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
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
ACUTE OTITIS MEDIA
• the presence of a middle-ear effusion
• signs and symptoms of infection– fever, irritability, pain,
otorrhoea
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
Antibiotic therapy
• Standard spectrum (sensitive to β-lactamase)– penicillin, erythromycin, ampicillins
• Extended spectrum– amoxicillin/clavulanate,
trimethoprim/sulfamethoxazole
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
Penicillin allergy
• trimethoprim-sulfamethoxazole
• clindamycin
• ceftriaxone IM, but will often need continuing oral medication
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
CHRONIC OTITIS MEDIA WITH EFFUSION
• the presence of a middle ear effusion
• asymptomatic apart from some hearing loss
CHRONIC SUPPURATIVE OTITIS MEDIA
“deafness and discharge”
• persistent disease
• insidious onset
• severe destruction
• irreversible sequelae
1. tubotympanic disease (“safe”)
central perforation
2. atticoantral disease (“unsafe”)
cholesteatomathe presence of keratinising squamous
epithelium in the middle ear
PRESENTATIONS OF MIDDLE EAR
DISEASE
PAIN(Otalgia)
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
DIFFERENTIAL DIAGNOSIS OF EAR PAIN
B. Middle ear
• acute otitis media
• bullous myringitis
• chronic suppurative otitis media
• middle ear tumour
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
DISCHARGE(Otorrhoea)
HEARING LOSS
FACIAL PARALYSIS
HEADACHE
VERTIGO
TINNITUS
Chris – age 53 years
• can hear a “washing machine" in the right ear
• getting worse for 4 months
• no pain
• no hearing loss
NO SYMPTOMS
YOU ARE INVITED!
1. ENT clinic at RVEEH
All clinical years students
Every week day afternoon
(and some mornings)
YOU ARE INVITED!
2. Hedley Summons Otolaryngology Prize
All clinical years students from University of
Melbourne
Coming in September!
Take-home message 1remember referred otalgia
Take-home message 2more is missed in medicine by not
looking than by not knowing