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

6. 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

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

8. 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 )

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

10. 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

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

12. Otitis Externa
Painful
Swimming
Earbuds
Rx – drops or
Quadriderm

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

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

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

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