Middle Ear

Question 1

What is acute otitis media (AOM)?

Answer 1

Acute inflammation of the middle ear often caused by the spread of a throat infection through the Eustachian tube

Question 2

What causes acute otitis media (AOM)?

Answer 2

Viruses usually

Question 3

How does acute otitis media (AOM) present?

Answer 3

Usually young children

Fever

Otalgia

Red inflamed tympanic membrane

Question 4

How do you treat acute otitis media (AOM)?

Answer 4

Self limiting over 4 days
Supportive

Amoxicillin (clarithromycin) if severe

Question 5

What is otitis media with effusion (OME)?

Answer 5

Chronic inflammation of ear resulting in fluid collection in middle ear causing conductive hearing loss

Question 6

How does otitis media with effusion (OME) present?

Answer 6

Young children

Conductive hearing loss

Associated with

• Development/behavioural problems
• Balance problems

Question 7

What does otitis media with effusion (OME) show on otoscope?

Answer 7

Opaque tympanic membrane

Fluid bubbles under tympanic membrane

Question 8

What does otitis media with effusion (OME) show on audiometry?

Answer 8

Conductive hearing loss

Question 9

What does otitis media with effusion (OME) show on tympanometry?

Answer 9

Flat tympanometry (reduced tympanic mobility from fluid)

Question 10

What are some risk factors for otitis media with effusion (OME)?

Answer 10

Smoking household

Older siblings

Day care

URTI and immunodefiencey)

Genetic craniofacial abnormalities

Question 11

How is otitis media with effusion (OME) managed?

Answer 11

Wait three weeks and review (90% resolve in 3 weeks)

If persisting, surgery

Question 12

What are the indications and options for surgical management of otitis media with effusion (OME)?

Answer 12

Indicated if otitis media with effusion (OME) persisting 3 weeks after primary care assessment

If under 3
- grommets

If over 3

• grommets (first intervention)
• grommets and adenoidectomy (second intervention)

Question 13

What are grommets?

Answer 13

Plastic tubes inserted across tympanic membrane to equalise pressure

They are eventually extruded (expelled) from tympanic membrane

Question 14

What is cholesteatoma?

Answer 14

Abnormal growth of keratinising squamous epithelium (skin) in the middle of the ear

Question 15

What two types of cholesteatoma are there?

Answer 15

Congenital

Acquired (from tympanic membrane perforation)

Question 16

How does cholesteatoma present?

Answer 16

‘Cheesy’, foul smelling discharge

Conductive hearing loss

Question 17

How does cholesteatoma show on otoscopy?

Answer 17

Crust-like lesion in upper tympanic membrane

Retraction pockets (part of eardrum lying deeper than it should be)

Pearly white mass behind tympanic membrane if congenital

Question 18

How are cholesteatoma treated?

Answer 18

Surgical excision

Question 19

What organism is associated with chronic acute otitis media (AOM)?

Answer 19

Pseudomonas aeruginosa

Question 20

What is ossicular chain disruption?

What does it cause?

What can cause it?

Answer 20

Loss of normal alignment of the ossicles

Conductive hearing loss

Longitudinal temporal bone fracture

Question 21

What is otosclerosis?

What does it cause?

Answer 21

Abnormal growth of bone near middle ear

Conductive hearing loss