ears! mark hambly. ear pain – what could it be? common presentation in gp most likely otitis media...
TRANSCRIPT
Ears!
Mark Hambly
• Ear pain – what could it be?
• Common presentation in GP
• Most likely otitis media or externa
• Below some tips on each with some quiz questions!
Question 1 – Otitis Media
• Acute suppurative otitis media (“ASOM”)– Which of the following 3 are required for a
diagnosis of ASOM• Pyrexia• Sudden onset• Red helix• Signs of middle ear effusion• Lymphadenopathy• Signs of ear inflammation
Question 2 – Otitis Media
• What proportion of ASOM is bacterial?– 50%– 60%– 80%– 90%
Question 3 – Otitis Media
• Which of the following are complications of OM?– Transient hearing loss– Perforation of TM– Mastoiditis– Balance disturbance– Recurrence
Question 4 – Otitis Media
• Treatment– Three options for antibiotic prescription
• None (with review)• Delayed• Immediate
– Which is most appropriate antibiotic?• Ciprofloxacin• Amoxicillin• Gentamicin
Otitis Media – other points
• Recurrent – 3+ episodes in 6 month– Refer to ENT
• Chronic suppurative– ‘safe’
• – perforation in pars tensa• Treatment as per otitis externa – swab and topical
abx/steroids
– ‘unsafe’• Could indicate cholesteatoma
Perforations
OM - Glue ear
• Effusion persists >3 months post OM (common to persist a month or two)
• In adult – sinister – refer
• In children <3, if mild hearing loss, can watch and wait (clearly would still need audiometry - ?ENT referral)
• If over 3 or S&L/behavioural difficulty - ENT
Otitis externa
• Symptoms– Itching– Pain, especially on jaw movements and
pulling pinna– Hearing loss
Otitis externa
– Infective– Inflammatory– Traumatic– Some predisposing factors
• Treatment– Analgaesia– Topical
• Steroid with antibiotic most common• No benefit in adding oral therapy
Examine for signs of cause
OE - Prevention
• Don’t put anything in the ear
• Don’t dry ears with paper/cloth towel after swimming– can just tip water out, dry with dryer– If recurrent - vinegar drops for afterwards
• Can use cotton buds with vasaline to prevent water ingress
AKT question from InnovAiT
• In AOM, which ONE of the following it true:– AOM and OM with effusion have separate
pathologies– AOM is diagnosed in primary care by history
and otoscopy in most cases– AOM usually becomes chronic– There is a clear association between AOM in
early life and language development at age 4– Systemic signs of illness with a middle ear
effusion confirm the diagnosis