Otitis externa
- Inflammatory disorders of the external ear are common
- Can be either an acute or chronic disorder
- Often associated with generalised skin disorders
- Common pathogens include staphylococcal species and pseudomonas aeruginosa
- Fungi, candida and aspergillus may also be involved
- The condition is often bilateral
- Treatment is with topical antibiotics and steroids
- Debris should be suctioned under direct vision
- Systemic antibiotics are rarely required
Acute suppurative otitis media
- Common in childhood
- Due to infection of the middle ear
- Commonest pathogens are Streptococci pneumoniae and Haemophilus influenzae
- Presents with severe ear ache
- Child is usually systemically unwell
- Tympanic membrane is often red and bulging
- Pain may be relieved by rupture of the tympanic membrane
- Child requires oral antibiotics for 10 days
Complications
- Chronic suppurative otitis media
- Adhesive otitis media
- Tympanosclerosis
- Ossicular destruction
- Acute mastoiditis
- Intracranial complications
Chronic suppurative otitis media
- Classified into two types
- Tubotympanic associated with perforation of the pars tensa
- Atticoantral associated with a retraction pocket of the pars flaccida
Tubotympanic CSOM
- Usually follows acute otitis media or trauma
- Results in chronic perforation of the tympanic membrane
- Presents with an intermittently discharging ear
- Associated with conductive hearing loss
- Treatment is with antibiotics, steroids and suction
- If conservative treatment fails a myringoplasty may be needed
- Temporalis fascia is usually used as the graft material
Atticoantral CSOM
- More dangerous condition than tubotympanic CSOM
- Associated with cholesteatoma formation
- Squamous epithelium proliferates in the attic of the middle ear
- Expanding ball of skin causes a low-grade osteomyelitis
- Presents with purulent aural discharge and conductive hearing loss
- Complications include:
- Vestibular symptoms
- Facial nerve palsy
- Meningitis
- Intracranial abscess
- Treatment is surgical and requires either:
- Atticotomy
- Modified radical mastoidectomy
Acute tonsillitis
- Common condition
- Approximately 60% cases are bacterial
- Often due to Group A streptococci
- Characterised by sore throat, fever, malaise
- Cervical lymphadenopathy usually occurs
- Tonsils are usually enlarged and coated with pus
- Treatment is with simple analgesia and penicillin
Quinsy
- A quinsy is a peritonsillar abscess
- Causes severe tonsillar pain and trismus
- Examination shows swelling of the soft palate above the involved tonsil
- The uvula is usually displaced
- Treatment is with intravenous antibiotics
- Abscess can be aspirated or drained under local anaesthetic
- Consider elective tonsillectomy
Indications for tonsillectomy
Absolute
- Sleep apnoea
- Suspected tonsillar malignancy
Relative
- Recurrent tonsillitis
- Chronic tonsillitis
- Peritonsillar abscess (Quincy)
- Diphtheria carriers
- Systemic disease due to beta-haemolytic streptococcus
Acute paediatric stridor
Congenital
- Laryngomalacia
- Laryngeal web
- Subglottic stenosis
Acquired
- Angioneurotic oedema
- Impacted foreign body
- Epiglottitis
- Laryngotracheobronchitis
- Vocal cord palsy
- Benign laryngeal papillomatosis
Acute epiglottitis
- Occurs in both adults and children
- In children it is a life-threatening disease
- In young children symptoms can progress rapidly
- Due to haemophilus influenzae infection
- Presents with stridor and drooling
- Patient may require intubation or tracheostomy
- Insertion of spatula may precipitate complete airway obstruction
- Also require humidified oxygen and antibiotics
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