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13.03.18 Otitis media

Acute otitis media
  • Routes of infection:
    • Eustachian tube
    • Perforation
    • Blood
  • Bugs:
    • Haemolytic Strep.
    • Strep. pneumoniae
    • Staph. aureus
  • Treatment:
    • Amoxicillin or augmentin if resistant
    • Pain relief
    • Sofradex drops if discharge (i.e. perforation) - Dexamethasone plus antibiotics
    • Myringotomy +/- ventilation tube (grommet)
  • Complications: (Remember can spread in all six directions)
    • Mastoiditis
    • Subperiostial abscess
    • Brain abscess


Glue ear

  • Affects 30% of 3-6 year-olds but resolves spontaneously
    • Treat if affecting language/schooling
  • Risk factors:
    • Cleft palate
    • Downs' syndrome
  • Treatment:
    • Adenotonsilectomy + grommet insertion


Cholesteatoma

  • Typically affects the attic region (top)
  • Symptoms:
    • Offensive discharge
    • Painless
    • Conductive hearing loss
  • Complications
    • Labyrinthitis
    • Facial nerve palsy
    • Hearing loss
    • Meningitis
    • Subdural empyema
    • Intracranial abscess


Causes of otalgia

  • Perichondritis (infection of skin/cartilage of outer ear)
  • Furuncle
  • Ramsay Hunt syndrome (RHS) type 2
    • AKA herpes zoster oticus
    • Caused by the reactivation of pre-existing herpes zoster virus in the geniculate ganglion
    • Symptoms and signs:
      • Acute facial nerve paralysis
      • Otalgia
      • Taste loss in the front two-thirds of the tongue
      • Dry mouth and eyes
      • Eruption of an erythematous vesicular rash in the ear canal, the tongue, and/or hard palate
      • Tinnitus, hearing loss, and vertigo from vestibulocochlear nerve involvement
  • Referred pain:
    • Glossopharyngeal
      • Oropharynx
    • Vagus
      • Larynx, hypopharynx, oesophagus
    • Trigeminal
      • Teeth, parotid, TMJ, tongue, nose, sinuses



Nerve supply of the outer ear



Notes

  • Brain abscesses are ring-enhancing
    • Pus doesn't get any contrast
    • Surrounding tissue is highly vascular/permeable due to inflammation => Lots of signal
  • Grommets go in where the light reflex is (anterior inferior)
  • Parotidectomy almost always damages the greater auricular nerve => Numb ear lobe
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