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