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If you are using a modern web browser, you may instead navigate to the newer desktop version of fpnotebook.
Another, mobile version is also available which should function on both newer and older web browsers. Although access to this page is not restricted, the information found here is intended for use by medical providers. Otitis media with effusion is a very common disease in children and presents with conductive hearing loss. JavaScript is currently disabled, this site works much better if you enable JavaScript in your browser.
OTITIS MEDIA Otitis media (OM) may be defined as inflammation of the middle ear due to any cause. OTITIS MEDIA -- DIAGNOSIS Children with acute otitis media frequently present with sudden onset of fever, ear pain, and fussiness. OTITIS MEDIA -- COMPLICATIONS Complications of acute otitis media were common in the pre- antibiotic era. HEARING LOSS Conductive hearing loss Cerumen impactions Swelling of the external auditory canal Tympanic membrane perforation Middle ear fluid Ossicular chain abnormalities Sensorineural hearing loss Injury to hair cells in the cochlea or neural elements innervating the hair cells. HEARING LOSS -- AUDIOMETRY Hearing threshold levels are determined between 250 and 8000 Hertz (Hz) for pure tones and measured in decibels (dB). HEARING LOSS -- AUDIOMETRY A conductive hearing loss in the left ear due to otitis media with effusion.
HEARING LOSS -- AUDIOMETRY This audiogram suggests noise exposure that may be encountered occasionally in younger individuals who have been exposed to hazardous or “toxic” noise.
HEARING LOSS -- TYMPANOGRAM Tympanometry is commonly used to evaluate the tympanic membrane (TM) and middle ear status. Three tympanograms demonstrating change in compliance of the middle ear (vertical axis) with changes in ear canal pressure. OTITIS EXTERNA Otitis externa (OE) is an inflammation or infection of the external auditory canal (EAC), the auricle, or both This condition can be found in all age groups.
OTITIS EXTERNA -- CONSIDERATIONS Ramsay Hunt syndrome, more accurately known as herpes zoster oticus, is caused by varicella-zoster virus (VZV) infection. OTITIS EXTERNA -- TREATMENT Commonly used topical eardrops are acetic acid drops (which decrease pH), antibacterial drops, and antifungal preparations. DIZZINESS Patients frequently present with a complaint of “dizziness,” including symptoms such as disequilibrium, syncope, lightheadedness, ataxia, and vertigo.
DIZZINESS – VESTIBULAR TESTING Vestibular testing can be performed to help determine whether the problem exists within the vestibular (balance) portion of the inner ear. DIZZINESS – VESTIBULAR TESTING There are four main parts to ENG testing Calibration test, which measures rapid eye movements Tracking test, which evaluates the ability of the eyes to track a moving target Positional test, which measures responses due to head movements Caloric test, which measures responses to warm and cold water introduced to the ear canal.
BENIGN PAROXYSMAL POSITIONAL VERTIGO (BPPV) One of the most common causes of vertigo is benign paroxysmal positional vertigo (BPPV).
BENIGN PAROXYSMAL POSITIONAL VERTIGO (BPPV) BPPV can usually be successfully treated with a canolith reposition maneuver (Epley or Semont maneuver) in the office setting. Bedside maneuver for the treatment of a patient with benign paroxysmal positional vertigo (BPPV) affecting the right posterior semicircular canal. LABRYNTHITIS -- TREATMENT Treatment is symptomatic Vestibular suppressant medications (meclizine) Antiemetics Short, tapering course of oral steroids It may take several weeks for symptoms to completely resolve Residual vestibulopathy that persists for months or even years is not uncommon, and is best managed with vestibular rehabilitation. The thick yellowish white fluid behind the eardrum looks like glue, hence the name glue ear. Audiogram is the measurement of hearing and Tympanogram is the pressure and movement of the ear drum. Antibiotics: Antibiotic therapy has been proved effective for children suffering from glue ear.
Myringotomy: Myringotomy is a method, which helps in draining the fluid from the middle ear. The child should have earplugs or cotton coated with petroleum jelly to avoid the water getting inside the ear especially going for swimming. Dr Paulose FRCS, DLO is a Consultant ENT Plastic & Laser Surgeon with over 38 years of world class experience in Ear, Nose, Throat and Laser Surgery treating patients across the world from UK, US, Middle East to Asia. Basic information for the concerned parent: Ear Infections and Early Learning has information that sheds light on the effects of hearing loss that comes and goes on children’s development. Research Summary: Otitis media with effusion (OME) often results in hearing loss for children with the condition.


