M Esymptomshandout
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M Esymptomshandout

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M Esymptomshandout M Esymptomshandout 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