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OME AND MYRINGOTOMY

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Q. WHAT ARE THE BASIC CAUSES OF OME?

  • Secondary to AOM
  • Re flux gastro-oesophagitis
  • Eustachian dysfunction
  • Specific causes:
  1. Adult onset otitis media
  2. Paranasal sinus disease
  3. Nasopharyngeal carcinoma
  4. Post raditaion sequelae

Q. HOW DO YOU CATEGORIZE THE SEQUELAE OF OTITIS MEDIA?

  • DIRECT DESTRUCTIVE EFFECTS OF THE LOCALIZED PROCESS
  1. Acute/ chronic perforation of TM
  2. Acute mastoditis
  3. Middle ear atelectasis
  4. Adhesive otitis media
  5. Tympanosclerosis
  6. Ossicular erosion or fixation
  7. Petrous apicitis
  8. Cholesteatoma
  9. Chronic otomastoiditis
  10. Labyrinthitis
  11. Facial Paralysis
  12. Intracranial infections
  13. SNHL
  • AUDITORY DEPRIVATION IN EARLY CHILDHOOD: It results in language and speech delay.

Q. WHAT IS THE RATE OF RETRACTION IN BILATERAL OME?

  • Untreated ear: 1.5%
  • Treated ear with tubes: 2 %

Q.WHO DESCRIBED THIS PROCEDURE FIRST?

  • Politzer in 1883

Q. WHAT ARE THE INDICATIONS OF MYRINGOTOMY?

  • Secretory Otitis Media
    – To confirm the diagnosis

– To aspirate fluid

– To insert ventilation tube (Grommet)

  • Retraction of the whole pars tensa
  • Acute otitis media

– TM bulging along with persistent pain and pyrexia despite adequate antibiotics therapy.

  • Suspected malignant disease of the nasopharynx: Fluid is aspirated for cytological study of malignant cells.

WHAT ARE THE OTHER TREATMENT MODALITIES FOR SEROUS OTITIS MEDIA?

  1. Adenoidectomy
  2. Administration of antibiotics
  3. Antihistaminics
  4. Decongestant
  5. Carbocisteine
  6. Eustachian tube inflation
  7. Attention to disease of nose/ sinuses/ nasopharynx and tonsils.

WHY IS MYRINGOTOMY WITH VT INSERTION PERFORMED ROUTINELY AT THE SAME TIME PERIOD AS ADENOIDECTOMY WHEN SOM IS SUSPECTED?

  1. To avoid a second surgical procedure because adenoidectomy alone fail to allow the ear to clear thick secretions.
  2. To gain hearing immediately because it is educationally important in school children.

WHICH FORM OF ANAESTHESIA WILL YOU PREFER FOR MYRINGOTOMY?

  • GENERAL ANAESTHESIA:

-All cases of AOM

        -Children with OME

        -Some adults with OME

  • LOCAL ANAESTHESIA:

-Older children and adults in whom repeated insertion of grommet is required because of frequenr recurrence.

-Procedure: Inject 4 quadrant with 2% Lignocaine and incision is given. Following this, run few drop of 5 %

Lignocaine to anaesthetize Promontory.

WHAT IS THE POSITION OF THE PATIENT DURING MYRINGOTOMY?

  • Supine on the operation table with head turned to one side resting on the ring which brings the operating ear above.

WHAT ARE THE DIFFERENT SITES OF INCISIONS FOR MYRINGOTOMY?

  1. SECRETORY OTITIS MEDIA (OME)
  • Radial incision
  • Antero-inferior
  • Antero-superior if ventilation is needed for longer term because the epithelial migration is slower in anterior superior quadrant resulting in less heaping of epithelial debris to one side of the tube , so less tube extraction.

2. ACUTE OTITIS MEDIA

  • Posteo-inferior

WHAT ARE THE ADVANTAGES OF RADIAL INCISION?

  1. It separates the fibrous layer rather than cutting through it. Thus heals readily with less scarring.
  2. It provides a grip to tube
  3. It helps to lessen the tube extrusion by acting as the barrier to epithelial migration medially.

WHAT SHOULD EB THE SIZE OF INCISION?

  • Same length as the external diameter of the inner flange (3-4 mm)

 

HOW MUCH TIME DOES  RESIDUAL FLUID TAKE TO DISAPPEAR ONCE THE MIDDLE EAR CLEFT IS PROPERLY AERATED?

  • 10 days

 

WHAT ARE THE DIFFERENT MATERIALS OF WHICH VT TUBE ARE MADE?

  1. Teflon
  2. Silicone
  3. Stainless Steel
  4. Polyethylene

WHAT ARE THE DIFFERENT TYPES OF VENTILATION TUBES?

  • SHORT TERM (<6months)
  1. Shepard
  2. Donaldson tube
  • MEDIUM TERM (1-2 years)
  1. Shah
  2. Reuter Bobbin
  3. Armstrong bevelled
  4. Paparella type 1
  5. Feuerstein Split tube
  6. Linderman-silverstein arrow tube.
  • LONG TERM (>2 years)
  1. Per-lee tube
  2. Goode T tube
  3. Paparella type 2 and 3

 

WHAT ARE THE PER-OPERTAIVE COMPLICATIONS OF MYRINGOTOMY?

  1. Damage to incus, Stapes, incudo-stapedial joint, facial nerve and chorda tympani nerve.
  2. Occasional damage to Jugular bulb.
  3. Intrusion of grommet into the middle ear.
  4. Excessive damage to TM.

 

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