How to Treat Otitis Media

Natures Amazing Ear Infection Cures By Naturopath Elizabeth Noble

Little Known Secrets To Cure An Ear Infection Fast! Here's A Taste Of What's Revealed In The Nature's Amazing Ear Infection Cures e-book: What type of ear infection do you or your loved one have? The 9 ear infection symptoms you can't afford to ignore. Danger at the drugstore what drugs you should never buy. Why antibiotics are useless and possibly dangerous for most ear infections. The problems with surgery. The causes and triggers of an ear infection everything from viruses, bacteria and fungi to allergies, biomechanical obstruction, environmental irritants, nutrient deficiencies, poor infant feeding practices and more. How to relieve even the most excruciating ear ache with a hot onion poultice. An ancient Ayurvedic recipe to control an ear infection. The herbal ear drops you can make in your own kitchen that are renowned for soothing ear pain. The wonderful essential oil ear rubs you can make to ease ear congestion and discomfort. The simplicity of homeopathy for treating an ear infection great for babies and young children. User-friendly acupressure, massage and chiropractic to relieve ear pain, enco. How to relieve problem ears with air travel.

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Otitis Media with Effusion Socalled Glue ear in Children

A middle-ear effusion is a common cause of conductive hearing loss. It may occur when either a head cold or barotrauma interferes with eustachian tube function, and it often follows acute otitis media. A postnasal space neoplasm may also cause eustachian tube dysfunction, and is to be excluded in any adult with a persistent otitis media with effusion. In children, otitis media with effusion is very common when adenoid tissue interferes with the eustachian tube. The middle-ear fluid tends to be tenacious ( glue ear ), unlike the thin, straw-colored exudate of adults.

Audiogram Of Otitis Media

Tympanic Membrane Promontory

In grade I, II, and III atelectasis, a long-term ventilation tube is usually inserted to prevent further retraction of the tympanic membrane. However, in cases with marked conductive hearing loss that denotes erosion of the incus or the superstructure of the stapes, ossiculoplasty is performed after extraction and sculpturing of the eroded incus or using a homologous incus. A large disk of tragal cartilage is used to reinforce the tympanic membrane. Indications for surgery in adhesive otitis media include cases with tympanic membrane perforation (grade V according to Sade 1979), with or without polypi, granulation or otorrhea, those cases with a large infected retraction pocket causing frequent otorrhea, or those with conductive hearing loss due to ossicular chain erosion. In all these cases a tym-panoplasty is performed using a postauricular incision. A disk of tragal cartilage is used with the peri-chondrium adherent to its lateral surface. If the handle of the malleus is present,...

Chronic Otitis Media With Effusion

Otitis Media With Effusion Adults

Middle-ear fluid, if persistent, may cause permanent changes in the drum. An otitis media with effusion can cause hearing loss for decades, and the diagnosis is frequently overlooked in a long-standing hearing loss. Impedance audiometry helps in diagnosis. There is no successful treatment at present for chronic otitis media with effusion when this fails to respond to insertion of a grommet. A further problem with chronic otitis media with effusion is the return of middle-ear fluid with hearing loss when the grommet extrudes. A larger flanged grommet (long-term grommet) which remains in position longer, and periodic replacement are the present remedies.

Otitis Media Introduction

Otitis Media (OM) is an infection of the middle ear most common in infants and toddlers during the winter months. It may be either viral or bacterial. Inflammatory obstruction of the eustachian tube causes accumulation of secretions in the middle ear and negative pressure from lack of ventilation. The negative pressure pulls fluid and microorganisms into the middle ear through the eustachian tube resulting in otitis media with effusion. The illness usually follows a URI or cold. The older child runs a fever, is irritable, and complains of severe earache, while a neonate may be afebrile and appear lethargic. The child may or may not have a purulent discharge from the affected ear. Myringotomy is a surgical procedure performed to equalize the pressure by inserting tubes through the tympanic membrane. The tympanostomy tubes remain in place until they spontaneously fall out. Most children outgrow the tendency for OM by the age of 6. There is a higher incidence in children exposed to...

