presentations of middle ear disease
Download
Skip this Video
Download Presentation
PRESENTATIONS OF MIDDLE EAR DISEASE

Loading in 2 Seconds...

play fullscreen
1 / 43

PRESENTATIONS OF MIDDLE EAR DISEASE - PowerPoint PPT Presentation


  • 1023 Views
  • Uploaded on

PRESENTATIONS OF MIDDLE EAR DISEASE. Elizabeth Rose Royal Victorian Eye and Ear Hospital Royal Children’s Hospital. A “look and learn” lecture. Middle-ear conditions Management of otitis media Differential diagnosis of ear pain Clinical cases An invitation! (Or Two!).

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'PRESENTATIONS OF MIDDLE EAR DISEASE' - Antony


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
presentations of middle ear disease

PRESENTATIONS OF MIDDLE EAR DISEASE

Elizabeth Rose

Royal Victorian Eye and Ear Hospital

Royal Children’s Hospital

a look and learn lecture
A “look and learn” lecture
  • Middle-ear conditions
  • Management of otitis media
  • Differential diagnosis of ear pain
  • Clinical cases
  • An invitation! (Or Two!)
otitis media a spectrum of disease
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 acontinuumof disease

acute otitis media aom
ACUTE OTITIS MEDIA(AOM)
  • the presence of a middle-ear effusion
  • signs and symptoms of infection
    • fever, irritability, pain, otorrhoea
management of aom
Management of AOM
  • Pain relief

Decongestants (oral/topical) and antihistamines

    • do not make the eustachian tube function better
    • do relieve the symptoms of a blocked nose
antibiotic therapy
Antibiotic therapy
  • if severe symptoms

- pain

- perforation

  • ≤ 2years of age
  • immune deficiency
  • cochlear implant
  • follow-up not possible
antibiotic therapy7
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
Penicillin allergy
  • trimethoprim-sulfamethoxazole
  • clindamycin
  • ceftriaxone IM, but will often need continuing oral medication
antibiotic therapy9
Antibiotic therapy
  • older children who can be accurate about their symptoms should be treated symptomatically
  • if no improvement after 2 days consider treatment with antibiotics
chronic otitis media with effusion come
CHRONIC OTITIS MEDIA WITH EFFUSION(COME)
  • the presence of a middle ear effusion
  • asymptomatic apart from some hearing loss
chronic suppurative otitis media csom deafness and discharge
CHRONIC SUPPURATIVE OTITIS MEDIA(CSOM)“deafness and discharge”
  • persistent disease
  • insidious onset
  • severe destruction
  • irreversible sequelae
slide12
1. tubotympanic disease(“safe”)

central perforation

2. atticoantral disease(“unsafe”)

cholesteatoma

the presence of keratinising squamous epithelium in the middle ear

slide13
MANAGEMENT OF CHRONICOTITIS MEDIA WITH EFFUSION(and also retraction/atelectasis of the tympanic membrane)
slide14
AKA
  • grommets
  • tubes
  • pressure equalisation tubes
  • middle ear ventilation tubes
slide15
COME

Who should have middle ear ventilation tubes?

slide16
1. COME for 4 months at least, with hearing loss

2. COME in a child ‘at risk’ regardless of the hearing

3. COME and structural damage to the tympanic membrane

1 hearing loss
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
slide20
2. An ‘at risk’ child has an increased risk of developmental difficulties due to:

physical

sensory

cognitive

behavioural

factors not related to the OME

slide21

‘At risk’

  • Suspected or diagnosed speech and language delay or disorder
  • Autism-spectrum disorder and other pervasive developmental disorders
  • Blindness or uncorrectable visual impairment
management of the at risk child may include
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
children with persistent ome who
Children with persistent OME who:
  • are not ‘at risk’
  • do not have significant hearing loss
  • donothave structural abnormalities of the eardrum or middle ear

should be examined every three months

slide25

PAIN

(Otalgia)

differential diagnosis of ear pain
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 pain27
DIFFERENTIAL DIAGNOSIS OF EAR PAIN

B. Middle ear

  • acute otitis media
  • bullous myringitis
  • chronic suppurative otitis media
  • middle ear tumour
differential diagnosis of ear pain28
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
discharge

DISCHARGE

(Otorrhoea)

you are invited

YOUARE INVITED!

1. ENT clinics at RVEEH

all clinical years students
All clinical years students

Every week day afternoon

(and some mornings)

you are invited39

YOUARE INVITED!

2. Hedley Summons Otolaryngology Prize

ad