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