AOM and Cholesteatoma

Question 1

AOM

Answer 1

inflammation of the middle ear accompanied by the symptoms and signs of acute inflammation with/out an accumulation of fluid

Question 2

who is predominantly affected by AOM

Answer 2

infants and children

Question 3

how does infection often spread to middle ear

Answer 3

from URT by Eustachian tube

Question 4

clinical presentation

Answer 4

rapid onset earache, fever ± irritability, vomiting after viral URT infection

conductive hearing loss

Question 5

what can happen to the tympanic membrane

Answer 5

it becomes opaque

can bulge or have impaired mobility (hearing loss?)

• Drum bulging causes pain
• Rupture of tympanic membrane is usually followed by rapid relief of pain and fever, and blood, purulent otorrhoea - mucus

Question 6

aetiology

Answer 6

often viral with 2y bacterial infection

• Strep. Pneumoniae, H. influenzae, Strep. Pyogenes, Moraxella

Question 7

what is the most common bacterial cause of AOM

Answer 7

H influenza

Question 8

diagnosis

Answer 8

clinical diagnosis

swab of pus if the drum has perforated

Question 9

treatment

Answer 9

80% resolve in 4 days without ABx

give ABx immediately to those who are systemically unwell but dont require admission or those who are at risk of serious complications

• amoxicillin (1), erythromycin (2)

analgesia

Question 10

complications of AOM

Answer 10

can spread to the mastoid area causing mastoidits - destruction of air cells in the mastoid ± abscess formation

Question 11

presentation of mastoiditis

Answer 11

• Presents with severe otalgia, classically behind ear
• Patient is typically very unwell
• Swelling, erythema and tenderness over mastoid process

Question 12

what is a common infectant of chronic OM

Answer 12

pseudomonas

Question 13

chronic OM

Answer 13

inflammation with middle ear fluid of several months duration

associated with chronic perforation of tympanic membrane

there are 2 types - squamous (cholesteatoma) and mucosal

Question 14

what is the most common symptom of both types of COM

Answer 14

chronic ear discharge with a strong odour

Question 15

mucosal COM

define active and inactive

Answer 15

• Results from a perforation in the TM, allowing the middle ear to become chronically infected
• Perforation discharging – active COM, dry perforation – inactive COM

Question 16

cholesteatoma

Answer 16

active squamous chronic otitis media and perforated tympanic membrane (acquired) results in abnormally situated keratinised squamous epithelium

neither cholesterol nor a tumour, locally destructive around the pars flaccida

Question 17

peak age for cholesteatoma

Answer 17

5-15 years

Question 18

pathology of cholesteatoma

Answer 18

The middle ear is normally lined by cuboidal/columnar glandular epithelium, here there is abnormally situated keratinised squamous epithelium. There is a high cell turnover and abundant keratin production with associated inflammation

Question 19

clinical features of cholesteatoma

Answer 19

• Foul discharge ± deafness (conductive), headache, pain,
• ‘Cottage cheese’ mucopus

Question 20

what are the serious rare complications of cholesteatoma

Answer 20

• meningitis/cerebral abscess
• can locally erode structures eg CNVII (facial nerve palsy), inner ear (vertigo) and temporal bone

Question 21

congenital cholesteatoma

Answer 21

the congenital form occurs behind an intact, normal-appearing tympanic membrane

Question 22

which criteria is used to define congenital cholesteatoma

Answer 22

Derlacki:

• The patient should not have previous episodes of middle ear disease
• Ear drum must be intact and normal
• Incidental finding
• If there is discharge and ear drum perforation, this must be from erosion by the congenital cholesteatoma

Question 23

what is the preferred imaging method for the middle ear

Answer 23

diffusion weighted MRI