EENT treatments Flashcards
Acute Otitis Externa-Diffuse
Ofloxacin (Floxin) otic soln or Ciprofloxacin
Cortisporin Otic soln or susp (Neomycin, Polymyxin B, Hydrocortisone)
Cipro HC or CiproDex otic soln
Acute Otitis Externa-Furunculosis
Oral Dicloxacillin or Cephalexin (Keflex)
I&D if needed
Otomycosis
Cleaning of canal
Cotrimazole 1% solution BID 10-14 days
Chronic Otitis Externa-Non infective
Topical Hydrocortisone cream/otic drops
Chronic Otitis Externa- Malignant/ Necrotizing
Aggressive glycemic control
IV and oral Antibiotics 6 - 8 weeks typically required
Antipseudomonal antibiotics: ciprofloxacin, penicillin, or cephalosporin
Ciprofloxacin 200-400mg BID 1st line
Piperacillin, Cefepime (Maxipime)
Treat until clinical improvement seen
Selected patients may be graduated to oral ciprofloxacin
Aminoglycoside or Fluoroquinolone
Ciprofloxacin 500 - 1000 mg BID
Treat until gallium (nuclear) scan is clear of inflammation (generally 6-8 weeks)
Surgical debridement
In severe, refractory cases only, not usually needed
Chronic Otitis Externa- Malignant/Necrotizing
Ciprofloxacin 200-400mg BID 1st line
Chronic Otitis Externa - Herpes Zoster Oticus
Steroids and antivirals
Prednisone and Famciclovir (Famvir) or Valacyclovir (Valtrex)
Auricle Hematoma
Within 7 days, otherwise refer
Prevents significant cosmetic deformity
Lidocaine 1%: auricle block
I&D
Irrigate pocket with NS
Compression dressing
Leave on for 7 days
Re-examine for recurrence every 24 hours for several days
Avoid NSAIDS
Antibiotic prophylaxis +/-
Perichondritis
Want to start within 5 days
Risks hospitalization and deformity
Oral or IV Ciprofloxacin
I&D
Acute Otitis Media
Initial therapy
Amoxicillin 875mg BID
Cefdinir (Omnicef) 300mg BID
Cefuroxime (Ceftin) 500mg BID
Azithromycin (Zithromax) 500 PO Day 1, then 250 QD PO on Days 2-5
Lack activity against most H. flu and ⅓ of pneumococcal isolates
If exposure to antibiotics within 30 days or recent treatment failure after 72 hours
Amoxicillin plus Clavulanate 875mg (Augmentin ES or XR) PO in divided doses BID,
Cefdinir (Omnicef) 300mg BID
Ceftriaxone (Rocephin) 1g-2g IM daily for 3 days, OR
Clindamycin 30-40 mg/kg/d PO in divided doses TID
Acute Otitis Media-Severe
IF Significant hearing loss, severe pain, fever > 102⁰F, immunocompromised, under 6 months of age and or marked TM erythema
Initial therapy or with associated bacterial conjunctivitis (Likely H. Influenza)
Augmentin ES, OR
Ceftriaxone (Rocephin)
If exposure to antibiotics within 30 days or recent treatment failure
Ceftriaxone (Rocephin), OR
Clindamycin, OR
Consider tympanocentesis
Duration of all pharmacotherapy
10 days for patients <6 years old and /or patients with severe disease, TM perforation or recurrent AOM
5 - 7 days (with consideration of observation only in previously healthy individuals with mild disease) for patients ≥6 years old
Failure to improve and/or clinical worsening in 48 - 72 hours needs re-evaluated
AOM complication- Bullous Myringitis
Same as AOM (Amoxicillin 875mg BID)
May need to cover for atypicals
Mycoplasma
Zithromax
AOM complication- Typanic Membrane Rupture
Audiogram to check hearing (repeat in 3 months)
Oral and Topical antibiotics
Oral same as AOM
Amoxicillin
Augmentin
Cefdinir
Low ototoxicity topical Ab
Ofloxacin
Ciprodex
Earplugs when swimming and bath
Auditory Eustachian Tube Dysfunction
Systemic and intranasal decongestants
Autoinflation by forced exhalation against closed nostrils
Allergies
Intranasal steroids
Avoid air travel and altitude change, underwater diving
AOM complication- Chronic Otitis Media
Topical Ab: Ofloxacin or Cipro with dexamethasone for exacerbations
Oral: Ciprofloxacin 500 mg BID X 1-6 weeks
Barotrauma
Oral decongestants taken several hours before arrival time or topical decongestant 1 hr before
Attempt autoinflation
Myringotomy
VT tubes if patient flies often and has severe symptoms
Mastoiditis
IV antibiotics 7-10 days
Empiric until culture results available
