Primary Care Otolaryngology

otitis media

examination, there may be an air-fluid level behind the eardrum and decreased mobility of the eardrum. Children with OME may have up to a 30- to 40-decibel (dB) conductive hearing loss, which in some studies affected speech development and learning . Antibiotic therapy is not usu- ally indicated for children with OME. Patients with OME are sometimes treated with a short course of oral or topical nasal steroids, to decrease the swelling in the eustachian tube and allow ventilation of the middle ear space . Referral to an otolaryngologist should be considered for children with at least three months of persistent middle ear effusion. Placement of PE tubes is often entertained for such children whose effusions are associ- ated with hearing loss. An adenoidectomy, or removal of the adenoid tissue in the nasopharynx, has been shown to reduce the need for PE tubes in children, presumably by removing a focus of eustachian tube inflammation. Adenoidectomy is often recommended if a child requires a second set of PE tubes, or with the first set of tubes if the child has significant nasal symptoms. Children usually grow out of the need for the tubes as they get older, as the eusta- chian tube assumes a longer and more downward-slanted course with time. However, there are certain subsets of patients, such as children with a history of cleft palate or trisomy 21, who can have long-term problems with otitis media and eustachian tube dysfunction. OME in an adult , especially if it is of recent origin and unilateral , should prompt an examination of the nasopharynx for a disease process affecting the eustachian tube . Early nasopharyngeal carcinoma is well known for its silent nature—often the only sign is unilateral OME. Later in the disease process, the tumor metastasizes to the cervical lymph nodes and extends into the skull base, causing cranial neuropathies . In the past, nasopharyn- geal examination was performed with mirrors, but most otolaryngologists now routinely use rigid or flexible endoscopic instrumentation. Complications of Acute Otitis Media Complications of acute otitis media were common in the pre-antibiotic era. It is largely because of those complications that otolaryngology devel- oped as a specialty more than 100 years ago. With advances in the diagno- sis and treatment of otitis media, such complications as mastoiditis and meningitis have decreased in incidence. However, as the prevalence of resistant organisms increases , especially Streptococcus pneumoniae , there is a chance that these complications may again become more common . Therefore, even if you never see a case during your medical school years, you must know about these complications and be able to recognize them if you encounter them in your practice. If untreated, acute otitis media can

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