Primary Care Otolaryngology

Chapter 5

lead to several complications , including perforation of the eardrum, tympanosclerosis, mastoiditis, and meningitis . Purulent ear drainage in the setting of acute otitis media is likely due to eardrum, or tympanic membrane, perforation. The eardrum is the path of least resistance in the ear; thus, a build-up of middle ear purulence during an episode of acute otitis media can result in spontaneous tympanic membrane (TM) rupture. Treatment is similar to that described above for acute otitis media. Most commonly, the perforation will heal on its own within two weeks. However, persistent perforations may require surgical repair. Occasionally, eardrum perforations can be associated with chronic ear drainage, also known as chronic suppurative otitis media . Another residual effect of acute otitis media and TM rupture is tympano- sclerosis . Tympanosclerois is the firm submucosal scarring that can appear as a chalky white patch on the eardrum. It can infrequently lead to conductive hearing loss if the middle ear, and ossicles are involved extensively . Other more severe complications of otitis media include meningitis and mastoiditis. Meningitis originating from otitis media is believed to occur by blood-borne spread of the bacteria from the middle ear space into the meninges . Historically, the most common offending organism was Haemophilus influenzae , though epidemiologic patterns have been chang- ing since the advent of the Haemophilus influenzae vaccine. Meningitis

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caused by otitis media is most often treated with intravenous antibiotics. A potential complication of pediatric meningitis is hearing loss. Fluid collection in the air cells of the mastoid bone just behind the ear often occurs when acute otitis media is pres- ent. However, if the fluid becomes infected and invades the bony struc- tures , acute mastoiditis develops. Patients with acute mastoiditis present with fever, ear pain, and a protruding auricle . Over the mastoid bone, the patient may have erythema of the skin, tenderness, and even a fluctuant mass. A CT scan is a useful diagnostic tool if acute mastoiditis is suspected.

Figure 5.3. Photograph of a tympanic membrane with chronic otitis media with effusion. Note the bubbles in the fluid behind the drum. While most effusions will resolve spontaneously, patients with persistent fluid may require tympanostomy tube placement.

Primary Care Otolaryngology