PRESENTATIONS OF MIDDLE EAR DISEASE PRESENTATIONS OF MIDDLE EAR DISEASE
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Transcript of PRESENTATIONS OF MIDDLE EAR DISEASE PRESENTATIONS OF MIDDLE EAR DISEASE
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PRESENTATIONS OF MIDDLE EAR DISEASE
Elizabeth Rose
Royal Victorian Eye and Ear Hospital
Royal Children’s Hospital
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OTITIS MEDIAA SPECTRUM OF DISEASE
• acute otitis media• chronic otitis media with effusion• atelectasis of the tympanic membrane• chronic adhesive otitis media• chronic suppurative otitis media
– tubotympanic (“safe”)– atticoantral (“unsafe”)
and may be a continuum of disease
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ACUTE OTITIS MEDIA
• the presence of a middle-ear effusion
• signs and symptoms of infection– fever, irritability, pain,
otorrhoea
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Management of AOM
• Pain relief
• Decongestants (oral/topical) and antihistamines do not make the eustachian tube function better
• Decongestants do relieve the symptoms of a blocked nose
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Antibiotic therapy
• Standard spectrum (sensitive to β-lactamase)– penicillin, erythromycin, ampicillins
• Extended spectrum– amoxicillin/clavulanate,
trimethoprim/sulfamethoxazole
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Antibiotic therapy
• Recommended treatment is:
amoxicillin 50mg/kg/day in 3 doses– Can give up to 100mg/kg/day– Continue for 5 days
• If no improvement in 2 days change to amoxicillin/clavulanate
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Penicillin allergy
• trimethoprim-sulfamethoxazole
• clindamycin
• ceftriaxone IM, but will often need continuing oral medication
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Antibiotic therapy• if severe symptoms
- pain - perforation
(use topical as well, e.g. Ciprofloxacin HC iii drops tds for 3 days)
• ≤ 2 years of age• immune deficiency• follow-up not possible
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CHRONIC OTITIS MEDIA WITH EFFUSION
• the presence of a middle ear effusion
• asymptomatic apart from some hearing loss
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CHRONIC SUPPURATIVE OTITIS MEDIA
“deafness and discharge”
• persistent disease
• insidious onset
• severe destruction
• irreversible sequelae
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1. tubotympanic disease (“safe”)
central perforation
2. atticoantral disease (“unsafe”)
cholesteatomathe presence of keratinising squamous
epithelium in the middle ear
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PRESENTATIONS OF MIDDLE EAR
DISEASE
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PAIN(Otalgia)
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DIFFERENTIAL DIAGNOSIS OF EAR PAIN
A. External auditory canal
• trauma ( e.g. from cotton bud abuse)
• auricular haematoma
• foreign body
• otitis externa
• external auditory canal tumour
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DIFFERENTIAL DIAGNOSIS OF EAR PAIN
B. Middle ear
• acute otitis media
• bullous myringitis
• chronic suppurative otitis media
• middle ear tumour
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DIFFERENTIAL DIAGNOSIS OF EAR PAIN
C. Referred pain– oropharynx (IXth nerve)
• tonsillitis/post-tonsillectomy• carcinoma, including posterior tongue
– laryngopharynx (Xth nerve)• pyriform fossa
– upper molar teeth, TMJ, parotid gland (Vc)• impacted wisdom teeth• changes to bite from new dentures
– cervical spine (C2, C3)• pain is often worse at night
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DISCHARGE(Otorrhoea)
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HEARING LOSS
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FACIAL PARALYSIS
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HEADACHE
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VERTIGO
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TINNITUS
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Chris – age 53 years
• can hear a “washing machine" in the right ear
• getting worse for 4 months
• no pain
• no hearing loss
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NO SYMPTOMS
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YOU ARE INVITED!
1. ENT clinic at RVEEH
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All clinical years students
Every week day afternoon
(and some mornings)
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YOU ARE INVITED!
2. Hedley Summons Otolaryngology Prize
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All clinical years students from University of
Melbourne
Coming in September!
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Take-home message 1remember referred otalgia
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Take-home message 2more is missed in medicine by not
looking than by not knowing