Ceftriaxane (Rocephin) 1g QD
Cefazolin (Ancef) - 0.5 - 1.5 g Q6 - 8 hr
Followed by oral antibiotics
Amoxicillin/Clavulanate acid
Cefdnir
Myringotomy
Surgical drainage of TM to allow drainage of middle ear fluid
Surgery if failure of conservative treatment: mastoidectomy and debridement of infected and necrotic bone
Cholesteatoma
Refer - surgery
Surgical marsupialization or removal
Mastoiditis
IV antibiotics 7-10 days
Empiric until culture results available
Ceftriaxane (Rocephin) 1g QD
Cefazolin (Ancef) - 0.5 - 1.5 g Q6 - 8 hr
Followed by oral antibiotics
Amoxicillin/Clavulanate acid
Cefdnir
Myringotomy
Surgical drainage of TM to allow drainage of middle ear fluid
Surgery if failure of conservative treatment: mastoidectomy and debridement of infected and necrotic bone
AOM complications- Chronic otitis media definitive management
Definitive management is surgical in most cases
TM repair may be accomplished with the temporalis muscle fascia
Successful reconstruction of the TM may be achieved in about 90% of cases
Often with elimination of infection and improvement in hearing
URI
NO ANTIBIOTICS !!!
Symptomatic
NSAIDS/Acetaminophen
Fluids
Nasal saline irrigation
Oral decongestants
Nasal decongestants - limited to a few days
Acute Bacterial Rhinosinusitis Infection
Careful observation is acceptable “treatment”
Observation is recommended for 7-10 days in uncomplicated cases for people who are immune competent with reliable follow up
Up to 70% improve within two weeks without antibiotic treatment
NSAIDS, nasal saline sprays and intranasal decongestants have shown to help with symptom reduction
Oxymetazoline 1-2 sprays q6-8h for 3 days (Afrin)
Watch for rebound congestion (rhinitis medicamentosa)
Intranasal steroids have shown benefit in reducing symptoms (Flonase)
Antibiotic treatment controversial in uncomplicated cases of ABRS
Only 5% experience shortening of symptoms
May be considered complicated when symptoms last more than 7-10 days
Or when symptoms including fever, facial pain, or swelling are severe
Immunodeficiency, complicated (spreading to other places/tissues)
Acute Bacterial Rhinosinusitis
Antibiotics if NO risk factors
Amoxicillin - Clavulanate (Augmentin) - 500 mg/125 mg PO TID or 875 mg PO BID
Adding Clavulanate improves coverage for H. flu and M. cat
Evidence stronger in children for adding Clavulanate
Macrolides, Bactrim, 2nd and 3rd generation Cephalosporins not recommended due to high rates of resistance to S. pneumo
Antibiotics IF risk factors
Amoxicillin - Clavulanate - high dose - 2 grams PO BID
Invasive Fungal Sinusitis
Surgical debridement
IV Amphotericin B
Can switch to oral Itraconazole for 3-6 months after improvement
Chronic Sinusitis
Refer to ENT
Antibiotics - culture guided, prolonged courses 3 - 4 weeks
Augmentin empirically
Clindamycin for penicillin allergic
Intranasal corticosteroids
Nasal saline irrigation
Sinus surgery
Failure of medical tx
Restoration of ventilation
Improve penetration of topical medications
Opens pathways, clears blockages
Chronic non-invasive Fungal Sinusitis
Difficult to cure
Overall survival poor, long-term survivors may have significant sinonasal complications
IV Amphotericin B initial
Switch to Itraconazole for at least 3-6 months, some possibly lifelong
Allergic Fungal Sinusitis
Endoscopic sinus surgery to remove mucin and debris, created drainage
Post-op systemic steroids mainstay
Tapering course over 3 month period
Wegener’s Granulomatosis
Steroids
Immunosuppressants (for maintenance as well)
Allergic Rhinitis
Intranasal Glucocorticoids - most effective and mainstay of treatment: persistent, moderate to severe
Allergic Rhinitis
Antihistamines - little effect on congestion–first line for mild symptoms, intermittent
1st Generation
Diphenhydramine (Benadryl), Hydroxyzine (Atarax, Vistaril), Chlorpheniramine, Brompheniramine
Side Effects
SEDATING, dry mouth, weight gain
2nd Generation: Generally first line Tx in intermittent, mild-intermittent symptoms
