M Esymptomshandout

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M Esymptomshandout

  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

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