-Preceding URI, fever, otalgia, HL, otorrhea. ute hurts more, patients come in complaining of pain. Upper Respiratory Infection (URI) can cause Acute OM by spreading and swelling.
Classification of OM: Chronic
-Possibly asymptomatic, sometimes hearing loss, “plugged”, “popping” -Can go unnoticed, a dull sensation may occur but possibly asymptomatic. Popping sounds from fluid, also during recovery stage fluid drains out E-tube. Middle ear covered in mucous membranes, liquidy, so those pops come similar to making liquid sounds with your mouth.
#1 Pathology leading to OM
Eustachian tube abnormalities: Mechanical/functional obstruction, Loss of stiffness or muscular control, Eg Down Syndrome and American Indians
Other pathologies leading to OM (non-E-Tube)
-Anatomical obstruction: Inflammation, Polyps, Cholesteatoma, Stenosis, Compression, Length abnormality, shorter more likely reflux into ME. Cholesteatoma doesn’t have to be in the TM, can be somewhere else. Stenosis could be due to tumor pressing up against tube closing it. Radiation treatments can cause tissues to inflame and not open as well. Inflammation of adenoids can also cause tube dysfunction.
Treatment - AOM
-Adults and older children - wait & watch -Antibiotics –E.g. Amoxil - Augmentin – , Zithromax -Hearing evaluation: Sensorineural component?, Define degree of CHL, Baseline and preop planning, Tympanometry to evaluate stage of disease, Assess ET function
Treatment - Recurrent AOM w/o persistent fluid
-Chemoprophylaxis: prevention by chemical , controversial -Myringotomy and tube insertion: decreased # and severity, +otorrhea and other complications, may require prophylaxis if severe. Persistent perf, scarring, tube plugging, early extrusion, extrude into ME etc -Adenoidectomy + tubes: 28% fewer (at 1 year followup) and 35% fewer (at 2 year f/u) episodes of AOM vs. tube only