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ENT: Acute Otitis Media, Otitis Media with Effusion, and Otitis Externa
Fichas del conjunto (16)
- 1What is AOM, who are particularly predisposed to it, & why?* Inflammation of the middle ear
* Most common infxn in children (90% will have had 1 or more infxn's by 2 YO)
* Children have shorter, more horizontal Eustachian tube allowing easier spread of infxn from nose/pharynx
ENTAAG p23. - 2What is a typical presentation of AOM & what are the S & Sx?* Often preceded by viral URTI
* Otalgia
* Fever
* Deafness
* Otorrhoea
* Mastoid may be tender & swollen
* Children may be fractious, awake at night
* OE - bulging tympanic membrane
ENTAAG p23. - 3—Otitis media - note bulging tympanic membrane that obscures structures of middle ear.
- 4Complications, Rx, & Mx of AOM.* Complications - infxn may become chronic; spread to mastoid (mastoiditis), inner ear, facial nerve (facial palsy),or brain; sensorineural hearing loss (caused by toxins); vertigo; perforation of tympanic membrane.
* Rx & Mx:
> Analgesia
> ABx's - eg co-amoxiclav PO
> When infxn has cleared always recheck tympanic membrane
* If recurrent infxn (>5 infxn in 6/12) consider grommets or prolonged ABx course
ENTAAG p23 & OHOENTS p94. - 5What is otitis media with effusion (OME) & what is it commonly known as?The persistence of fluid in the middle ear for >3/12. Caused by exposure to infxn & non-functioning Eustachian tube. V common in children. AKA glue ear. Don't confuse with chronic suppurative otitis media - chronic middle infxn with perforated tympanic membrane.
OHOENTS p97 & ENTAAG p27. - 6S & Sx of OME.* Decreased hearing
* Recurrent ear infxn's
* Poor speech development
* Failing performance at school
* Antisocial behaviour
What otoscopic sign is shown on the next card?
OHOENTS p97. - 7—Retracted tympanic membrane.
- 8What is the Mx & Rx of OME?* Initially wait & see - most cases resolve within a few months. Use good communication skills eg facing the child when talking, getting their attention before speaking, etc
* If OME persists:
> Hearing aid - consider social implications for a child
> Insertion of grommets
OHOENTS p97 & ENTAAG p27. - 9—Cholesteatoma.
- 10What is cholesteatoma & what are the complications?Squamous epithelium from the external ear migrates into the middle ear and collects as a mass. Can become erosive eating into bone & soft tissue - serious condition!
Complications:
* Progressive hearing loss
* Acute mastoiditis
* Labyrinthitis
* Facial palsy
* Meningitis
* Intracranial abscesses
* Venous sinus thrombosis
ENTAAG p25. - 11S & Sx of cholesteatoma.Suspect if perforated tympanic membrane with:
* Persistent smelly discharge
* No improvement with drops
* Severe hearing loss
* Dizziness
* Unexplained neurological S & Sx
ENTAAG p25. - 12Mx & Rx of cholesteatoma.Suspected cholesteatoma needs referral to ENT surgeons. Initial Rx:
* Aural toilet
* Microscopy & suction
* Topical ABx/steroid (eg Sofradex) drops for 10/7
* Review @ 1/12
* Audiometry
* CT scan of temporal bone
If DS is established Sx is likely to be required.
OHOENTS p100. - 13What is otitis externa & what are some risk factors?Inflammation/infxn of the skin of the external auditory canal. May be caused by trauma (eg from cotton bud cleaning, foreign body) becoming infected (commonly Pseudomonas & Staphylococcus spp).
Risk factors:
* Swimmers & surfers
* Daily hairwashers
* Diabetics
* People with skin conditions eg psoriasis, eczema
ENTAAG p21 & OHOENTS p82. - 14S & Sx of otitis externa & Rx.S & Sx:
* P
* Itching
* May be discharge
Rx:
* Cleaning of ear canal eg suctioning
* Keeping ear dry
* ABx/steroid drops
ENTAAG p21. - 15What is malignant/necrotising otitis externa & how does it present?Progressive osteomylitis of the temporal bone resulting from otitis externa. Those compromised immunity are at risk (eg poorly controlled DM). Pt's CO severe, deep seated P unresponsive to analgesia. ^Risk of morbidity if untreated.
ENTAAG p21. - 16Rx of malignant/necrotising otitis externa.* Regular aural toilet
* Systemic & topical ABx's
* Surgical debridement
ENTAAG p21.
Información
- Descripción
- SGUL LOB's for ENT: Acute Otitis Media, Otitis Media With Effusion, and Otitis Externa.
- Creado por
- Andrew Street
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