Otitis Media Flashcards
What does otitis externa discharge look like?
Scanty discharge as there’re no mutinous glands
Blood can result from trauma to the canal
Liquid wax can sometimes leak out
What does middle ear disease discharge look like?
Mucous discharges are almost always middle ear disease
Serosanguinous discharge suggests a granular mucosa of chronic otitis media
An offensive discharge suggests cholestatoma
How can you test if nasal discharge is CSF?
Halo sign on filter paper
Raised glucose
B2 transferris is present
Describe the presentation of acute OM.
Rapid onset of pain, fever, irritability
Anorexia, vomiting often after viral URTI
What are common causative organisms of OM?
Pnumococcus
Haemorphilus
Moraxella
Also other streps/staphs
What causes pain in acute OM?
Bulging of the tympanic membrane causes pain which eases if the drum perforates
What is management in acute otitis media?
Optimise analgesia
Acute OM resolves in 60% without abx
Antibiotics if required (symptoms over 4 days)
Appropriate oral or topical antibiotics according to swab reutls
Clean EAC to remove infected material from meatus
When should antibiotics be prescribed immediately?
Symptoms lasting more than 4 days Systemically unwell Immunocompromised < 2 years old with bilateral OM Perforation and/or discharge in the canal
What is antibiotic treatment for acute OM?
Amoxicillin for 5 days
erythromycin or clarithromycin if penicillin allergic
What are complications of acute OM?
Mastoiditis Petrositis Labyrinthitis Facial palsy Meningitis Intracrnail anscess
What is OME?
Occurs when an effusion is present after regression of the symptoms of OM.
What is chronic otitis media? Symptoms?
Benign?
Chronic serous OM?
Chronic suppurative OM?
Ear with a tympanic membrane perforation in the setting of recurrent or chronic infections.
- Hearing loss, otorrhoea, fullness, otalgia
Benign = dry tympanic membrane perforation without active infection
Chronic serous OM = continuous serous drainage - straw coloured
Chronic suppurative OM = persistent purulent drainage through a perforated tympanic membrane
What is management for chronic OM?
Topical/systemic antibiotics based on swab results
Aural cleaning
Water precautions
Careful follow-up
Surgery may be required - myringoplasy or mastoidectomy
What are complications of chronic OM?
Prolonged low middle ear pressure allows for development of retraction pocket of the pars tense or falcida.
As this enlarges, squamous epithelium builds up and can no longer escape from the neck of the sac, resulting in cholesteatoma
What is cholesteatoma? Main features?
Squamous epithelium that is trapped within the skull base causing local destruction.
10-20 years old
Note: not cholesterol nor a tumour - it is locally destructive around and beyond the pars flaccid
Foul smelling discharge
Hearing loss
Headache
Pain
Facial pralysis
Vertigo
Attic crust seen in uppermost part of eardrum
What is management of cholesteatoma?
Mastoid surgery is needed to make a safe dry ear by removing disease
What is mastoiditis? Features?
Middle ear inflammation leads to destruction of air cells in mastoid bone ± abscess formation.
Otalgia: severe, behind ear History of recurrent otitis media Fever Swelling, erythema, tenderness, over mastoid process External ear may protrude forward
What is management of mastoiditis?
CT
Admit for IV ab
Myringotomy ± definitive mastoidectomy
What are risk factors for otitis media?
URTI - autumn/winter Bottle feeding Passive smoking Dummy Presence of adenoids Asthma Malformations GORD
What is myringoplasty?
Repair of the tympanic membrane alone
Perforation in TM is patched using a graft
Acts as a scaffold for the tympanic membrane to grow across
What is mastoidectomy?
For its with mastoiditis or advanced cholesteatoma
Mastoid surgery and tympanoplasty - surgical repair of tympanic membrane and ossicles - is used to eradicate the source of chronic infection, excise the cholesteatoma and reconstruct the hearing mechanism.Removal or mastoid air cells.
What are causes of perforated tympanic membrane?
Infection
Barotrauma
Direct trauma
What is management for perforated tympanic membrane?
No treatment is needed in the majority of cases as the tympanic membrane will usually heal after 6-8 weeks.
It is advisable to avoid getting water in the ear during this time.
It is common practice to prescribe antibiotics to perforations which occur following an episode of acute otitis media.
Myringoplasty may be performed if the tympanic membrane does not heal by itself
