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)

ContactRehana De Jong

9929 8562

RehanaDeJong@eyeandear.org.au

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