OTITIS MEDIA SEROSA.pptx

8/10/2019 OTITIS MEDIA SEROSA.pptx

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OTITIS MEDIA SEROSAMR2 CHRISTIE ZAMORA MENDOZA


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DEFI

Several potential causes.

The leading causes include:

Viral upper respiratoryinfection

Acute otitis media (AOM)

Chronic dysfunction of the

eustachian tube.

However, other potential include CILIARY DPROLIFERATION OF FLUIDGOBLET CELLS, ALLERGY ABACTERIAL ANTIGENS, and

MUCOGLYCOPROTEINS

and much of the fluid pres

HALL

The presence of fluid in the middle ear decreases tympanic membrane and mid

leading to decreased hearing, a fullness sensation in the ear, and occasionall

pressure changes.

collection of fluid in the middle ear withoutsigns or symptoms of acute ear infection.


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PREVA

90 percent of children: having at least one episode of OME by ag

OME disproportionately affects some subpopulations of children.

HIGH RISK

for anatomcauses a

compromifunction of

eustachian

cleft palate

Down syndrome

craniofacial anomalies

individuals of American Indian,Alaskan, and Asian backgrounds

adenoid hyperplasia.


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PREVA

Adults usually happens after patients develop a severe uppe

infection such as sinusitis, severe allergies, or rapid change in

after an airplane flight or a scuba dive.

Many episodes of

spontaneously within 3 m 30 to 40 % of childre

episodes 5 to 10 % of cases last m

Despite the high prevalence of OME,

its long-term impact on child

developmental outcomes such as

speech, language, intelligence, and

hearing remains unclear.


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ETIO

Not clear.

Evidence indicates that OME occurs due to the persistence o

middle ear after an episode of AOM, or that it is related to a

dysfunction, with or without the presence of infection in the uppe


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DIAGNO

Clinical diagnosis is performed through otoscopy with

visualization of the fluid, which may present

characteristics of:

plasma exudation

tympanic membrane remains translucid, and the presence

of blisters or the level of liquid may be verified, in addition

to the degree of retraction

mucus secreted by mucus secreting cells

there is loss of translucency in the tympanum, with frequent

increase of its radial vascularization.


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DIAGNO

TYMP NOMETRY

Excellent diagnostic test

85% of specificity in

cases of middle ear

secretion

increased impedance

Jerger, in 1980.


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DIAGN


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DIAGNO

CLINICAL HISTORY TAKING, FOCUSING ON:

poor listening skills

indistinct speech or delayed language development

inattention and behaviour problems

hearing fluctuation

recurrent ear infections or upper respiratory tract infections

balance problems and clumsiness

poor educational progress

INICAL EXAMINATION, FOCUSING O

Otoscopy

general upper respiratory health

general developmental status

earing testing, which should be c

staff using tests suitable for the de

the child, and calibrated equipm

tympanometry.

Formal assessment of a child withsuspected OMEshould include:

Co-existing causes of hearing loss should be considered when assessing a child managed appropriately.


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TRATAM

doubts concerning the besttreatment

Evolution: duration, rate ofrecurrence, and rate of recovery.

follow its own course, periodicalcontrols.

Bernstein: the maturation of theauditory tube in children,combined with the resolution oflocal inflammatory responseimproves most cases of OME.

limiting concomitant passive

controlling allergy and sinusit

reducing the number of upp

respiratory tract infections

encouraging breastfeeding

finding alternatives to day cawith a large number of child


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Recommendation 1a

Clinicians should use pneumatic otoscopy as the primary diagnost

OME. OME should be distinguished from acute otitis media (AOM).

Recommendation 1b

Tympanometry can be used to confirm the diagnosis of OME. (This opticohort studies and a balance of benefit and harm.)

Recommendation 1c

Population-based screening programs for OME are not recommend

asymptomatic children


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Recommendation 2

Clinicians should document the laterality and duration of effusion, and the presenc

associated symptoms at each assessment of the child with OME.

Recommendation 3

Clinicians should distinguish the child with OME who is at risk for speech, langu

problems from other children with OME and should more promptly evaluate hlanguage, and need for intervention.

(1) speech and language therapy concurrent with managing OME

(2) hearing aids or other amplification device for hearing loss independent of OME

(3) insertion of tympanostomy tube,

(4) hearing testing after resolution of OME to document improvement.


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Recommendation 4

Clinicians should manage the child with OME who is not at risk with watchful w

months from the date of effusion onset (if known), or from the date of diag

unknown).

Recommendation 5

Antihistamines and decongestants are ineffective for OME and are not rec

treatment. Antimicrobials and corticosteroids do not have long-term efficac

recommended for routine management. (This recommendation is based o

review of randomized controlled trials and a preponderance of harm over bene


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Recommendation 6

Hearing testing is recommended when OME persists for three months o

any time that language delay, learning problems, or a significant

suspected in a child with OME. Language testing should be conducte

with hearing loss.

Recommendation 7

Children with persistent OME who are not at risk should be re-examine

six-month intervals until the effusion is no longer present, significant

identified, or structural abnormalities of the eardrum or middle ear are s


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RECOMMENDATION 8

When children with OME are referred by the primary care clinician f

by an otolaryngologist, audiologist, or speech-language pathologis

referring clinician should document the effusion duration and the sp

for referral (evaluation, surgery), and provide additional relevant inf

such as history of AOM and developmental status of the child.


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RECOMMENDATION 9

When a child becomes a surgical candidate, tympanostomy tube insertion is the preferred initial p

adenoidectomy should not be performed unless a distinct indication exists (nasal obstruction, chron

Repeat surgery consists of adenoidectomy plus myringotomy, with or without tube insertion. Tonsille

myringotomy alone should not be used to treat OME.

A recommendation of surgery should be based on the individual.

Determining candidacy for surgery for OME is

based on:

hearing status

associated symptoms

the childs developmental risk

the anticipated chance of timely

spontaneous resolution of the effusion.

Candidates for surgery include childre

(1) OME lasting four months or long

hearing loss or other signs and symp

(2) recurrent or persistent OME in

regardless of hearing status

(3) OME and structural damage t

membrane or middle ear.


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Recommendation 10

No recommendation is made regarding complementary and altern

medicine as a treatment for OME.

Recommendation 11

No recommendation is made regarding allergy management as a

OME.


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We support the adoption of expectant management in as

children for a period of up to 6 months.

This recommendation is based on well-documented observat

spontaneous regression of OME and takes into consideration

future aspects of bacterial resistance, which warrants the ca

antibiotics only in situations of AOM


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We stress that common sense is the basic rule in special cases presenting learning

risk for otologic complications.. Surgical drainage with the placement of a ventila

alternative in both high risk children (carried out earlier than in asymptomatic childr

children in whom expectant management was no sufficient to resolve OME.

This surgical intervention aims at avoiding both irreversible lesions of the tympanic

complications related to hearing loss, quickly restoring normal hearing.

Finally, it is important to stress that the surgical alternative should only be adopte

observation of the principles described above.


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Gracias!

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