Otitis Media and Meniere Disease

Question 1

What is otitis media?

Answer 1

• Inflammation of the middle ear
• Can be Acute (AOM), OM with effusion (OME) or Chronic

Question 2

What is acute OM?

Answer 2

• Abrupt onset
• Has effusion (liquid in ear, may have pus if bacterial)
  ~ Strep. pneumoniae
  ~ H. influenzae
  ~ Moraxella catarrhalis
  ~ Rhinovirus
  ~ Respiratory syncytial virus (RSV)

Question 3

What are the clinical features of AOM?

Answer 3

• Otalgia (ear pain)
• Hearing loss (conductive)
• Fever

Question 4

Assessment of AOM?

Answer 4

• Otoscopic examination
• Presence of effusion in ear
• Fullness/bulging of tympanic membrane (may have erythema)
• Limited mobility of the tympanic membrane
  ~ TM should move when blowing through the mouth
• Tympanogram (probe detects how ear responds to changes in air pressure)
• Acoustic reflectometry

Question 5

How to manage AOM?

Answer 5

• Pain management
• Myringotomy (cut TM to release pressure)
• Antibiotics

Question 6

What is OM with effusion?

Answer 6

• No s/s of acute infx
• Fluid still present but Eustachian tube is still blocked

Question 7

What is chronic OM?

Answer 7

• Inflammation lasting more than 12 weeks
• Irreversible damage
  ~ Perforation of the tympanic membrane
  ~ Calcification of ossicles (small bones of ear)
  ~ Cholesteatoma (hardening of tympanic membrane)
  ~ Purulent drainage
• Conductive hearing loss present
• Pain is rarely present

Question 8

What are the bones that make up the ossicles?

Answer 8

• Malleus
• Incus
• Stapes

Question 9

Conductive vs sensorineural hearing loss?

Answer 9

Conductive:
- Affects middle ear
- Poor sound transmission to inner ear

Sensorineural:
- Affects inner ear and auditory nerve
- Affected sound transmission to brain

Question 10

What are the risk factors for OM?

Answer 10

• Pre-school children
  ~ Eustachian tube is more horizontal -> easier for bacteria to travel into
• Dysfunction of eustachian tube
• Premature birth, male, family hx, orofacial abnormalities

Question 11

What is Meniere’s disease?

Answer 11

• Excessive accumulation of endolymph in the membranous labyrinth
• Vol ^ with distention of scala media until membrane ruptures
• Neural end organs of the cochlea degenerate

Question 12

Symptoms of Meniere’s disease?

Answer 12

• Tinnitus
• Fluctuating hearing loss
• Severe vertigo
• Progressive sensorineural hearing loss
• Vertigo may improve as hearing impairment worsens