Middle ear (PEARLS)
| Cholesteatoma |
Cholesteatoma presents with painless otorrhea, brown/yellow discharge with a strong odor
- Caused by chronic eustachian tube dysfunction which results in chronic negative pressure and inverts part of the TM causing granulation tissue that over time, erodes the ossicles and leads to conductive hearing loss
TX: Surgical removal |
Otitis media (ReelDx)
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The clinical diagnosis of AOM requires 1) bulging of the tympanic membrane or 2) other signs of acute inflammation (eg, marked erythema of the tympanic membrane, fever, ear pain) and middle ear effusion
- Age two and under limited mobility of the TM with pneumotoscopy
- S. pneumoniae 25%, H. influenzae 20%, M. catarrhalis 10%
TX: First line amoxicillin, second line augmentin, macrolides if penicillin allergic
- Treat < 2 y for 10 days and > 2 y for 5-7 days
- Complications: Mastoiditis and bullous myringitis
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| Tympanic membrane perforation (ReelDx) |
Tympanic membrane perforation presents with pain, otorrhea, and hearing loss/reduction
TX: Most heal spontaneously, keep clean and dry, treat with antibiotics
- The only class of antibiotics that are non-ototoxic are the Floxin drops and should be used if you are going to be prescribing drops with a perforated TM
- Surgery if persists past 2 months
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