PRESENTATIONS OF MIDDLE EAR DISEASE PRESENTATIONS OF MIDDLE EAR DISEASE

5,907 views

Published on

Published in: Health & Medicine
0 Comments
11 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
5,907
On SlideShare
0
From Embeds
0
Number of Embeds
29
Actions
Shares
0
Downloads
383
Comments
0
Likes
11
Embeds 0
No embeds

No notes for slide

PRESENTATIONS OF MIDDLE EAR DISEASE PRESENTATIONS OF MIDDLE EAR DISEASE

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

×