Me Symptoms Handout

8/7/2019 Me Symptoms Handout

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PRESENTATIONS OF

MIDDLE EAR DISEASE

Elizabeth Rose

Royal Victorian Eye and Ear Hospital

Royal Childrens Hospital


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A look and learn lecture Middle-ear conditions

M

anagement of otitis media Differential diagnosis of ear pain

Clinical cases

An invitation! (Or Two!)


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OTITIS MEDIAA 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


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ACUTE OTITIS MEDIA

(AOM) the presence of a middle-ear

effusion

signs and symptoms ofinfection

fever, irritability, pain,

otorrhoea


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Management of

AO

M

Pain relief

Decongestants (oral/topical) and

antihistamines

do notmake the eustachian tube function

better

do relieve the symptoms of a blocked nose


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Antibiotic therapy

ifsevere symptoms

- pain

- perforation 2 years of age

immune deficiency

cochlear implant follow-up not possible


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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


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Penicillin allergy

trimethoprim-sulfamethoxazole

clindamycin

ceftriaxone IM, but will often need

continuing oral medication


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Antibiotic therapy

older children who can be accurate about

their symptoms should be treatedsymptomatically

if no improvement after 2 days consider

treatment with antibiotics


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CHRONIC OTITIS MEDIA

WITH EFFUSION(COME)

the presence of a

middle ear effusion

asymptomatic apart

from some hearing loss


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CHRONIC SUPPURATIVE

OTITIS MEDIA

(CSOM)deafness and discharge

persistent disease insidious onset

severe destruction

irreversible sequelae


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1. tubotympanic disease (safe)

central perforation

2. atticoantral disease (unsafe)

cholesteatomathe presence of keratinising squamous

epithelium in the middle ear


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MANAGEMENT OF CHRONIC

OTITIS MEDIA WITH EFFUSION

(and also retraction/atelectasisof the tympanic membrane)


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AKA

grommets

tubes

pressure equalisation tubes

middle ear ventilation tubes


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COME

Who should have

middle ear

ventilation tubes?


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1. COME for4 months at

least, with hearing loss2. COME in a child at risk

regardless of the hearing

3. COM

E and structuraldamage to the tympanic

membrane


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1. Hearing loss median hearing loss is mild but there

is a wide range

no data on the criteria for what is

a significant hearing loss


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50% of childrenwith persistent

OME have hearingthresholds at

20 dB


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20% of children

with persistentOME have hearingthresholds at>35 dB


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2. An at risk child has anincreased risk of developmentaldifficulties due to:

physicalsensory

cognitive

behaviouralfactors not related to the OME


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Suspected or diagnosed speech and

language delay or disorder

Autism-spectrum disorder and other

pervasive developmental disorders

Blindness or uncorrectable visual

impairment

At risk


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Management of the at risk child

may include: speech and language therapy

along with management of the

OME

hearing aids for hearing loss

independent of the OME


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Children with persistent OME

who:

are not at risk

do not have significant hearing

loss do not have structural

abnormalities of the eardrum or

middle ear

should be examined every three

months


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PRESENTATIONS

OF MIDDLE EAR

DISEASE


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PAIN(Otalgia)


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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


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DIFFERENTIAL DIAGNOSIS OF

EAR PAIN

B. Middle ear

acute otitis media

bullous myringitis

chronic suppurative otitis media

middle ear tumour


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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 (C2, C3)

pain is often worse at night


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DISCHARGE(Otorrhoea)


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HEARING

LOSS


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FACIAL PARALYSIS


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HEADACHE


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VERTIGO


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TINNITUS


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NO

SYMPTOMS


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YOU ARE INVITED!

1. ENT clinics atRVEEH


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All clinical years students

Every week day

afternoon(and some mornings)


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ContactRehana De Jong

9929 8666

[email protected]


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YOU ARE INVITED!

2. Hedley SummonsOtolaryngology Prize


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All clinical years students

from University of

Melbourne

Coming in

September!


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Take-home message 1

remember referred otalgia


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Take-home message 2more is missed in medicine by not

looking than by not knowing


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ENT clinic

Fifth Floor

Outpatients

9929 8666

[email protected]

Documents

Me Symptoms Handout