41. Ear Presentations

Question 1

Outline the aetiology and pathophysiology of otitis media with effusion

Answer 1

Aetiology = chronic inflammatory changes, Eustachian tube dysfunction.

Not an actual infection, build-up of fluid and -ve pressure in middle ear, due to Eustachian tube dysfunction: can predispose to infection. Decreases mobility of TM and ossicles affecting hearing

Question 2

List the signs and symptoms of otitis media with effusion

Answer 2

Conductive hearing loss

Sensation of pressure

TM will appear dull

TM light reflex will be lost

Question 3

How should otitis media with effusion be Ix?

Answer 3

Audiometry = conductive hearing loss

Tympanometry = reduced membrane compliance

Flexible nasoendoscopy

Question 4

How should otitis media with effusion be Mx?

Answer 4

Most resolve spontaneously in 2-3 months. Some may persist - require grommets (tympanostomy tube) to ventilate middle ear

Question 5

What are the possible complications of otitis media with effusion?

Answer 5

Hearing loss

Delayed language development - in children

Recurrent acute otitis media

Question 6

How does deafness present in children?

Answer 6

• Lack of startle reflex
• Lack of head turn to sound
• Asking for things to be turned up
• Non-reactive

Question 7

Outline a DDx for deafness in children

Answer 7

• Autosomal domianant hearing loss
• Autosomal recessive hearing loss
• Genetic
• Perforated eardrum
• Otosclerosis or Meniere’s diseases (progressive)
• Infections: meningitis, measles, mumps, whooping cough.
• Taking ototoxic medications
• Serious head injury.
• Exposure to loud noise
• Birth complications