Q. HOW DO YOU CATEGORIZE THE SEQUELAE OF OTITIS MEDIA?
DIRECT DESTRUCTIVE EFFECTS OF THE LOCALIZED PROCESS
Acute/ chronic perforation of TM
Acute mastoditis
Middle ear atelectasis
Adhesive otitis media
Tympanosclerosis
Ossicular erosion or fixation
Petrous apicitis
Cholesteatoma
Chronic otomastoiditis
Labyrinthitis
Facial Paralysis
Intracranial infections
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?
Adenoidectomy
Administration of antibiotics
Antihistaminics
Decongestant
Carbocisteine
Eustachian tube inflation
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?
To avoid a second surgical procedure because adenoidectomy alone fail to allow the ear to clear thick secretions.
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?
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?
It separates the fibrous layer rather than cutting through it. Thus heals readily with less scarring.
It provides a grip to tube
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?
Teflon
Silicone
Stainless Steel
Polyethylene
WHAT ARE THE DIFFERENT TYPES OF VENTILATION TUBES?
SHORT TERM (<6months)
Shepard
Donaldson tube
MEDIUM TERM (1-2 years)
Shah
Reuter Bobbin
Armstrong bevelled
Paparella type 1
Feuerstein Split tube
Linderman-silverstein arrow tube.
LONG TERM (>2 years)
Per-lee tube
Goode T tube
Paparella type 2 and 3
WHAT ARE THE PER-OPERTAIVE COMPLICATIONS OF MYRINGOTOMY?
Damage to incus, Stapes, incudo-stapedial joint, facial nerve and chorda tympani nerve.
Protection