Ear infections in childhood:

Acute otitis media

•  Usually healthy child

•  Sudden onset ear pain, blocked feeling

•  Fever, h/o URTI

Findings:

•  Congested, dull drum with / w/o discharge

•  Audiogram – conductive hearing loss

•  Tympanogram – type “B” curve

Treatment:

•  Antibiotics

•  Anti-histaminics

•  Nose drops

•  Analgesic Anti-inflammatory agents

IF toxicity persists:

•  Myringotomy to drain the mucopus

 

Otitis media with effusion:

  • Overweight dull child

•  h/o frequent URTI & mouth breathing

•  h/o frequent sore throat / tonsillitis / fever

•  No systemic s/s

Findings:

•  Dull drum / yellow tinge with bubbles if acute

occ. Blue tinge with retracted TM

 

 

Glue ear:

•  Audiogram – conductive hearing loss

•  Tympanogram – type “B” or “C” curve

•  When valsalva is positive / bubbles exist

•  Tympanogram –
negative pressure + stapedius reflex

Antibiotics – 1 course of amoxy-clav
Anti-histaminics
Nose drops
Analgesic Anti-inflammatory agents
Steroids
valsalva

•  In addition: GROMMET
Insertion w/ Adenoidectomy under vision!!

Typical presentation of a child with a central perforation:

•  7 year old child

•  Frequent otorrhea

•  Freq colds

•  Mouth breather

•  HOH on affected side

•  Audiogram – CHL

•  X-ray – adenoid enlargement

Treatment:

•  If small (<3mm) – conservative treatment

•  Antibiotics – culture directed after 10 days of broad-spectrum

•  Treat underlying URTI

•  Ear drops –

Non-steroid ONLY – ciprofloxacin

aminoglycoside

Fluconazole

Preferably eye drops

•  Stop immediately upon cessation of otorrhea!!

•  If the perforation is large:

Surgery ONLY – AGE NO BAR !!!