Generally preferred over 1st generation antihistamines d/t less sedating properties
Going to someone’s house with pets; episodic
Longer acting
Cetirizine (Zyrtec), Loratadine (Claritin)
Cetirizine is sedating in 10% of patients
Fexofenadine (Allegra), Desloratadine (Clarinex), Levocetirizine (Xyzal)
Side effects include dry mouth, antihistamine tolerance
Can “rotate” medications
Mastoiditis
IV antibiotics 7-10 days
Empiric until culture results available
Ceftriaxane (Rocephin) 1g QD
Cefazolin (Ancef) - 0.5 - 1.5 g Q6 - 8 hr
Followed by oral antibiotics
Amoxicillin/Clavulanate acid
Cefdnir
Myringotomy
Surgical drainage of TM to allow drainage of middle ear fluid
Surgery if failure of conservative treatment: mastoidectomy and debridement of infected and necrotic bone
AOM complications- Chronic otitis media definitive management
Definitive management is surgical in most cases
TM repair may be accomplished with the temporalis muscle fascia
Successful reconstruction of the TM may be achieved in about 90% of cases
Often with elimination of infection and improvement in hearing
Cholesteatoma
Refer - surgery
Surgical marsupialization or removal
Allergic Rhinitis Antihistamines and Deconestants
Antihistamines
Nasal Antihistamines
Azelastine (Astelin), Olopatadine (Patanase)
Rapid onset
Can improve nasal congestion
Decongestants
Oral
Pseudoephedrine (Sudafed)
Contraindications - narrow angle glaucoma, urinary retention, uncontrolled HTN, marked CAD or CVD, hyperthyroidism
Topical
Phenylephrine (Sudafed), Oxymetazoline (Zicam/Afrin))
Rebound vasodilation, rhinitis medicamentosa
Side Effects
Insomnia, tremor, tachycardia, hypertension
Allergic Rhinitis
Cromolyn sodium (NasalCrom): mast cell stabilizer
Topical nasal spray
Mast cell stabilizer
Prophylactic
Leukotriene antagonists
Leukotrienes - inflammatory mediators produced by mast cells, basophils, and eosinophils, that are accompanied by the production of histamines and prostaglandins
Trigger smooth muscle contraction
Montelukast (Singulair)
Used in the treatment of asthma as well
Monotherapy or in combination with antihistamines
Adverse effects
Neuropsychiatric changes - dreams, insomnia, anxiety, depression, suicidal thinking
Allergic Rhinitis Anticholingergics
Anticholinergics
Topical
Ipratropium bromide
Useful for post nasal drip and rhinorrhea
Perennial symptoms
Combined with intranasal steroids
Useful in vasomotor rhinitis
Adjunctive therapies
Nasal saline irrigation
Vasomotor Rhinitis
Intranasal steroid or antihistamine
Ipratropium
Daily nasal saline lavage
Rhinitis Medicamentosa
Discontinue use of nasal decongestant
Start intranasal corticosteroids
Nasal Polyps
Topical nasal steroids for 1 - 3 months
Short course of oral steroids
Surgical removal
If medication unsuccessful
Mastoiditis
IV antibiotics 7-10 days
Empiric until culture results available
Ceftriaxane (Rocephin) 1g QD
Cefazolin (Ancef) - 0.5 - 1.5 g Q6 - 8 hr
Followed by oral antibiotics
Amoxicillin/Clavulanate acid
Cefdnir
Myringotomy
Surgical drainage of TM to allow drainage of middle ear fluid
Surgery if failure of conservative treatment: mastoidectomy and debridement of infected and necrotic bone
Cholesteatoma
Refer - surgery
Surgical marsupialization or removal
AOM complications- Chronic otitis media definitive management
Definitive management is surgical in most cases
TM repair may be accomplished with the temporalis muscle fascia
Successful reconstruction of the TM may be achieved in about 90% of cases
Often with elimination of infection and improvement in hearing
Nasal Fractures
I&D with anterior nasal packing
Antistapylococcal oral abx
Aphthous Stomatitis
Treatment
No treatment has proven effective
Supportive treatment
Viscous lidocaine
Topical corticosteroids in an adhesive base help with symptom relief
Triamcinolone acetonide in Orabase
One week tapering course of prednisone if severe
40-60 mg/day, then taper
Magic Mouthwash
diphenhydramine, nystatin, lidocaine
diphenhydramine and mylanta
