Glue Ear and Otitis Externa Martin Porter Consultant

Glue Ear and Otitis Externa Martin Porter Consultant ENT Worcester

Take home messages 1. Do not refer Glue Ear to ENT 2. Do not give antibiotics to otitis externa

Otitis media/Glue ear • Classification • Diagnosis • Management • Indications for surgery • Follow up arrangements • FAQs

Classification • Acute otitis media • Otitis media with effusion (OME) • Otitis • Serous otitis media (SOM) • Glue ear • Catarrhal otitis media

Diagnosis • History –Deafness –Pain –Discharge –Behaviour –Speech

Diagnosis • History • Examination

Management • Watchful waiting –Video –Leaflets –Internet –Reassess • Smoking • Make allowances

Grommet operations 1994 -5 43 K 2008 -9 25 K

Grommet protocol 1. Subjective problem parents or teachers 2. Objective otoscopy or tympanometry 3. Quantify 25 d. B loss 4. Persistent three months minimum • Exceptions

Grommet follow up • Audiology lead follow up! –Six weeks –discharge to GP • Exceptions –multiple handicap –Structural changes

FAQ’s What are the alternatives? • Further watchful waiting • Antibiotics • Diet • Otovent • Osteopathy • Hearing aid

FAQ’s • Role of adenoidectomy • Role of tonsillectomy • Chances of recurrence • Swimming after operation • Complications –Infection –Perforation

Summary • Glue ear is common • Most cases are self limiting • Watchful waiting for the majority –Education –Making allowances • Grommets for a select minority • Audiological follow up

Otitis Externa • Definition • Predisposing factors • Pathology • Differential diagnosis • Prevention • Treatment • FAQs

Otitis externa-definition

Otitis externa –predisposing factors • Skin conditions • Trauma • Wet • Diabetes • Middle ear disease • Antibiotics!

Otitis externa -pathology • Inflammation of skin • Infection of skin • Bacterial – – – Pseudomonas Staph Coliforms – Aspergillus – Candida – Herpes • Fungal • Yeast • Viral

Otitis-differential diagnosis • Otitis externa • Adult • Painful itch • Thin discharge • Trauma/water • Narrow ear canal • Otitis media • Child/Adult • Painful/painless • Mucoid discharge • Preceding URTI • Normal ear canal

Otitis Externa- prevention • Remove wax – – – Softener Syringe Microsuction – – Earcalm Steroid drops – Ear plugs/cotton wool/bands • Treat Itch • Avoid water

Otitis externa - Treatment • Anti-irritant – – Ear calm Aluminium acetate – – Betnosol ear drops Betnovate scalp application – – – Mop Microsuction Remove foreign body – – Topical +/-wick Systemic • Anti inflammatory • Toilet • Antibiotic

Otitis Externa- FAQs • Perforations • Syringing

Summary • Prevention is better than cure • Avoid antibiotics unless absolutely necessary