AAO-HNSF Primary Care Otolaryngology Handbook

OTITIS MEDIA

Clinical Example A 49-year-old, nondiabetic male comes to your clinic with a draining right ear. The otorrhea has been off and on for years. The ear, nose, and throat exam is normal, except for copious purulence coming out of an eardrum perforation. You prescribe oral antibiotics and an antibiotic eardrop. You tell him to keep water out of his ear, which he does, and he comes back in two weeks, without ear drainage. You order an audiogram, which shows a 20-dB conductive hearing loss and good discrimination. He comes in draining again in two weeks, despite the fact that he has not gotten his ear wet. You repeat medical therapy and, once again, he clears but drains a month later. He has a deep nidus of infection in his mastoid cavity that needs to be cleared. You schedule him for a CT scan, which shows no cholesteatoma but mastoid opacification, and you then perform a tympa- nomastoidectomy . This surgery involves drilling out the mastoid bone to eliminate the nidus of infection and repairing the eardrum hole. The take- home message is that patients with recurrent ear drainage despite treat- ment with topical antibiotic drops require otolaryngology referral for further evaluation.

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