Mastoiditis
IV antibiotics 7-10 days
Empiric until culture results available
Ceftriaxane (Rocephin) 1g QD
Cefazolin (Ancef) - 0.5 - 1.5 g Q6 - 8 hr
Followed by oral antibiotics
Amoxicillin/Clavulanate acid
Cefdnir
Myringotomy
Surgical drainage of TM to allow drainage of middle ear fluid
Surgery if failure of conservative treatment: mastoidectomy and debridement of infected and necrotic bone
AOM complications- Chronic otitis media definitive management
Definitive management is surgical in most cases
TM repair may be accomplished with the temporalis muscle fascia
Successful reconstruction of the TM may be achieved in about 90% of cases
Often with elimination of infection and improvement in hearing
Cholesteatoma
Refer - surgery
Surgical marsupialization or removal
Mastoiditis
IV antibiotics 7-10 days
Empiric until culture results available
Ceftriaxane (Rocephin) 1g QD
Cefazolin (Ancef) - 0.5 - 1.5 g Q6 - 8 hr
Followed by oral antibiotics
Amoxicillin/Clavulanate acid
Cefdnir
Myringotomy
Surgical drainage of TM to allow drainage of middle ear fluid
Surgery if failure of conservative treatment: mastoidectomy and debridement of infected and necrotic bone
Cholesteatoma
Refer - surgery
Surgical marsupialization or removal
AOM complications- Chronic otitis media definitive management
Definitive management is surgical in most cases
TM repair may be accomplished with the temporalis muscle fascia
Successful reconstruction of the TM may be achieved in about 90% of cases
Often with elimination of infection and improvement in hearing
Herpes Gingivostomatitis
Antivirals effective to shorten the course if started within 24-48 hours of onset of symptoms (pain, burning, itching)
Not effective once vesicles have erupted
Acyclovir 200 – 800mg five times daily x 7-10 days
Valacyclovir (Valtrex) 1000mg BID x 7-10 days
Viscous lidocaine 2%
Antivirals also available in topical preparations
Oral Candidiasis
Nystatin 100,000 units/mL
Fluconazole (Diflucan) 100 mg
Magic mouthwash
Nystatin, lidocaine, Benadryl, Maalox or Mylanta
Angular Chelitis
Topical antifungal cream or ointment applied twice daily
Clotrimazole or Miconazole
Glossitis
If the primary cause cannot be identified, then empiric nutritional replacement therapy may be of value
Glossodynia
No specific treatment (underlying cause)
clonazepam: works on GABA receptors, have on tongue
TCA’s
Behavioral therapy
Leukoplakia
No known treatment to date that will reverse leukoplakia
Surgically remove areas of leukoplakia
Advise patients to eliminate contributory factors
Tobacco, alcohol
Follow up
Close follow up is warranted
every 3 months in first year, then yearly
Erythroplakia
If identified, refer to specialist for biopsy and treatment
Surgical excision with clear margins
Otolaryngologist, head and neck surgeon, or radiation oncologist
Advise to eliminate contributory factors
Tobacco, alcohol
Hairy Leukoplakia
Not technically needed
Highly Active Antiretroviral Therapy (HAART)
Acyclovir or Valcyclovir show modest improvement
Topical Podophyllin (cytotoxic agent)
Geographic tongue
No treatment necessary
Hairy Tongue
Improve oral hygiene
Smoking cessation
Tongue scrapers
Sialolithiasis
Local heat
Massage
Hydration
Small stone - salivary secretion first line
Sialogogues (Salagen, Evoxac)
Sour candy
If no improvement
Incise duct remove stone
Sialendoscopy
Large stone – interventional removal of duct
Suppurative Parotitis
IV antibiotics initially d/t possible spread to deep neck tissue
Nafcillin or 1st generation Cephalosporin PLUS either Metronidazole or Clindamycin
Vancomycin or Linezolid (Zyvox) if MRSA suspected
Can switch to oral antibiotics when clinical improvement
Clindamycin plus Ciprofloxacin
Or Amocicillin/Clavulanate Acid alone
Hydration
Surgical I&D if no clinical response after 48 hours of IV antibiotics
Sialadenitis: Submandibular Gland
Hydration
Warm compresses
IV Abx same as Parotid Sialadenitis
I&D if abscess formation or unresponsive to abx.
