Case 4 - Otitis Media

Question 1

what are the subtypes of middle ear infection and inflammation (otitis media)

Answer 1

• acute otitis media
• otitis media with effusion
• chronic suppurate ottis media

Question 2

what is otitis media with effusion

Answer 2

• glue ear - refers to chronic inflammation of the middle ear with collection of fluid in the Eustachian tube

Question 3

what is the most common cause of hearing problems in childhood

Answer 3

otitis media with effusion

Question 4

what is OME typically a complication of

Answer 4

acute otitis media

Question 5

what is the most disabling type of OM

Answer 5

chronic suppurate otitis media

Question 6

what is acute otitis media

Answer 6

cause is usually viral e.g rhinovirus, adenovirus, enterovirus and RSV

Question 7

what does acute otitis media usually present with

Answer 7

deep ear pain and sensation of blocked ear

Question 8

what is chronic suppurative otitis media

Answer 8

chronic disorder with persistent rupture of the tympanic membrane and subsequent otorrhoea - ear discharge

Question 9

at what ages is OME common

Answer 9

between 1 and 6
- prevalence at aged 2 is 20%

Question 10

percentage of children who will have at least one episode by age 10

Answer 10

80%

Question 11

what is the aetiology of OME

Answer 11

• usually in winter
• chronic conolonisation of adenoids
• cleft palate
• male
• frequency URTI
• smoker or patents who smoke
• allergic rhinitis
• chronic sinusitis

Question 12

what is the presentation of OME in children

Answer 12

• hearing loss: reduced communication, TV too loud and asks things to be repeated frequently
• ear pain
• balance problems
• bilateral

Question 13

presentation of OME in adults

Answer 13

• usually unilateral
• hearing loss
• sensation of fullness in the ear
• popping sounds, tinnitus
• ear pain
• balance problems

Question 14

what are the examination findings:

Answer 14

• opaque ear drum
• loss of light reflex
• Indrawn or retracted tympanic membrane - rarely can be bulging
• bubbles in fluid behind the tympanic membrane - fluid level visible behind tympanic membrane

Question 15

what would a hearing test show

Answer 15

a mild conductive hearing loss

Question 16

what is a significant hearing loss

Answer 16

> 25dB hearing loss
- a 30dB hearing loss reduces conversational speech to the equivalent of a quiet whisper

Question 17

what investigation would show an immobile eardrum

Answer 17

pneumatic tympanogram

Question 18

what is the prognosis of OME

Answer 18

spontaneously resolves in more cases: up to 90% by 12 weeks

Question 19

what percentage of children will have a recurrent case

Answer 19

30%

Question 20

percentage of children who will have complete resolution in one year

Answer 20

90%

Question 21

have medical treatments any proven benefits for OME

Answer 21

no, they are not recommended and this includes antibiotics, antihistamines and decongestants

Question 22

when do you refer to ENT for assessment

Answer 22

if remain symptomatic at 3 months, or has reduced hearing at 3 months for consideration of grommets

Question 23

when is surgical management indicated

Answer 23

• persistent bilateral OME lasting more than 3 months
• hearing loss of greater than 25 dB in the best ear
• language, education or social developmental delay

Question 24

what are grommets

Answer 24

• first line surgical treatments
• small, plastic ventilation tubes, placed into the tympanic membrane which allow fluid to drain into the external ear canal
• proven to improve hearing loss

Question 25

what is there a risk of with grommets

Answer 25

tympanosclerosis

Question 26

what surgery is recommended if frequent URTI’s are implicated

Answer 26

adeniodectomy

Question 27

what is laser myringotomy

Answer 27

• an incision made by laser into the tympanic membrane
• doesn’t require anaesthetic and is painless
• allows fluid to drain from middle ear

Question 28

disadvantage of laser myringotomy

Answer 28

hole heals up within 3-4 weeks - which is not long enough to allow for clearance of OME. rarely used.