ears! mark hambly. ear pain – what could it be? common presentation in gp most likely otitis media...

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