Dental Caries (fluoride use)
Fluoride Use
Oral drops, chewable tablet: Prevention of dental caries (FDA approved in ages 6 months to 16 years; consult specific product formulations for appropriate age group)
Lozenges: Prevention of dental caries (FDA approved in ages ≥ 6 years and adults)
Gel, paste, oral rinse: Prevention of dental caries (Prescription and OTC products: FDA approved in ages ≥ 6 years and adults; consult specific product formulations for appropriate age group); reduction of tooth sensitivity (Prevident 5000 sensitive: FDA approved in ages ≥ 12 years and adults)
Fluoride varnish: Treatment of hypersensitive teeth, sensitive root surfaces, and as a cavity preparation to seal dentinal tubules (Approved in ages ≥ 6 months to 5 years); has also been used for prevention of dental caries
Dental Abscess small and large
Small abscesses
PCN VK treatment of choice +/- Metronidazole
If Penicillin allergic: Clindamycin
Analgesics
Chlorhexidine mouth rinses
Large abscesses
I&D
+/- IV antibiotics
Dental referral
Gingivits
Good oral hygiene practices
Tooth brushing
Flossing
Acute Necrotizing Ulcerative Gingivitis
Debridement
Metronidazole or
Clindamycin or
Augmentin
Warm, ½ strength peroxide rinses or Chlorhexidine rinses as adjunct
Mastoiditis
IV antibiotics 7-10 days
Empiric until culture results available
Ceftriaxane (Rocephin) 1g QD
Cefazolin (Ancef) - 0.5 - 1.5 g Q6 - 8 hr
Followed by oral antibiotics
Amoxicillin/Clavulanate acid
Cefdnir
Myringotomy
Surgical drainage of TM to allow drainage of middle ear fluid
Surgery if failure of conservative treatment: mastoidectomy and debridement of infected and necrotic bone
Cholesteatoma
Refer - surgery
Surgical marsupialization or removal
AOM complications- Chronic otitis media definitive management
Definitive management is surgical in most cases
TM repair may be accomplished with the temporalis muscle fascia
Successful reconstruction of the TM may be achieved in about 90% of cases
Often with elimination of infection and improvement in hearing
Viral Pharyngitis-Influenza
Supportive care for all viruses
Fever reducers/pain relievers, magic mouthwash, cold food
Tamiflu
Within 48 hours of symptoms onset
Viral Pharyngitis-HSV
Supportive care for all viruses
Fever reducers/pain relievers, magic mouthwash, cold food
Acyclovir / Valacyclovir (Valtrex)
Viral Pharyngitis
Supportive care for all viruses
Fever reducers/pain relievers, magic mouthwash, cold food
Avoid contact sports for 4 weeks
Risk of splenic rupture
Can use oral Prednisone taper if tonsillar swelling is significant
Antivirals and Steroids not recommended in regular treatment; does not reduce duration
Group A Streptococcus
Pen VK
Pen G benzathine (Bicillin) IM as a single dose
Amoxicillin
Cephalexin (Keflex)/ Cefdinir / Cephalosporins
Penicillin allergic reaction of rash
Azithromycin / Clindamycin
Anaphylaxis reaction
Group A Strep Patient Education
Have pt change toothbrush after 24 hours
Not contagious any longer after 24 hours of treatment
Strep will “go away” on it’s own without antibiotics
However, a patient will remain contagious for 2-3 weeks after symptoms abate
Group A Strep second line
Augmentin
Erythromycin
Clindamycin
Azithromycin (Zithromax)
Retropharyngeal Abscess
Airway first
Empiric IV antibiotics
Ampicillin / Sulbactam (Unasyn) or
Ceftriaxone plus Metronidazole or
Clindamycin plus Levofloxacin
Surgical drainage of abscess with ultrasound guided needle aspiration or open drainage
Clinical improvement should be seen within 24 - 48 hours
Consider new antibiotics and / or surgery if not
Otolaryngologist consult
Continue IV treatment until afebrile and able to tolerate oral antibiotics
Metronidazole or Levofloxacin
Total of 2-3 weeks
Laryngitis
Viral
Voice rest
Hydration
Bacterial
Antibiotics
PCN
Erythromycin
Supportive care
Actors/singers
Can be given oral steroids or erythromycin to help speed up recovery for performances
Croup
Dexamethasone
Nebulized Epinephrine
Supportive care including humidified air or oxygen, antipyretics, fluid intake, nebulized saline
Oral Prednisone also an option?
