ear infections in chn
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ear problemTRANSCRIPT
Ear Infections in Ear Infections in ChildrenChildren
Matt Stumpe, M.D.Matt Stumpe, M.D.Mid Kansas Ear, Nose, & ThroatMid Kansas Ear, Nose, & Throat
Personal InterestPersonal Interest
Ear AnatomyEar Anatomy
External EarExternal Ear–– AuricleAuricle–– CanalCanal
Middle EarMiddle Ear–– Ear DrumEar Drum–– OssiclesOssicles
Inner EarInner Ear
InfectionsInfections
Can involve any of the 3Can involve any of the 3–– External earExternal ear
Swimmers Ear or Otitis externaSwimmers Ear or Otitis externa
–– Middle earMiddle earOtitis media (most common child infection)Otitis media (most common child infection)
–– Inner EarInner EarLabyrinthitisLabyrinthitis
Normal Ear ExamNormal Ear Exam
Middle ear InfectionsMiddle ear Infections
Otitis mediaOtitis media–– Most common ear infection in young Most common ear infection in young
childrenchildren–– Likelihood much higher in first 3 years of Likelihood much higher in first 3 years of
lifelife
Childhood differencesChildhood differences
Eustachian TubeEustachian Tube–– ChildhoodChildhood
1717--18mm in length18mm in lengthHorizontalHorizontal
–– AdultAdult3131--38mm in length38mm in length45 degree angle45 degree angle
Childhood DifferencesChildhood Differences
Immune NaïveImmune NaïveEnvironmental exposureEnvironmental exposure–– Exploration through touch and tasteExploration through touch and taste
Shared GermsShared Germs
Confounding FactorsConfounding Factors
Factors associated with increaseFactors associated with increase–– Pacifier usePacifier use–– Daycare attendance Daycare attendance –– Environmental tobacco smokeEnvironmental tobacco smoke
Factors associated with decreaseFactors associated with decrease–– Breast FeedingBreast Feeding
Eustachian Tube Eustachian Tube InflammationInflammation
AnatomyAnatomyViral infectionViral infectionAllergyAllergy
Ear DrumEar Drum
Air is needed Air is needed behind ear drum behind ear drum Negative pressure, Negative pressure, fluid can build up in fluid can build up in earearHearing can be Hearing can be effectedeffected
Ear FluidEar Fluid
Ear effectsEar effects
Ear InfectionEar Infection
“Scarred Ear Drum”: “Scarred Ear Drum”: TympanosclerosisTympanosclerosis
Tympanosclerosis Normal
Middle Ear Infection Middle Ear Infection SymptomsSymptoms
PainPainFeverFeverDecreased hearingDecreased hearing
Medical treatmentMedical treatment
AntibioticsAntibioticsDecongestantsDecongestantsNasal irrigationNasal irrigationNasal SteroidNasal Steroid
Surgical Management: Surgical Management: Ear TubesEar Tubes
One of the most common surgeries for One of the most common surgeries for ChildrenChildrenProvide alternative route for pressure Provide alternative route for pressure changes and fluidchanges and fluidAllow Child to outgrow anatomic Allow Child to outgrow anatomic issuesissues
Ear Tube limitationsEar Tube limitations
Average tube stays 9Average tube stays 9--12 months12 months–– Can extrude earlyCan extrude early–– Can retain tubeCan retain tube
Usually tubes come out on ownUsually tubes come out on own
Ear drum perforationEar drum perforation
Ear TubesEar Tubes
Ear TubeEar Tube
Ear Drum PerforationEar Drum Perforation
Most heal Most heal spontaneouslyspontaneouslyLocation and size Location and size dictate effect on dictate effect on hearinghearing
Ear Drum PerforationsEar Drum Perforations
Surgery for Ear Drum Surgery for Ear Drum PerforationPerforation
4 month Post OP picture
AdenoidsAdenoids
Enlarged AdenoidsEnlarged Adenoids–– Impair Eustachian Impair Eustachian
tube functiontube function–– Harbor infective Harbor infective
agentsagents
AdenoidectomyAdenoidectomy
AdenoidectomyAdenoidectomy
Proven to decrease incidence of Otitis Proven to decrease incidence of Otitis MediaMediaTheorized to improve eustachian tube Theorized to improve eustachian tube functionfunctionTheorized to decrease pathogens near Theorized to decrease pathogens near middle earmiddle ear
Middle Ear Infection Middle Ear Infection ComplicationsComplications
MastoiditisMastoiditisFacial ParalysisFacial ParalysisMeningitisMeningitisBrain AbscessBrain Abscess
Swimmers EarSwimmers Ear
Otitis ExternaOtitis Externa
Swimmers earSwimmers earEar Canal slightly acidicEar Canal slightly acidic–– Moisture leads to change in pHMoisture leads to change in pH
SymptomsSymptoms–– Itching, Pain, Drainage, Decreased Itching, Pain, Drainage, Decreased
hearinghearing
Outer Ear Infection Outer Ear Infection CausesCauses
Water Trapped in Water Trapped in EarEarQQ--Tip trauma Tip trauma Wax ImpactionWax Impaction
Swelling of CanalSwelling of Canal
Trapping of Trapping of –– MoistureMoisture–– InfectionInfection
Inability to deliver Inability to deliver dropsdrops
Outer ear InfectionOuter ear Infection
SeveritySeverity
TreatmentTreatment
AntibioticsAntibioticsDebridementDebridementEar DropsEar DropsEar WickEar Wick
Almost ThereAlmost There
Inner Ear InfectionsInner Ear Infections
LabyrinthitisLabyrinthitisSterile Environment Sterile Environment –– No connection to outside worldNo connection to outside world
Inflammatory mediatedInflammatory mediatedSymptomsSymptoms–– Hearing loss, Ringing, VertigoHearing loss, Ringing, Vertigo
Labyrinthitis CausesLabyrinthitis Causes
AutoAuto--ImmuneImmuneViralViralBacterialBacterialTumorTumor
TreatmentTreatment
SteroidsSteroids–– SystemicSystemic–– TranstympanicTranstympanic
AntibioticsAntibioticsAntiviralsAntiviralsImagingImaging
ConclusionConclusion
Children many factors increase Children many factors increase incidence of ear infectionincidence of ear infectionMultiple modalities of treatment Multiple modalities of treatment dependent on correct diagnosisdependent on correct diagnosisQuestions?Questions?
Contact InformationContact Information
Matt Stumpe, M.D.Matt Stumpe, M.D.MidMid--Kansas Ear, Nose & Throat Kansas Ear, Nose & Throat AssociatesAssociatesTelephone: 316Telephone: 316--684684--28382838Toll Free Telephone: 800Toll Free Telephone: 800--794794--4ENT4ENT