Ears! Mark Hambly

Ear pain – what could it be? Common presentation in GP Most likely otitis media or externa Below some tips on each with some quiz questions!

Question 1 – Otitis Media Acute suppurative otitis media (“ASOM”) Which of the following 3 are required for a diagnosis of ASOM Pyrexia Sudden onset Red helix Signs of middle ear effusion Lymphadenopathy Signs of ear inflammation Diagnosis made form signs and symptoms – symptoms – ear pulling, pyrexia, irritability, commonly following URTI Also worth pointing out – most common in children 3-6 but 30% children below this will visit GP each year

Question 2 – Otitis Media What proportion of ASOM is bacterial? 50% 60% 80% 90% And 4% of the others thought to have a bacterial component

Question 3 – Otitis Media Which of the following are complications of OM? Transient hearing loss Perforation of TM Mastoiditis Balance disturbance Recurrence THL – common but usually mild to moderate Perforation, Sould heal within 2 weeks – if symptoms persist or still perf at 6 weeks then ref ENT

Question 4 – Otitis Media Treatment Three options for antibiotic prescription None (with review) Delayed Immediate Which is most appropriate antibiotic? Ciprofloxacin Amoxicillin Gentamicin 80% resolve within 3 days In trial immediate vs delayed prescribing, symptoms were relieved after 24 hours in Rx group but 10% more diarrhoea and in other group symptoms were also improving and only 24% used abx. 5 day

Otitis Media – other points Recurrent 3+ episodes in 6 month Refer to ENT Chronic suppurative ‘safe’ – perforation in pars tensa Treatment as per otitis externa – swab and topical abx/steroids ‘unsafe’ Could indicate cholesteatoma 80% resolve within 3 days In trial immediate vs delayed prescribing, symptoms were relieved after 24 hours in Rx group but 10% more diarrhoea and in other group symptoms were also improving and only 24% used abx. 5 day

Perforations

OM - Glue ear Effusion persists >3 months post OM (common to persist a month or two) In adult – sinister – refer In children <3, if mild hearing loss, can watch and wait (clearly would still need audiometry - ?ENT referral) If over 3 or S&L/behavioural difficulty - ENT

Otitis externa Symptoms Itching Pain, especially on jaw movements and pulling pinna Hearing loss

Examine for signs of cause Otitis externa Examine for signs of cause Infective Inflammatory Traumatic Some predisposing factors Treatment Analgaesia Topical Steroid with antibiotic most common No benefit in adding oral therapy And consider swab of severe/recurrent

OE - Prevention Don’t put anything in the ear Don’t dry ears with paper/cloth towel after swimming can just tip water out, dry with dryer If recurrent - vinegar drops for afterwards Can use cotton buds with vasaline to prevent water ingress Locorten-Vioform – covers most things Oral therapy can be useful when topical not likely to work.

AKT question from InnovAiT In AOM, which ONE of the following it true: AOM and OM with effusion have separate pathologies AOM is diagnosed in primary care by history and otoscopy in most cases AOM usually becomes chronic There is a clear association between AOM in early life and language development at age 4 Systemic signs of illness with a middle ear effusion confirm the diagnosis