The Middle Ear The Good, The Bad and The Ugly Gary Kroukamp ENT Kingsbury Hospital

Middle Ear Diseases - Otosclerosis - TB ACUTE OTITIS MEDIA PAIN++ , Red drum, Children>>adults CHRONIC SUPPURATIVE OTITIS MEDIA OTORRHOEA, chronic, painless Without cholesteatoma With cholesteatoma MIDDLE EAR EFFUSION/OME/GLUE EAR Hearing loss (mild-mod) Children>> adults - Otosclerosis - TB

ACUTE OTITIS MEDIA Easily diagnosed URT pathogens High dose Amoxil/Augmentin (resistant pneumococcus) Analgesia

CHRONIC SUPPURATIVE OTITIS MEDIA CLUES TO CHOLESTEATOMA: Squamous epithelium Really bad anaerobe smell Attic perforation diagnostic; BUT “central” doesn’t exclude Relentless otorrhoea (no response to Rx )

CHRONIC SUPPURATIVE OTITIS MEDIA WITHOUT CHOLESTEATOMA Rx : Local works best: Toilet: syringing mopping & Antibiotic/Steroid drops Pus swab & repeat Refer ? Cholesteatoma?

MIDDLE EAR EFFUSION / OME / GLUE EAR Children>adults History not always obvious: asymptomatic Clinical signs difficult to see (child&subtle) TM movement useful: pneumatise tympanometry

TYMPANOSCLEROSIS This is NOT cholesteatoma/ disease Usually clinically insignificant Very low incidence hearing Loss

Otitis Externa Painful Swimming Earbuds Rx – drops or Quadriderm

HOW TO DISTINGUISH MASTOIDITIS FROM POSTAURICULAR LYMPHADENITIS 2° TO OTITIS EXTERNA / IMPETIGO Signs of inflammation over mastoid ANTRUM? Inflammation of T.M.?

WHEN TO DO NOTHING! Traumatic perforation due to “dry” trauma 90% will heal

Otosclerosis Conductive hearing loss Progressive Normal tympanic membrane Unknown aetiology CT scan with typical audio is diagnostic Surgery vs HAid

TB Middle Ear TB elsewhere Multiple perforations Painless Facial Nerve Palsy in children Pus swab unresponsive CSOM