian
tube anatomy and function
Abnormalities in shape of the face, palate or
eustachian
tube
Down
syndromeSlide12
Chronic Otitis Media:
Signs and Symptoms
COM occurs gradually over many years
in patients with longstanding or frequent ear trouble. But it can (rarely) develop over several months in a patient with no previous history of ear disease.
Any of the above symptoms should prompt an evaluation by an ENT or
otologist
/
neurotologist
.
Warning signs of chronic otitis media include:
Hearing loss
(most common)
Facial weakness
Persistent blockage of fullness of the ear
Persistent deep ear pain or headache
Chronic ear drainage (
can range from a watery consistency to a yellow-green, foul-smelling discharge)
Fever
Drainage or swelling behind the ear
Development of balance problems
Confusion
or sleepinessSlide13
Chronic Otitis Media:
Treatment OptionsAppropriate topical antibiotic drops (remove small granulations in middle ear resulting from inflammation)
AND
Aural toilet
(thoroughly cleansing of the ear; reduce quantity of infected material/discharge and facilitate antibiotic action)
Sometimes surgery may be necessary
Mastoidectomy
removes mastoid air cells, granulations & debris
Tympanoplasty
repairs eardrum; closes perforation of tympanic membraneSlide14
Otitis Media with Effusion (Glue Ear)
Not an ear infection
Thick/sticky fluid behind the eardrum
Usually occurs after treatment for OM, when fluid (effusion) can remain in the middle ear for a few days or weeks.
Can lead to OM – when the tube is partially blocked, fluid builds up in middle ear
bacteria already inside become trapped and begin to grow
infection
.Slide15
Otitis Media with Effusion: Contributing Risk Factors
Oedema of the lining of the Eustachian tube (creates negative pressure in middle ear that sucks fluid from mucous lining)
increased fluid. Due to:
Allergies – most common in spring
Irritants
Respiratory infections
Blockage/closure of the tube, due to:
Drinking while lying on back
Sudden air pressure increases e.g. airplane, mountain road
Children get more OME than adults (and younger more than older), due to:
Shorter tube, more horizontal, straighter – easy for bacterial entry
Tube floppier, with opening that is small and easily blocked.
Immune system not as developed
get more colds.
Other risk factors include:
Congenital abnormalities e.g. Cleft palate, immune deficiencies
Genetic factors e.g. Down’s Syndrome
Repeated ear infections, especially <6m, and close succession.
Attendance at day care
Passive smokingSlide16
Signs and Symptoms
Often children with OME don’t act sick – no obvious symptoms, as no infection.Muffled hearing (transient) – usually 15-40dB hearing threshold (mild-moderate); loss of >35dB in about 20% of cases; fluctuating hearing loss (with varied fluid volume).
Sense of ‘fullness’ in the ear
Children might have obvious difficulty hearing e.g. turn the
tv
up louder, as ‘What?’ often.
Can have behavioural impact:
Distractibility
Overactivity
Social withdrawal
Irritability
Inattention
Inappropriate response behaviours
Specific ‘ear’ symptoms e.g. pulling on ear, head banging, rolling head from side to side
Complications:
Acute ear infection
Cyst in middle ear
Permanent damage to the ear with partial/complete hearing loss
Scarring of the eardrum (
tympanosclerosis
)
Speech or language delay (rare)Slide17
Otitis Media with Effusion: Tests
Examine the eardrum for:Air bubbles on the surfaceDullness when light is used
No movement when little puffs of air are blown at it
Fluid behind it
Tympanometry – shows amount and thickness of fluid.
Acoustic
otoscope
/
reflectometer
– detects presence of fluid.
Audiometer – to determine what treatment.Slide18
Otitis Media with Effusion: Treatment Options
Watchful waiting – 2-3 months (unless there are signs of infection).
Smaller, daily dose of antibiotics to prevent new infections, if child has had repeat ear infections (with/without oral steroids)
Changes:
Avoid cigarette smoke
Encourage breastfeeding of infants
Treat allergies, stay away from triggers.
If fluid still present after 6 weeks:
Further observation
Hearing test
Single trial of antibiotics (if not given earlier) – not always helpful.
A significant hearing loss (>20dB)
antibiotics or ear tubes.
At 4-6m, tubes probably needed, even where there is no significant hearing loss.
Adenoids might need to be removed to restore proper functioning of the Eustachian tube.
Insubstantial evidence for:
Antihistamine-decongestant combinations
Oral
mucolytics
Eustachian tube
autoinflation
Surgical:Myringotomy (pressure release)
Tympanostomy
tubes (grommets)
Adenoidectomy (only when concurrent adenoid issues
)Slide19
Why do children get more middle ear infections than adults?
Children < 7 years old are more prone to otitis media due to shorter, narrower and more horizontal Eustachian tubes
than in the adult ear
They also have not developed the
same resistance
to viruses and bacteria as adults.
Breastfeeding for the first 12 months of life is associated with decrease in number of otitis media infections in children
.