1. OTITIS MEDIA

2. Definition Otitis media :inflammation of the middle ear without reference to etiology or pathogenesis Acute otitis media : inflammation of the middle ear with rapid onset of one or more local or systemic signs and symptoms of acute infection within the middle ear (otalgia, otorrhea, fever, anorexia, vomiting or diarrhea) Recurrent otitis media (5 to 10% of children) > 3 episodes of AOM in 3 months with evidence of cure between episodes > 4 episodes of AOM in 6 months

3. Normaal TV Acute otitis media Acute otitis media

4. Otitis media met efusie – secretoire otitis media glue ear …

5. 5. Pathogenesis of OM ET dysfunction Infection Host respons Liberation of inflammatory mediators Increase of vascular permeability Increase of glandular secretion Inflammation Mucosal proliferation

6. 1. Role of the Eustachian Tube 1. Pressure regulation of middle ear 2. Clearance ‘Drainage’ of middle ear secretions mucociliary muscular 3. Protection from sound and secretion anatomic immunologic and mucociliairy

7. Eustachian tube Usually closed Opens during swallowing, yawning, and sneezing Opening involves cartilaginous portion Tensor veli palatini responsible for active tubal opening No constrictor function

8. Dysfunction : 1. Impairment of pressure regulation Open adenoid Tumor Inflammation Intrinsic Extrinsic Functional obstruction Obstruction Weak TVP Anatomic obstruction After Bluestone

9. Infection ET dysfunction Host respons Liberation of inflammatory mediators Increase of vascular permeability Increase of glandular secretion Inflammation Mucosal proliferation