Due to: persistent noise exposure, age-related (presbycusis), genetic factors, and infectious or postinflammatory processes. The 0-dB level is “normalized” to young, healthy adults and doesn’t mean there is absence of detectable sound.
Note that bone conduction thresholds are normal in both ears, but air conduction on the left is 30 dB poorer than that measured on the right. Note that low-tone thresholds are relatively normal, with a drop in thresholds at higher frequencies.
This test assesses the mobility of the TM and its response to pressure changes in the external auditory canal. Type A is normal, with the greatest compliance at the point where the pressure in the ear canal is equal to that of atmospheric pressure (peak is at 0).
If the condition does not respond to treatment as expected, an otolaryngologist should evaluate the patient. It is characterized by facial nerve paralysis and sensorineural hearing loss, with bullous myringitis and a vesicular eruption of the concha of the pinna and the external auditory canal (EAC). True vertigo (an illusion of motion) is primarily associated with the balance organs of the inner ear.
BPPV is caused by sediment, such as calcium carbonate crystals, that have become free floating within the inner ear. Dislodged otoliths repositioned into the vestibule is about 80 percent effective in eliminating symptoms of BPPV. The presumed position of the debris within the labyrinth during the maneuver is shown in panels A–D.
It is thought to be caused by inflammation, secondary to a viral infection, of the vestibular portion of the eighth cranial nerve or of the inner ear balance organs (vestibular labyrinth). If glue ear is not given proper treatment, it will lead to delayed speech in young children, and affect a child’s behavior and educational progress. It is also known as chronic otitis media with effusion, or middle ear effusion or secretory otitis media. This helps in allowing free flow of air between the Eustachian tube and the nose and throat. In ear tube surgery, the surgeon will make an incision in the eardrum to remove the excess fluid from the middle ear. In order to provide appropriate and effective audiologic management, it is important to understand the impact of OME on speech recognition ability when hearing loss is present. There are two common variants: (1) acute otitis media (AOM) and (2) otitis media with effusion (OME). There is decreased movement of the eardrum on pneumatic otoscopy (insufflation of air into the ear canal).
Mastoiditis -- Patients with acute mastoiditis present with fever, ear pain, and a protruding auricle. Some patients hear 0 dB, but reaching the threshold of hearing usually requires louder test signals.
This is a consequence of the normal aging process and may vary widely from patient to patient. Type B demonstrates very poor compliance at any frequency, suggestive of a tympanic membrane (TM) immobilized by fluid in the middle ear or a TM perforation (no peak). Skull base osteomyelitis occurs most often in patients who are diabetic or immunocompromised.
Rotatory chair testing is the “gold standard” for diagnosing bilateral vestibular weakness. Turning the head quickly or into a certain position, causes this free- floating material to move the endolymph in the inner ear, stimulating the vestibular division of the eighth cranial nerve.
The middle ear is filled with air that travels through the Eustachian tube to the back of the nose. Children, when colds and sore throats in children can infect the tube will lead to glue ear. Detecting hearing loss in small children is not easy since they will not be able to converse properly. Refer to the webpage on cholesteatomas for more information about this disease and how it can effect learning.
This study examined the speech recognition abilities of normal-hearing six- and seven-year-old children (n = 12) and adults (n = 12) using monosyllabic words and nonsense syllables presented at two levels of simulated conductive hearing loss characteristic of OME. Average speech recognition scores decreased as the degree of simulated conductive hearing loss increased.


In mucoid types the appearance of the tympanic membrane becomes dull, opaque, and vascularized. Ears Otitis media Hearing loss Otitis externa Vertigo Nose Sinusitis Allergic rhinitis Epistaxis Throat Strep. Common bacteria that cause acute OM in children are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Meningitis With increasing antibiotic resistance, especially Streptococcus pneumoniae, these complications may again become more common.
Type C represents a tympanogram in which the compliance of the membrane is greatest at a point where the pressure in the canal is 200 mm of water below that of atmospheric pressure (peak shifted to the left). The patient is slowly spun in a rotating chair and dizzinessis is measured with optokinetic testing and a fixation test. The Dix-Hallpike test is performed with the patient’s head rotated 45? toward the right ear, and the neck slightly extended with the chin pointed slightly upward. The patient will usually awaken with room-spinning vertigo that will gradually become less intense over 24–48 hours. When this happens, the middle ear builds up pressure, which leads to the formation of a thick and glue-like fluid. If the infection is present and if it is not treated on time, child will end up with a hearing loss. The operation is done through the eardrum externally without any cut on the child’s skin. Other permanent damage can also be caused from longstanding hearing loss due to middle ear infection. Both age groups scored significantly poorer for nonsense syllables than for monosyllabic words. In advanced stages the tympanic membrane is retracted and the length of the malleus looks shortened. In healthy children older than two years of age who present with less severe symptoms, observation for 48 hours may be considered. This suggests inefficient eustachian tube function with persistent negative pressure in the middle ear. The diagnosis is strongly suggested by a history of diabetes mellitus, severe otalgia, cranial neuropathies, and characteristic EAC findings.
Moving platform posturography is a method of quantifying balance, but should not be used alone to diagnose vestibular disorders.
Medical therapy with vestibular suppressants is ineffective because the episodes of vertigo are so fleeting, and should be discouraged. In general, the children performed more poorly than the adults with the exception of the easiest listening condition for word stimuli.
If the patient does not respond to medical treatment, myringotomy and ventilation tube insertion may be necessary. During the audiogram, independent thresholds are determined for each ear for both air conduction (conductive hearing) and bone conduction (sensorineural hearing). It is most useful in quantifying balance improvement (or worsening) following treatment for a particular problem, and can help identify the functional dizzy patient. Once the vertigo and the nystagmus provoked by the Dix-Hallpike test cease, the patient’s head is rotated about the rostral-caudal body axis until the left ear is down (panel B). Furthermore, children appeared less able than adults to use their knowledge of familiar words to improve performance. These findings suggest that rehabilitative strategies may best be focused on combining familiarization techniques and amplification options. Unilateral otitis media with effusion in adults requires a detailed investigation for nasopharyngeal carcinoma.
ECOG is not really a test of the vestibular system, but is a useful test of hearing in the evaluation of Meniere’s disease.
The test is a variant of brainstem audio-evoked response and, if possible, should be performed during active Meniere’s attacks. With the head kept turned toward the left shoulder, the patient is rought into the seated position (panel D).
Once the patient is upright, the head is tilted so that the chin is pointed slightly downward.



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