1. Ears!
Mark Hambly

2. 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!

3. 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

4. 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

5. 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

6. 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

7. 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

8. Perforations

9. 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

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

11. 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

12. 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.

13. 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