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Transcript of Otitis Media
Tugging or pulling at an ear
Crying more than usual
Acting more irritable than usual
Difficulty hearing or responding to sounds
Loss of balance
Fever of 100 F (38 C) or higher
Drainage of fluid from the ear
Loss of appetite
Diarrhea Ear pain
Drainage of fluid from the ear
Sore throat Eustachian tube dysfunction
When the tube does not open properly, is not patent, or is blocked in one way or another.
Can be blocked because of series of factors:
Swelling and/or fluid caused by respiratory infection
Allergies Usually rapid onset and short duration.
Typically occurs during or after a respiratory infection.
Up to 3 weeks is considered acute.
Typically associated with fluid accumulation in the middle ear together with signs or symptoms of ear infection; a bulging eardrum usually accompanied by pain, or a perforated eardrum, often with drainage of purulent material (pus, also termed suppurative otitis media).
Fever may be present. A persistent inflammation of the middle ear, lasting more than a month.
Follows acute otitis media.
May develop after a prolonged period of time with fluid or negative pressure behind the tympanic membrane.
Can cause ongoing damage to the middle ear and eardrum, and there may be continuing drainage through a hole in the eardrum.
Often starts with pain and no fever.
Ear pressure or popping can be persistent for months.
Loss of hearing can be the result. Signs and Symptoms in Children Otitis media with effusion
Acute otitis media
Chronic otitis media Who does it affect? Affects people of all ages, but most common in children.
"Most children have at least one case of otitis media by age 3, and at least three episodes occur by age 3 in 33% of children overall and in ~80% of those in day care centers" (Essentials of Audiology, p. 172). Eustachian tube may fail to open due to structural or functional abnormalities affecting tensor palatini muscle.
This is common in cleft palate patients. The eustachian tube is tilted downward by ~45 degrees.
Infants and young children have a eustachian tube that is horizontal, shorter, and wider. Their tensor palatini muscles also operate less efficiently. Why is it common in infants and young children? Eustachian tube dysfunction Prevents middle ear from being ventilated, causing air within the middle ear cavity to stagnant.
Some of the stagnant air is absorbed by tissue within the middle ear.
Negative air pressure- air pressure is lower inside the ear compared to the outside.
Aerotitis- caused by abrupt pressure change, which causes the tympanic membrane to retract and prevents the opening of the eustachian tube. Otitis Media with Effusion (OME) "Occurs when there is an accumulation of fluid (effusion) in the middle ear in the absence of an acute infection, by negative pressure caused by eustachian tube dysfunction, or as an inflammatory response after an acute infection" (Essentials of Audiology, p. 173). OME Effusions usually start out with serious fluid.
Serous fluid: watery and clear fluid that is free of cells and other materials.
Continuation of the disease with involve mucoid fluid.
Mucoid fluid: thick and viscous, containing white blood cells and other cellular material.
At this stage the middle ear infection would be described as secretory otitis media. OME Mucoid otitis media may be applied if thickening continues.
Leads to adhesive or "glue ear"
Potential blood in the middle ear (hemotympanum)
Middle ear fluid can be detected by seeing a fluid line, if the ear is not completely filled with fluid or bubbles.
Diagnosis is completed by using a pneumatic otoscope. Complications of Otitis Media Cholesteatoma: a skin cyst located in the middle ear and mastoid.
Most common in chronic otitis media.
Labyrinthitis: an ear disorder that involves irritation and swelling inflammation of the inner ear.
Mastoiditis: an infection of the mastoid bone of the skull.
Conductive hearing loss
Sensorineural hearing loss
Infections or traumatic brain injuries
Example- ossicular discontinuities: interruptions in the ossicular chain. Management of Otitis Media Otitis Media with Effusion
Those children who do not have a speech-language-hearing, learning, or development disorder.
A 3 month period of monitoring for children age 2 months-12 years.
If necessary, surgical insertion of a PE tube in the eardrum. Management of Otitis Media Acute Otitis Media
Generally treated with antibiotics.
Treatment for ventilating the ears:
Valsalva maneuver: Forcing the eustachian tube open
Blowing forcefully with the mouth closed and nose pinched.
Politzerization: Middle ear ventilation.
Free end of the rubber tube in placed in the one nostril. The other nostril is pinched closed. Air is forced by squeezing the bulb. Management of Otitis Media Recurrent Otitis Media
Adenoidectomy: removal of the adenoids.
Myringotomy: surgical incision in the tympanic membrane in order to drain the middle ear.
Pressure equalization (PE), tympanostomy, or ventilation in inserted in the incision in order to keep it open. Management of Otitis Media Mastoidectomy: surgical removal of a disease.
Radical mastoidectomy: disease is widespread, severe, or aggressive.
Modified radical mastoidectomy: surgical removal of pathological tissue and alleviation of diseased tissue. The eardrum and ossicles are not damaged.
Simple mastoidectomy: remove diseased tissue in the mastoid. The posterior canal wall in not broken through.
Tympanoplasty: surgical reconstruction of the eardrum and structures of the middle ear. Sources http://emedicine.medscape.com/article/994656-overview
Gelfand, S. A. (2001). Essentials of audiology. New York, New York: Thieme. Type A- Sensorineural Type B- Conductive http://books.google.com/books?id=_tcPcPTwNQoC&pg=PA175&lpg=PA175&dq=otitis+media+audiogram+in+right+ear&source=bl&ots=c2Nm3qXcHb&sig=e18fs5WYscv5lXFzwp_jLqcbXEM&hl=en&sa=X&ei=HO-3ULmEDaiA2QWTx4HQAQ&ved=0CC4Q6AEwAA#v=onepage&q=otitis%20media%20audiogram%20in%20right%20ear&f=false Audiograms of Otitis Media