1. Glue Ear and Otitis Externa Martin Porter Consultant ENT Worcester

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

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

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

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

6. Diagnosis History Examination

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

11. Grommet operations 1994-543K 2008-925K

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

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

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

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

17. 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

18. Otitis Externa Definition Predisposing factors Pathology Differential diagnosis Prevention Treatment FAQs

19. Otitis externa-definition

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

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

25. 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

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

27. 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

29. Otitis Externa- FAQs Perforations Syringing

30. Summary Prevention is better than cure Avoid antibiotics unless absolutely necessary