DRUGS DO NOT DO DRUGS !!! Hearing disorders in children/ Hala AlOmari
Hearing disorders in children/ Hala AlOmari
Otitis media Lecture 8 24 February 2015 Hearing disorders in children/ Hala AlOmari
Acute otitis media Chronic otitis media Otitis Media Hearing disorders in children/ Hala AlOmari
Acute otitis media Non-infective Infective Cause Sudden Eustachian tube obstruction Barotrauma Locking of the Eustacian tube Viral Bacterial * often starts as viral but secondary bacterial infection may follow Pathology Negative middle ear pressure Acute retraction of the ear drum (very painful) Effusion into the middle ear Infection may follow Proliferation of bacteria and white blood cells ear drum bulges under pressure Ear drum may burst (pus in the ear canal) Treatment Swallowing decongestants -Antibiotics - myringotomy Hearing disorders in children/ Hala AlOmari
Acute otitis media- Infective Symptoms pain- increasing until the ear drum bursts Pyrexia ( increased temperatures) Unwell Hearing loss Consequences Returns to normal Persistent effusion Permanent scarring of the ear drum Perforation persists Acute mastoiditis Hearing disorders in children/ Hala AlOmari
Acute otitis media- Infective Acute mastoiditis Very rare Spread of the infection from the middle ear into the mastoid antrum and mastoid air- cells Symptoms Increasing pain Increasing pyrexia Swelling of the ear Hearing disorders in children/ Hala AlOmari
Acute otitis media- Infective Acute mastoiditis Signs Lateral displacement of the pinna Maximum tenderness of the antrum (high) Velvety feel to skin over the mastoid Tragus not tender (characteristic of otitis externa) Treatment Intervenous antibiotics Cortical mastoidectomy Hearing disorders in children/ Hala AlOmari
Acute otitis media- Infective Acute mastoiditis Complications Facial palsy Labrynthitis Intracranial pus _ Subdural abscess - extradural abscess - meningitis - brain abcsess Hearing disorders in children/ Hala AlOmari
Chronic otitis media Forms Chronic serous otitis media= otitis media with effusion= glue ear Chronic suppurative otitis media Long term complications of otitis media. Hearing disorders in children/ Hala AlOmari
Remember Ear infections are more common in children because their eustachian tubes are shorter, narrower, and more horizontal than in adults, making the movement of air and fluid difficult. Hearing disorders in children/ Hala AlOmari
Chronic serous otitis media_ Causes Eustachian tube malfunction Anatomical Nasal disease Immune deficiency Allergic rhinnitis Adenoids Cleft palate Other mass post nasal Hearing disorders in children/ Hala AlOmari
Chronic serous otitis media_ pathology Middle ear hypoxia Increase in mucous producing cells Increase in mucous production Hearing disorders in children/ Hala AlOmari
Chronic serous otitis media_ symptoms Hearing loss - variable (30- 50 dB) Recurrent otalgia Speech delay Behavioural problems Dizziness Hearing disorders in children/ Hala AlOmari
Chronic serous otitis media_ signs Fluid behind the ear drum Dull ear drum Injection of ear drum Retracted ear drum Hearing disorders in children/ Hala AlOmari
Chronic serous otitis media_ associated problems Adenoids - snoring - mouth breathing Cleft palate - depends on the type of repair Hearing disorders in children/ Hala AlOmari
Chronic serous otitis media_ Investigation Pure tone audiogram (age appropriate) Tympanometry VRA Eustachian tube function test Hearing disorders in children/ Hala AlOmari
Chronic serous otitis media_ management Medical Decongestants Low dose antibiotics otovent Surgical Grommets Adenoidectomy 3-4 months watchful waiting before the surgical intervention Depends also on when the child is seen (winter or summer) Hearing disorders in children/ Hala AlOmari
Chronic otitis media Forms Chronic serous otitis media= otitis media with effusion= glue ear Chronic suppurative otitis media Long term complications of otitis media. Hearing disorders in children/ Hala AlOmari
Chronic suppurative otitis media Long term perforation Two forms Tubotympanic disease Atticoantral disease Hearing disorders in children/ Hala AlOmari
Chronic suppurative otitis media Tubotympanic disease Perforation is central Ear is safe Not associated with cholesteatoma Safe ear disease is characterized as a central perforation of the pars tensa with the inflammatory process affecting the mucosa of the middle ear cleft. Hearing disorders in children/ Hala AlOmari
Chronic suppurative otitis media Symptoms Hearing loss , variable dependent on the extent of the perforations Discharge Irritation Investigation Pure tone audiogram Eustachian tube function test Management Hearing aid Reconstruction Hearing disorders in children/ Hala AlOmari
Chronic suppurative otitis media Atticoantral disease Perforation- marginal in pars tensa at the attic Affects the middle ear Unsafe Associated with cholesteatoma Hearing disorders in children/ Hala AlOmari
Chronic suppurative otitis media Symptoms and signs As for tubotympanic disease Discharge is often offensive Both forms can have active discharge/ sometimes discharges/ inactive discharge Hearing disorders in children/ Hala AlOmari
Cholesteatoma Cholesteatoma is a destructive and expanding growth consisting of keratinizing squamous epithelium in the middle ear and/or mastoid process. Although these are not strictly speaking tumours or cancers they can still cause significant problems because of their erosive and expansile properties resulting in the destruction of the ossicles as well as their possible spread through the base of the skull into the brain. They are also often infected and result in chronically draining ears. Hearing disorders in children/ Hala AlOmari
Chronic otitis media Forms Chronic serous otitis media= otitis media with effusion= glue ear Chronic suppurative otitis media Long term complications of otitis media. Hearing disorders in children/ Hala AlOmari
Long term complications of otitis media with effusion Tympanoscelerosis Retraction pockets Atelectasis (drum is floppy) Adhesive otitis media Effects CHL Altered compliance Hearing disorders in children/ Hala AlOmari