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Chapter 5
Primary Care Otolaryngology
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
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.