HIS 125 Otitis Media and Otosclerosis

Otitis Media & Otosclerosis

Otitis Media

Eustachian tube dysfunction is the most

significant factor in the development of Otitis

Media.

The most common complication associated with

Otitis media is the conductive component of

twenty to thirty-five decibels of hearing loss.


Otitis Media

Eustachian tube dysfunction prevents middle

ear secretions from draining and creates

negative pressure in the middle ear space.

This negative pressure leads to periodic

aspiration of contaminated nasopharyngeal

secretions, which in turn cause bacterial

infection of the middle ear (otitis media).


Otitis Media

Untreated patients or the treatment failure of otitis media may result in:

permanent hearing loss

permanent perforation of TM

Cholesteatoma

Mastoiditis

Ossicular discontinuity

Tympanosclerosis


Otitis Media

Intracranial complications from untreated

Otitis media may result in:

Meningitis

Encephalitis

Brain abscess


Otitis Media

Recurrent Otitis media has also been

implicated as a possible source of delayed

development, cognitive disabilities, and

detrimental behavior problems in young

children.


Otitis Media

Ninety percent of all children in the United States will have at least one bout of otitis media before age six.

Nearly twenty percent of children who suffer ear infections will at some time require surgery to treat the problem.

Eighteen percent of children under age five have a medical office visit related to otitis media.


Otitis Media

The incidence of otitis media in children has been found to be a function of age (under five years), gender (higher incidence in males), race (more whites).

Recurrent episodes of otitis media are generally contributed to day care outside of the home, passive exposure to smoking, and bottle propping.


Otitis Media

There are three general categories for otitis media. They are:

1. Otitis Media without effusion

2. Otitis Media with effusion

3. Otitis Media with perforation

The type of effusion for #2 or #3 may be either serous (watery), purulent (pus like), mucoid (mucus like liquid).


Otitis Media

Each of the three general categories may be

further classified based upon the duration.

1. Acute—zero to twenty-one days

2. Subacute—twenty-two days to eight weeks

3. Chronic—lasting longer than eight weeks


Otitis Media

Acute otitis media commonly presents with ear pain in association with symptoms of upper respiratory tract infections such as stuffy nose and/or cough. Fever is present in less than half of the reported cases.

NOTE: Not all cases of ear pain are caused by otitis media. Other considerations for ear pain may be mumps, toothache, foreign body in the ear canal.


Otitis Media

Otoscopy may reveal a red or yellow TM

TM mobility is markedly reduced or absent

as measured by tympanometry.

A red TM with absent mobility is consistent

with an Acute otitis media diagnosis.


Otitis Media

Let’s review Northern, page #131for a diagram

regarding the comprehensive management of

otitis media with effusion, based upon the

duration of the event.


Otitis Media

Most middle ear effusions clear within the first six weeks of treatment. However, residual otitis media may occur fifteen percent of the time. Residual otitis media will created a fifteen to twenty decibel conductive hearing loss with the patient reporting no pain—just the hearing loss. Note: Children will not complain about the HL. They just become inattentive, or develop behavior problems.


Otitis Media

When otitis media evolves into persistent middle

ear effusion, surgical intervention becomes the

management method of choice.

This involves a myringotomy with ventilation tube,

or possibly an adenoidectomy, or a combination

of the two procedures.


Otitis Media

Chronic otitis media is the appropriate diagnosis

when irreversible damage to the middle ear

structures has occurred i.e. adhesive otitis,

perforation of the TM, erosion of the ossicles,

cholesteatoma, etc.

NOTE: Corrective surgery is required to treat

chronic otitis media damage.


Otitis Media

Let’s review Northern, page #134 to examine

the referral criteria for otitis media and middle

ear disorders.


Otosclerosis

This condition often results in the impairment of

the mobility of the footplate of the stapes within

the oval window thus, creating a conductive

component to hearing loss.

It is generally a genetic condition mostly

affecting white females (a two to one female to

male ratio)


Otosclerosis

It generally manifests itself as a bilateral

conductive hearing loss in the third or fourth

decades of human life.

Variable tinnitus may precede or coincide with its

development.

The tympanic membranes appear normal.


Otosclerosis

Audiometric findings often reveal Carhart’s

notch. This is a characteristic conductive “notch”

found at 2K.

Let’s review Northern, page #142 for a visual

description of this characteristic Carhart notch.


Otosclerosis

Stapes mobilization and stapedectomy are the

surgical procedures commonly used in the

treatment of this condition.

Generally, the surgery is unilateral on the ear

with the worst hearing thresholds, provided the

word recognition is the same in both ears.

Note: Surgery for the second ear is delayed for

at least a year or more.


Otosclerosis

A successful procedure will last for six to ten

years with few post-surgical complications.

Let’s review Northern, pages #144 and #146

for samples of pre-surgical and post-surgical

audiograms.

Documents

HIS 125 Otitis Media and Otosclerosis