Glue Ear and Otitis Externa Martin Porter Consultant ENT Worcester

Take home messages 1. Do not refer Glue Ear to ENT 2. Do not give antibiotics to otitis externa

Otitis media/Glue ear Classification Diagnosis Management Indications for surgery Follow up arrangements FAQs

Classification Acute otitis media Otitis Otitis media with effusion (OME) Serous otitis media (SOM) Glue ear Catarrhal otitis media

Diagnosis History – Deafness – Pain – Discharge – Behaviour – Speech

Diagnosis History Examination

Management Watchful waiting – Video – Leaflets – Internet – Reassess Smoking Make allowances

Grommet operations K K

Grommet protocol 1.Subjective problem parents or teachers 2.Objective otoscopy or tympanometry 3.Quantify 25 dB loss 4.Persistent three months minimum Exceptions

Grommet follow up Audiology lead follow up! – Six weeks – discharge to GP Exceptions – multiple handicap – Structural changes

FAQ’s What are the alternatives? Further watchful waiting Antibiotics Diet Otovent Osteopathy Hearing aid

FAQ’s Role of adenoidectomy Role of tonsillectomy Chances of recurrence Swimming after operation Complications – Infection – Perforation

Summary Glue ear is common Most cases are self limiting Watchful waiting for the majority – Education – Making allowances Grommets for a select minority Audiological follow up

Otitis Externa Definition Predisposing factors Pathology Differential diagnosis Prevention Treatment FAQs

Otitis externa-definition

Otitis externa –predisposing factors Skin conditions Trauma Wet Diabetes Middle ear disease Antibiotics!

Otitis externa -pathology Inflammation of skin Infection of skin Bacterial – Pseudomonas – Staph – Coliforms Fungal – Aspergillus Yeast – Candida Viral – Herpes

Otitis-differential diagnosis Otitis externa Adult Painful itch Thin discharge Trauma/water Narrow ear canal Otitis media Child/Adult Painful/painless Mucoid discharge Preceding URTI Normal ear canal

Otitis Externa- prevention Remove wax – Softener – Syringe – Microsuction Treat Itch – Earcalm – Steroid drops Avoid water – Ear plugs/cotton wool/bands

Otitis externa - Treatment Anti-irritant – Ear calm – Aluminium acetate Anti inflammatory – Betnosol ear drops – Betnovate scalp application Toilet – Mop – Microsuction – Remove foreign body Antibiotic – Topical +/-wick – Systemic

Otitis Externa- FAQs Perforations Syringing

Summary Prevention is better than cure Avoid antibiotics unless absolutely necessary