Otitis Media

Question 1

define

Answer 1

this is inflammation of the middle ear

Question 2

define otitis media with effusion (glue ear)

Answer 2

this is inflammation of the inner ear with fluid behind the tympanic membrane

Question 3

why does fluid in the ear need to be removed?

Answer 3

it increases in viscosity so needs to be removed due to increased risk of infection

Question 4

what is glue ear associated with?

Answer 4

URTIs (perforation heals spontaneously)

eustachian tube dysfunction/obstruction

Question 5

what conditions are associated with abnormally shaped eustachian tubes?

Answer 5

Down’s syndrome

cleft palate

Question 6

what should be considered in adults with otitis media?

Answer 6

rhinosinusitis (same mucosa so oedema)
nasopharyngeal carcinoma
lymphoma

Question 7

what increases the incidence of otitis media?

Answer 7

day care
older siblings
smoking household
recurrent URTI
allergies
not breastfed

Question 8

presentation of glue ear

Answer 8

children can present with speech delay or behavioural problems
have to shout loud due to hearing loss

Question 9

diagnosis of glue ear

Answer 9

tympanogram tests middle ear function (will be flat)
retracted drum
dull colour
radiology should be black but appears grey due to presence of fluid

Question 10

superior complications in glue ear

Answer 10

infection can erode through bone causing extradural or subdural abscess on the brain that can progress to meningitis

Question 11

medial complications in glue ear

Answer 11

sensorineural hearing loss/ tinnitus/ vertigo/ facial palsy

Question 12

posterior complications of glue ear

Answer 12

venous sinus thrombosis

Question 13

lateral complications of glue ear

Answer 13

mastoid abscess that causes ear to stick out

Question 14

management

Answer 14

remove pus (yellow > grey)
watchful waiting, review at 3 months (prolong if winter as hearing usually worse)
surgery

Question 15

when should referral of glue ear be considered?

Answer 15

persistent
bilateral OME (>3months)
CHL >25dB
speech/language problems
developmental behavioural problems

Question 16

surgical management for glue ear

Answer 16

< 3= grommets
> 3= grommets
>3 (second intervention, usually if grommets fall out)= grommets and adenoidectomy

Question 17

describe a grommet

Answer 17

this is a stent

hole is made in the eardrum and fluid removed before the grommet is attached

Question 18

complications of grommets

Answer 18

infection= weak blood supply so poor healing
early extrusion
retention= held onto/ fell into middle ear
persistent perforation= hole made does not close
swimming/bathing issues

Question 19

what are swimming/bathing issues with grommets

Answer 19

hearing loss

dizzy if water enters the middle ear as cannot distinguish which way is up (drowning- earplugs as management)