8/10/2019 OTITIS MEDIA SEROSA.pptx
1/26
OTITIS MEDIA SEROSAMR2 CHRISTIE ZAMORA MENDOZA
8/10/2019 OTITIS MEDIA SEROSA.pptx
2/26
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.
8/10/2019 OTITIS MEDIA SEROSA.pptx
3/26
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.
8/10/2019 OTITIS MEDIA SEROSA.pptx
4/26
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.
8/10/2019 OTITIS MEDIA SEROSA.pptx
5/26
8/10/2019 OTITIS MEDIA SEROSA.pptx
6/26
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
8/10/2019 OTITIS MEDIA SEROSA.pptx
7/26
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.
8/10/2019 OTITIS MEDIA SEROSA.pptx
8/26
DIAGNO
TYMP NOMETRY
Excellent diagnostic test
85% of specificity in
cases of middle ear
secretion
increased impedance
Jerger, in 1980.
8/10/2019 OTITIS MEDIA SEROSA.pptx
9/26
DIAGN
8/10/2019 OTITIS MEDIA SEROSA.pptx
10/26
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.
8/10/2019 OTITIS MEDIA SEROSA.pptx
11/26
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
8/10/2019 OTITIS MEDIA SEROSA.pptx
12/26
8/10/2019 OTITIS MEDIA SEROSA.pptx
13/26
8/10/2019 OTITIS MEDIA SEROSA.pptx
14/26
8/10/2019 OTITIS MEDIA SEROSA.pptx
15/26
8/10/2019 OTITIS MEDIA SEROSA.pptx
16/26
8/10/2019 OTITIS MEDIA SEROSA.pptx
17/26
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
8/10/2019 OTITIS MEDIA SEROSA.pptx
18/26
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.
8/10/2019 OTITIS MEDIA SEROSA.pptx
19/26
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
8/10/2019 OTITIS MEDIA SEROSA.pptx
20/26
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
8/10/2019 OTITIS MEDIA SEROSA.pptx
21/26
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.
8/10/2019 OTITIS MEDIA SEROSA.pptx
22/26
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.
8/10/2019 OTITIS MEDIA SEROSA.pptx
23/26
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.
8/10/2019 OTITIS MEDIA SEROSA.pptx
24/26
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
8/10/2019 OTITIS MEDIA SEROSA.pptx
25/26
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.
8/10/2019 OTITIS MEDIA SEROSA.pptx
26/26
Gracias!