Oto Primary Care FINALhigh

otitis media

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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.

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