Tubotympanic Type

Subject: Child Health Nursing

Overview

Chronic otitis media of the tumoral or tympanic type is often referred to be a harmless form of the condition. Common in children with recurrent attacks or complications of acute otitis media, infection from tonsillitis, allergy to ingestion of food such as milk, fish, etc., the tubotympanic type of chronic otitis media is characterized by ear discharge that is more offensive, mucoid or mucopurulent, constant or intermittent, and appears during upper respiratory infections. Antibiotics such as poly max and gentamicin are used both locally and systemically in cases when polyps are present. Children who do not improve with medical treatment or whose conditions require surgical correction, such as those with an auditory polyp or granulation that must be removed before antimicrobial therapy, may have surgery.

Tubotympanic Type

Chronic otitis media of the tubotympanic type is also called a safe or benign type of CSOM. It affects the upper and lower parts of the middle ear cleft and is linked to a central hole.

Cause

  • Age (common in childhood group)
  • Recurrent attack or complication of acute otitis media
  • Infection from tonsillitis
  • Adenoids and sinuses
  • Allergy to ingestion of food such as milk, fish, etc
  • Organisms responsible for CSOM are proteus, E.coil, staphylococcus aureus, bacteroids, and streptococci

Pathology

  • Perforation of pars tensa: It is a central perforation and its size and positivity vary.
  • Middle ear mucosa: middle ear mucosa looks normal when a disease is inactive and looks edematous when diseases are active.
  • Poly: In the external canal, a polyp appears as a smooth mass of edematous and inflammatory mucosa that has protruded via a hole. In this case, the observation is pale and meaty.
  • Ossicular chain: may show some necrosis, especially of the long process of the incus.
  • Tympano sclerosis: Connective tissue underneath the tympanic membrane or the mucosa of the middle ear hyalinizes and then calcifies. Deposits of white chalk can be detected on the ossicle, joint, tendon, oval, and circular window.
  • Fibrosis and adhesion: results due to the healing process

Clinical presentation

  • Ear discharge: more offensive, mucoid or mucopurulent, constant or intermittent, appears during upper respiratory tract infection or an accidental entry of water into the ear.
  • Hearing loss: conductive type of hearing loss is developed. The child can hear better in the presence of discharge.
  • Perforation: Always central, but may lie anterior, posterior, or inferior to the handle of the malleus.
  • The mucosa looks red, edematous, and swollen. Occasionally, a polyp may be seen.

Diagnosis

  • History: such as swimming in dirty water without earplugs, repeated upper respiratory tract infection, and history of itching of an ear.
  • Presentation: Ear discharge and deafness
  • Examination of the ear with an autoscope
  • Audiogram: to assess the degree of hearing loss
  • Culture and sensitivity: a test of ear discharge to detect the organism.
  • X-ray examination of the mastoid bone

Treatment

  • Aural drainage
    Dry mopping with cotton, suction clearing, or irrigation with sterile normal saline can be used to clear the ear of any discharge or debris, and the ear must be dried following irrigation.
  • Antibiotics
    Antibiotics including neomycin, polymax, and gentamicin, used both topically and systemically. These are taken 3–4 times a day in conjunction with steroids.
  • Treatment of underlying/ contributory causes
    • Surgical treatment:
      • Surgery is done on children who don't get better with medicine or whose illness needs to be fixed by surgery, like aural polyps or granulations that need to be removed before antibiotics therapy.
    • Reconstructive surgery

      • Myringoplasty with or without ossicular reconstruction

      • Ossiculoplasty: reconstruction of ossicles.

      • Tympanoplasty is performed in children older than 8 years of age and having a simple tympanic perforation without cholesteatoma.

         

         

 

 
Things to remember
  • Chronic otitis media of the tumoral or tympanic type is often referred to be a harmless form of the condition.
  • A central hole and the anteroinferior portion of the middle ear cleft are involved.
  • A kid with recurring attacks or complications of acute otitis media, infection from tonsillitis, allergy to ingestion of food such as milk, fish, etc., may develop the tubotympanic variety of chronic otitis media.
  • Hearing loss, red, edematous, and swollen mucosa, and a discharge that is more unpleasant, mucoid, or mucopurulent may be present after an upper respiratory tract infection or after unintentional water entry into the ear.
  • It's possible to spot a polyp once in a while.
  • Antibiotics including neomycin, polymax, and gentamicin, used both topically and systemically. These are given with steroid medication three to four times daily.
  • When medical treatment fails to alleviate a child's symptoms, or when the condition itself necessitates surgical correction—for example, when an auditory polyp or granulation must be removed before antimicrobial therapy can be administered—surgery is performed.
Questions and Answers

Chronic otitis media of the tubotympanic variety is also referred to as a safe or benign variety. It includes the middle ear's anterior inferior portion cleft and is linked to a central perforation.

Cause

  • Age (common in childhood group) (common in childhood group).
  • Recurrent acute otitis media attacks or their complications.
  • tonsillitis-related infection.
  • sinuses and adenoids
  • Food allergies include those to foods like milk, fish, etc.
  • Proteus, E. coil, staphylococcus aureus, bacteroids, and streptococci are the organisms in charge of CSOM.
  • Ear discharge: A mom-offensive, mucoid or mucopurulent rash may develop as a result of an upper respiratory infection or an unintentional water ingestion in the ear.
  • Hearing loss: Hearing loss of the conductive type develops. When there is discharge, the child hears better.
  • Perforation: The malleus handle is always in the middle, but it could also be anterior, posterior, or inferior.
  • The mucosa appears swollen, edematous, and red. An occasional polyp might be visible.

Treatment

  • Aural drainage: By dry-mopping with cotton, suction clearance, or irrigation with sterile normal saline, remove all ear discharge and debris. The ear then needs to be dried.
  • Antibiotics: Administration of antibiotics, such as gentamicin, polymax, and neomycin, locally and systematically. These are given along with steroids three to four times per day.

Treatment of underlying/ contributory causes:

  • Surgical treatment: Children who are not responding to medical therapy or whose disease requires surgical correction, such as an aural polyp or granulation that must be removed before receiving antibiotic therapy, undergo surgical treatment.

  • Reconstructive surgery:
    • With or without ossicules reconstruction, myringoplasty
    • Children who are older than 8 years old and have a straightforward tympanic perforation without cholesteatoma are candidates for tympanoplasty.
    • Ossiculoplasty: Ossicles that have been rebuilt.

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