Otitis Externa, Media, Glue Ear ☺️

Question 1

AOM

• epidemiology, etiology
• presentation

Answer 1

Vv common in young children

• MOST COMMON - bacterial (S pneu, H inf, M catarrhalis)
• from URTI => viral

Ear pain - tugging

• fever
• hearing loss
• recent URTI symptoms
• discharge from perforation

Bulging tympanic membrane => loss of light reflex
Opaque/red TM
Perforated => discharge

Question 2

AOM

• management
• complications

Answer 2

Self limiting, supportive - fluids, analgesia

Abx - peniciliin/erythromycin

• no improvement/worse in 4days
• systemic illness
• IC/high risk
• bilateral and U2
• perforation, discharge found

Complications

• mastoiditis
• meningitis, brain abscess
• VII paralysis

Question 3

AOE

• epidemiology, etiology
• presentation

Answer 3

• MOST COMMON - P aeruginosa, S aureus
• common in swimmers, older adults

Itchy canal
Ear, tragus or pinna pain or tenderness
Discharge
Conductive hearing loss

Question 4

AOE

• management
• complications

Answer 4

Self limiting
Supportive - keep ear dry, analgesia + antibacterial otic drops

If IC, infection severe, spread beyond outer ear => ciprofloxacin

Complications

• cellulitis, pinna perichondritis/chondritis, abscess, parotitis
• COE - persistent inflammation from fungal infection
• MOE - lifethreatening progression to osteomyelitis in temporal

Question 5

Signs of MOE

• pathophysiology
• presentation
• diagnosis
• management

Answer 5

OE found in IC and diabetics => infection of soft tissues and bony ear canal => temporal bone osteomyelitis

Diabetes/IC
Severe, constant, deep ear pain
Temporal headache
Purulent discharge
Dysphagia, hoarse, VII problems

CT

Non resolving OE with increasing pain => urgent ENT
IV ABx with pseudomonas cover

Question 6

Glue ear/OM with effusion

• epidemiology, etiology
• presentation
• investigations

Answer 6

Fluid collects within middle ear without acute infection signs
-MOST COMMON AFTER AOM in young children

Conductive hearing loss, tinnitus
Mild, intermittent ear pain with fullness
Speech, language delay in children

Pneumatic otoscopy
Tympanometry - assess eardrum reaction to sound
Audiometry - assess for hearing loss

Question 7

Glue ear/OM with effusion

-management

Answer 7

Watchful waiting for 3 months

• assess for worsening hearing, delay in reaching developmental milestones
• if symptoms persist => ENT referral
• if Downs => immediate referral

Non surgical

• autoinflation - drain fluid via auditory tube with Valsalva
• hearing aids - bilateral persistant OME

Surgical
-grommet insertion into ear drum => fluid drainage. Will fall out in their own time