Epiglottitis
Cellulitis of the supraglottis and surrounding structures
Without treatment, can progress to life-threatening airway obstruction
Results from bacteremia and or direct invasion of the epithelial layer by the pathogenic organism
The posterior nasopharynx is the primary source of pathogens in epiglottitis
Airway emergency in children
Caused by Haemophilus influenzae type B
Vaccinate!!!
Also caused by caustic ingestion, foreign body, thermal injury
Epiglottitis
Empiric IV antibiotic treatment should begin after blood and epiglottic cultures are obtained
3rd Generation Cephalosporin (Ceftriaxone) plus Vancomycin first line
3rd Generation Cephalosporin (Ceftriaxone) plus Clindamycin also accepted as first line
If anaphylaxis occurs with penicillin, can use Vancomycin plus fluoroquinolone
Most will treat for 7-10 days
Antipyretics
+ / - steroids
Ludwig’s Angina
Admit to hospital
CT with IV contrast imaging of choice
Close monitoring of airway and possible intubation
Empiric IV antibiotic
Ampicillin-sulbactam (Unasyn) alone
Ceftriaxone plus metronidazole
For penicillin allergic: Clindamycin plus levofloxacin
Obtain culture via needle aspiration if possible
May need surgical drainage
However, this is not a typical abscess, so there is usually nothing to drain initially
Tumors on Larynx
Vocal cord nodules
Voice habit modification
+/- surgical excision
Vocal cord polyps
Lifestyle change
Inhaled steroid spray
Removal
Squamous cell carcinoma
Surgery
Radiation and / or chemotherapy
Vocal cord paralysis
Maintain airway
Unilateral is occasionally temporary, may resolve spontaneously
May take at least a year
Surgery may be needed
AOM complications- Chronic otitis media definitive management
Definitive management is surgical in most cases
TM repair may be accomplished with the temporalis muscle fascia
Successful reconstruction of the TM may be achieved in about 90% of cases
Often with elimination of infection and improvement in hearing
Cholesteatoma
Refer - surgery
Surgical marsupialization or removal
Mastoiditis
IV antibiotics 7-10 days
Empiric until culture results available
Ceftriaxane (Rocephin) 1g QD
Cefazolin (Ancef) - 0.5 - 1.5 g Q6 - 8 hr
Followed by oral antibiotics
Amoxicillin/Clavulanate acid
Cefdnir
Myringotomy
Surgical drainage of TM to allow drainage of middle ear fluid
Surgery if failure of conservative treatment: mastoidectomy and debridement of infected and necrotic bone
TMJ
Joint rest
To allow muscles of mastication to relax
Reduce mandibular condyle movement
Avoid chewing gum, biting nails, excessive talking
Eat a soft diet
Reduce stress
Physical therapy
Exercises include mouth opening and closing in a straight line
Intra-oral devices
Splints, night guards, bite guards
Botox injections
Muscle relaxation
Only temporary relief
3-4 months
Mastoiditis
IV antibiotics 7-10 days
Empiric until culture results available
Ceftriaxane (Rocephin) 1g QD
Cefazolin (Ancef) - 0.5 - 1.5 g Q6 - 8 hr
Followed by oral antibiotics
Amoxicillin/Clavulanate acid
Cefdnir
Myringotomy
Surgical drainage of TM to allow drainage of middle ear fluid
Surgery if failure of conservative treatment: mastoidectomy and debridement of infected and necrotic bone
Cholesteatoma
Refer - surgery
Surgical marsupialization or removal
AOM complications- Chronic otitis media definitive management
Definitive management is surgical in most cases
TM repair may be accomplished with the temporalis muscle fascia
Successful reconstruction of the TM may be achieved in about 90% of cases
Often with elimination of infection and improvement in hearing
