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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. Otitis media, and check out Otitis media on Wikipedia, Youtube, Google News, Google Books, and Twitter on Digplanet.
An integral symptom of acute otitis media is ear pain; other possible symptoms include fever, and irritability (in infants).
Discharge from the ear can be caused by acute otitis media with perforation of the ear drum, chronic suppurative otitis media, tympanostomy tube otorrhea, or acute otitis externa. By reflux or aspiration of unwanted secretions from the nasopharynx into the normally sterile middle-ear space, the fluid may then become infected a€” usually with bacteria. Acute otitis media in children with moderate to severe bulging of the tympanic membrane or new onset of otorrhea (drainage) is not due to external otitis. However, sometimes even examination of the eardrum may not be able to confirm the diagnosis, especially if the canal is small. Otitis media with effusion (OME), also known as serous otitis media (SOM) or secretory otitis media (SOM), and commonly referred to as glue ear,[20] is a collection of effusion (fluid) that occurs in the middle-ear space due to the negative pressure produced by dysfunction of the Eustachian tube. Chronic suppurative otitis media, incorrectly called chronic otitis media or chronic ear infection, involves a hole in the tympanic membrane and active bacterial infection within the middle-ear space for several weeks or more. Long-term antibiotics, while they decrease rates of infection during treatment, have an unknown effect on long-term outcomes such as hearing loss.[24] This method of prevention has been associated with emergence of antibiotic-resistant otitic bacteria. It is important to weigh the benefits and harms before using antibiotics for acute otitis media. Antibiotics should be prescribed for severe bilateral or unilateral disease in all infants and children with severe signs and symptoms, such as moderate to severe ear pain and high fever. For bilateral acute otitis media in infants younger than 24 months of age, without severe signs and symptoms, antibiotics should be prescribed. Children 24 months or older with non-severe disease can have either antibiotics or observation. A treatment option for chronic suppurative otitis media with discharge is topical antibiotics.


In severe or untreated cases, the tympanic membrane may perforate, allowing the pus in the middle-ear space to drain into the ear canal. Children with recurrent episodes of acute otitis media and those with otitis media with effusion or chronic suppurative otitis media have higher risks of developing conductive and sensorineural hearing loss.
This hearing loss is mainly due to fluid in the middle ear or rupture of the tympanic membrane.
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). In those with less severe disease they may only be recommended in those who do not improve after two or three days.[6] The initial antibiotic of choice is typically amoxicillin. Trauma, such as a basilar skull fracture, can also lead to discharge from the ear due to cerebral spinal drainage from the brain and its covering (meninges).
Eventually the negative middle-ear pressure can reach a point where fluid from the surrounding tissues is sucked in to the middle ear's cavity (tympanic cavity), causing a middle-ear effusion. Also, the diagnosis may be made in children who have mild bulging of the ear drum and recent onset of ear pain (less than 48 hours) or intense erythema (redness) of the ear drum. If wax in the ear canal obscures a clear view of the eardrum it should be removed using a blunt cerumen curette or a wire loop.
There may be enough pus that it drains to the outside of the ear (otorrhea), or the pus may be minimal enough to only be seen on examination using the otoscope or, more effectively, with a binocular microscope.
As over 80% of acute episodes settle without treatment, about 20 children must be treated to prevent one case of ear pain, 33 children to prevent one perforation, and 11 children to prevent one opposite-side ear infection.
If the child worsens or fails to improve in 2 to 3 days antibiotics should be administered.
Prolonged duration of otitis media is associated with ossicular complications and, together with persistent tympanic membrane perforation, contributes to the severity of the disease and hearing loss. 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. This is seen as a progression from a Type A tympanogram to a Type C to a Type B tympanogram.
Also, an upset young child's crying can cause the eardrum to look inflamed due to distension of the small blood vessels on it, mimicking the redness associated with otitis media. Over weeks and months, middle-ear fluid can become very thick and glue-like, which increases the likelihood of its causing conductive hearing impairment.
This disease is much more common in persons with poor Eustachian tube function and very common in certain races such as Native North Americans. For every 14 children treated with antibiotics, one child has an episode of either vomiting, diarrhea or a rash.[36][needs update] If pain is present, treatment to reduce it should be initiated.
Even though the perforation of the tympanic membrane suggests a highly painful and traumatic process, it is almost always associated with a dramatic relief of pressure and pain. 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.
OME is typically not associated with symptoms.[3] Occasionally a feeling of fullness is described.
In a simple case of acute otitis media in an otherwise healthy person, the body's defenses are likely to resolve the infection and the ear drum nearly always heals.
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. It is defined as the presence of non-infectious fluid in the middle ear for more than three months. 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). Chronic suppurative otitis media (CSOM) is middle ear inflammation of greater than two weeks that results in episodes of discharge from the ear.
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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24.04.2014 admin



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