AAO-HNSF Primary Care Otolaryngology Handbook

OTITIS MEDIA

with a history of cleft palate or those with trisomy 21, are predisposed to long-term problems with otitis media and Eustachian tube dysfunction. Otitis media with effusion in adolescents and adults , especially if it is of recent origin and unilateral , should prompt an examination of the nasopharynx for a disease process affecting the Eustachian tube. Early nasopharyngeal carcinoma is well known for its silent nature—often the only sign is unilateral otitis media with effusion . Later in the disease process, the tumor metastasizes to the cervical lymph nodes and extends into the skull base, causing cranial neuropathies . Patients with persistent unilateral middle ear effusion should be referred to an otolaryngologist for examination of the nasopharynx using a rigid or flexible endoscope passed through the nose. Complications of Acute Otitis Media Complications of acute otitis media were common in the pre-antibiotic era. It is largely because of those complications that otolaryngology developed as a specialty more than 100 years ago. With advances in the diagnosis and treatment of otitis media, severe complications, such as mastoiditis and meningitis , have decreased in incidence. However, as the prevalence of resistant organisms increases , especially Streptococcus pneumoniae , these complications may again become more common . Thus, it is essential that providers be aware of the presenting signs and symptoms of complications of acute otitis media and be able to initiate evaluation and treatment. Purulent ear drainage in the setting of acute otitis media is likely caused by eardrum, or tympanic membrane, rupture (perforation). The eardrum is the path of least resistance in the ear; thus, a buildup of middle ear purulence during an episode of acute otitis media can result in sponta- neous TM rupture . Treatment is similar to that described above for acute otitis media. Most commonly, the perforation will heal on its own within two weeks. However, persistent perforations may require surgical repair. Occasionally, eardrum perforations can be associated with chronic ear drainage, also known as chronic suppurative otitis media . These patients may benefit from topical antibiotic therapy. Another residual effect of acute otitis media and TM rupture is tympanosclerosis or myringoscle- rosis —a firm submucosal scarring that can appear as a chalky white patch on the eardrum. This can infrequently lead to conductive hearing loss if the middle ear and ossicles are involved extensively. Other more severe complications of otitis media include meningitis and mastoiditis . Meningitis originating from otitis media is believed to

25

www.entnet.org