Otitis media

Question 1

What are the features of acute otitis media?

Answer 1

Otalgia
Hearing loss
Children may tug at ear
Fever
Unwell
Recent viral URTI symptoms are common

Otoscopy:
Erythematous, bulging TM
Perforated TM +/- discharge

Question 2

What are the 4 types of chronic otitis media?

Answer 2

Active mucosal = occurs when tympanic membrane is perforated which allows infection to develop in middle ear
Inactive mucosal = dry perforation
Active squamous = results from cholesteatoma
Inactive squamous = shallow self-cleaning retracted tympanic membrane

Question 3

What is otitis media with effusion? How is it treated?

Answer 3

Inflammation of middle ear with an effusion
Not infection but this can occur after
Causes conductive hearing loss, tinnitus and otalgia
Occurs due to blocked Eustachian tube from inflammation/swelling, creating -ve pressure that draws fluid into middle ear and stopping ossicles from moving freely

Treatment:
Self-limiting
Grommets help to bring ear into middle ear to improve hearing

Question 4

What is the management for otitis media?

Answer 4

Self-limiting
Water precaution
Microsuction

Abx used if :
Symptoms last more than 4 days
Systemically unwell
Immunocompromised or high risk of complications
Younger than 2 with bilateral otitis media
Otitis media with perforation

1st line abx = co-amoxiclav
2nd line if penicillin allergy = erythromycin or clarithromycin

If medical management fails and TM does not repair, then surgery with myringoplasty

Question 5

What are the complications of otitis media?

Answer 5

Mastoiditis
Meningitis
Brain abscess
Facial nerve paralysis
Vertigo
Hearing loss

Question 6

What is the treatment of cholesteatoma?

Answer 6

Topical abx/steroid drops if infection
Microsuction
Audiogram - to assess hearing
Mastoidectomy - to remove cholesteatoma and reconstruct ossicles and TM

Question 7

What are the features of a cholseteatoma?

Answer 7

Foul smelling, non-resolving discharge
Hearing loss

Otoscopy:
Attic crust

Question 8

What are the features of mastoiditis?

Answer 8

Otalgia usually pain behind ear
Hx of recurrent otitis media
Fever
Very unwell
Swelling, erythema and pain over mastoid process
Discharge from ear if ear is perforated