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PRESENTATIONS OF MIDDLE EAR DISEASE 	 PRESENTATIONS OF MIDDLE EAR DISEASE
 

PRESENTATIONS OF MIDDLE EAR DISEASE PRESENTATIONS OF MIDDLE EAR DISEASE

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    PRESENTATIONS OF MIDDLE EAR DISEASE 	 PRESENTATIONS OF MIDDLE EAR DISEASE PRESENTATIONS OF MIDDLE EAR DISEASE PRESENTATIONS OF MIDDLE EAR DISEASE Presentation Transcript

    • PRESENTATIONS OF MIDDLE EAR DISEASE Elizabeth Rose Royal Victorian Eye and Ear Hospital Royal Children’s Hospital
    • OTITIS MEDIA A SPECTRUM OF DISEASE
      • acute otitis media
      • chronic otitis media with effusion
      • atelectasis of the tympanic membrane
      • chronic adhesive otitis media
      • chronic suppurative otitis media
        • tubotympanic (“safe”)
        • atticoantral (“unsafe”)
        • and may be a continuum of disease
    • ACUTE OTITIS MEDIA
      • the presence of a middle-ear effusion
      • signs and symptoms of infection
        • fever, irritability, pain, otorrhoea
    • Management of AOM
      • Pain relief
      • Decongestants (oral/topical) and antihistamines do not make the eustachian tube function better
      • Decongestants do relieve the symptoms of a blocked nose
    • Antibiotic therapy
      • Standard spectrum (sensitive to β -lactamase)
        • penicillin, erythromycin, ampicillins
      • Extended spectrum
        • amoxicillin/clavulanate, trimethoprim/sulfamethoxazole
    • Antibiotic therapy
      • Recommended treatment is:
      • amoxicillin 50mg/kg/day in 3 doses
        • Can give up to 100mg/kg/day
        • Continue for 5 days
      • If no improvement in 2 days change to amoxicillin/clavulanate
    • Penicillin allergy
      • trimethoprim-sulfamethoxazole
      • clindamycin
      • ceftriaxone IM, but will often need continuing oral medication
    • Antibiotic therapy
      • if severe symptoms
      • - pain
      • - perforation
      • (use topical as well, e.g. Ciprofloxacin HC iii drops tds for 3 days)
      • ≤ 2 years of age
      • immune deficiency
      • follow-up not possible
    • CHRONIC OTITIS MEDIA WITH EFFUSION
      • the presence of a middle ear effusion
      • asymptomatic apart from some hearing loss
    • CHRONIC SUPPURATIVE OTITIS MEDIA “deafness and discharge”
      • persistent disease
      • insidious onset
      • severe destruction
      • irreversible sequelae
      • 1. tubotympanic disease (“safe”)
        • central perforation
      • 2. atticoantral disease (“unsafe”)
        • cholesteatoma
        • the presence of keratinising squamous epithelium in the middle ear
    • PRESENTATIONS OF MIDDLE EAR DISEASE
    • PAIN (Otalgia)
    • DIFFERENTIAL DIAGNOSIS OF EAR PAIN
      • A. External auditory canal
      • trauma ( e.g. from cotton bud abuse)
      • auricular haematoma
      • foreign body
      • otitis externa
      • external auditory canal tumour
    • DIFFERENTIAL DIAGNOSIS OF EAR PAIN
      • B. Middle ear
        • acute otitis media
        • bullous myringitis
        • chronic suppurative otitis media
        • middle ear tumour
    • DIFFERENTIAL DIAGNOSIS OF EAR PAIN
      • C. Referred pain
        • oropharynx (IXth nerve)
          • tonsillitis/post-tonsillectomy
          • carcinoma, including posterior tongue
        • laryngopharynx (Xth nerve)
          • pyriform fossa
        • upper molar teeth, TMJ, parotid gland (Vc)
          • impacted wisdom teeth
          • changes to bite from new dentures
        • cervical spine (C 2 , C 3 )
          • pain is often worse at night
    • DISCHARGE (Otorrhoea)
    • HEARING LOSS
    • FACIAL PARALYSIS
    • HEADACHE
    • VERTIGO
    • TINNITUS
    • Chris – age 53 years
      • can hear a “washing machine" in the right ear
      • getting worse for 4 months
      • no pain
      • no hearing loss
    • NO SYMPTOMS
    • YOU ARE INVITED! 1. ENT clinic at RVEEH
    • All clinical years students
      • Every week day afternoon
      • (and some mornings)
    • Contact Rehana De Jong
      • 9929 8562
      • [email_address]
    • YOU ARE INVITED! 2. Hedley Summons Otolaryngology Prize
    • All clinical years students from University of Melbourne
      • Coming in September!
    • Take-home message 1 remember referred otalgia
    • Take-home message 2 more is missed in medicine by not looking than by not knowing