The Child s Ear. Normal? Abnormal? And what do we do next?

Transcription

1 The Child s Ear Normal? Abnormal? And what do we do next?

2 Anatomy of the Ear:

3 Outer (External) Ear

4 External Ear:

5 Middle Ear:

6 Inner Ear:

7 Inner Ear: Cochlea

8 Inner Ear: Semicircular Canals

9 Why do we care?

10 And. Ear pain, discharge from the ear, and suspected hearing loss are three of the most common and specific ear symptoms for which parents seek medical attention for their children One study revealed more than a third of sick visits to pediatricians involved ear symptoms Delayed diagnosis can have serious long-term sequelae including including increased medical costs, need for surgery, missed school days, and permanent hearing loss

11 Examining the Ear:

12 Techniques/Equipment: Otoscope/ Insufflator

13 Managing Difficult Exams:

14 Examining the Ear: External ear: Pinna Preauricular area Postauricular area including lymph nodes, mastoid process Ear canal

15 External Ear!

16 Cleaning Ears:

17 Best Way to Clean Ears At Home

18 Other Ways: Debrox drops Gentle lavage with bulb suction and warm water

19 And in the Office:

20 Middle Ear: Normal Tympanic Membrane

21 TM Landmarks:

22 Which side?

23 Disorders of the External Ear: Discharge Displacement Discoloration Deformity

24 Discharge:

25 Otitis Externa or Swimmer s Ear

26 Can also be caused by foreign bodies:

27 Or Trauma:

28 Otitis Externa: Symptoms Signs Treatment Prevention

29 Displacement: Mastoiditis

30 Discoloration: Battle Sign

31 Basilar skull fracture also often associated with hemotympanum

32 Deformity: Congenital- minor to extensive May indicate other organ malformations Microtia/auricle malformations Preauricular sinuses/pits/cysts Preauricular tags

33 Preauricular Pit/ Sinus

34 Preauricular Tags:

35 Infected/Retained earrings

36 Middle Ear Disorders: Normal Tympanic Membrane

37 Otitis Media:

38 Definitions of Otitis Media: Acute Otitis Media : 1. history of acute onset of signs and symptoms 2. the presence of middle ear effusion 3. signs and symptoms of middle ear inflammation

39 Acute Otitis Media Signs and Symptoms

40 A Little Note on Ear Pulling

41 Acute Otitis Media:

42 Acute Otitis Media:

43 Bullous Myringitis

44 Acute Otitis Media AAP/AAFP Clinical Practice Guidelines Published in 2004 to provide recommendations for primary care clinicians for the management of uncomplicated AOM in children ages 2 months to 12 years Based on a comprehensive review of evidence based literature related to AOM

45 To treat or not to treat? I want the bubblegum medicine

46 Age Certain Dx Uncertain Dx <6 months Antibacterial therapy 6 mo to 2 y Antibacterial therapy Antibacterial therapy Antibacterial therapy if severe illness, observation option if nonsevere >2 y Antibacterial therapy if severe illness, observation option if not severe Observation option

47 Complications of Untreated Otitis Media: Tympanosclerosis

48 Complications of Untreated Otitis Media: Tympanic membrane perforation

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50 Complications of Untreated Otitis Media: Mastoiditis

51 Cholesteatoma:

52 Perforation with Cholesteatoma

53 Cholesteatoma: Formed by trapped epithelial tissue that grows beneath the surface of the tympanic membrane Most are sequelae of untreated or chronic-recurrent otitis media Will continue to enlarge if not surgically removed Locally destructive can erode mastoid bone, destroy ossicles, even invade inner ear structures or skull

54 Definitions of Otitis Media: Otitis Media With Effusions: 1. The presence of fluid in the middle ear WITHOUT signs or symptoms of an acute ear infection 2. May occur spontaneously because of poor eustachian tube dysfunction, before the development of AOM or as a result of AOM. Oti

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56 Otitis Media with Effusion

57 Otitis Media with Effusion:

58 Otitis Media with Effusion AAP/AAFP Clinical Practice Guidelines Published in 2004 after multidisciplinary review of evidence-based literature of otitis media with effusion. Recommendations regarding diagnosis and treatment of OME in children ages 2 months to 12 years 8 major recommendations made No medication intervention recommended based on lack of evidence of benefit (decongestants, antibiotics, steroids,etc.) No recommendation made on possible benefit with allergy therapy If surgery is needed, tympanostomy tube insertion is the preferred initial procedure.

59 Tympanostomy Tubes

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62 So Lets protect our children s wonderful ears