Factors Involved in Treatment Algorithm for Chronic Otitis Media

The initial evaluation of patients with chronic otitis media should include a thorough otologic and general medical history. The otologic history must include careful documentation of symptoms and previous treatment, both medical and surgical. The general medical history should include documentation of potential predisposing factors including upper respiratory allergy, smoking, diabetes mellitus, and possible immunologic compromise. Examination should include a thorough otologic and complete head and neck examination. Audiometry is essential. Bac-teriologic cultures, including anaerobes in cases of chronic otitis media with otorrhea may be helpful. Computed tomography (CT) of the temporal bones, in both the axial and coronal planes, will provide valuable information concerning pneuma-tization of the mastoid, extent of cholesteatoma and granulation tissue, potential complications such as dehiscence of a semicircular canal or the facial nerve, or unexpected findings such as extension of...

Otitis Media To Treat or Not to Treat

The first objective in the effective management of otitis media is not whether or when to treat, but to accept that this is a disorder that is still badly diagnosed and that adequate diagnosis is the keystone to adequate management. Otitis media is a multifactorial disease process involving immunology, infectious disease, anatomic considerations, social and socioeconomic issues, and genetics, among other factors. Before physicians can attain a clear understanding of otitis media, a clear universally accepted classification system will need to be developed. Otitis Media To Treat or Not to Treat There have been few true advances in the treatment of otitis media since Armstrong's reintroduction of the tympanostomy tube in 1954.1 Management decisions have revolved around three primary options not to treat, to use antibiotics, or to recommend tympanostomy tubes. Other modalities have been suggested, some shown to be of little benefit (decongestants, antihistamines),2 and others to have a...

Classification of Otitis Media

The terminology in the literature associated with otitis media is complex and quite variable. Most classification systems for otitis media attempt to describe the disease process on the basis of the duration of the process, the type of inflammatory fluid involved, the presence of tympanic membrane perforation, the presence of suppurative or nonsuppurative disease and other criteria.6 The confusion in the literature regarding classification impedes our ability to describe the disease process and thus complicates clinical research and our ability to communicate effectively about otitis media.7 1. Acute otitis media Suppurative or purulent middle ear process associated with purulent middle ear effusion with one or more of the following signs otalgia, otorrhea, fever, and acute onset of irritability. Otoscopic findings demonstrate purulent middle ear effusion and a bulging tympanic membrane with loss of tympanic landmarks possibly with the presence of an acute draining perforation. 2....

Microbiology of Otitis Media

The microbiology of otitis media has been carefully elucidated by numerous studies.8-12 However, with the increased use of antimicrobial agents, the emergence of resistant bacteria has become a significant problem related to otitis media. Data from studies performed by Bluestone and Klein9 demonstrate that Streptococcus pneumoniae remains the primary bacterial cause of otitis media, followed by Haemophilus (38 ), Haemophilus influenzae (27 ), and Moraxella caterrhalis (10 ). In this same study, 28 demonstrated no bacteria or nonpathogenic bacteria. Approximately 30 to 40 of patients with acute otitis media demonstrate respiratory viruses that may be present in combination with bacterial pathogens.13 Respiratory syncytial virus has recently been implicated as a major viral pathogen in otitis media.14 In recent years, the incidence of resistant bacteria has increased in cases of otitis media. First noted was the advent of b-lactamase-producing Haemophilus influenzae and Moraxella...

Treatment Options for Otitis Media

To understand fully when it is appropriate to treat otitis media in children, the pathophysiology of the various subtypes of otitis media should be understood and the appropriate diagnosis must be made. In addition, various treatment modalities for otitis media both medical and surgical may benefit a particular patient. The importance of individualization of treatment for every patient with otitis media must be emphasized. Otitis media is a multifactorial process. Different treatment modalities may be warranted in patients based on their particular social situation, immunologic status, age, associated medical problems, or other factors. Various treatment modalities for otitis media will be briefly discussed to help the practitioner decide which patient should be treated, and by what particular treatment strategy.

Medical Management Options for Otitis Media Antibiotics

Antimicrobial therapy has continued to be a mainstay of therapy for patients with otitis media. Recently, there has been evidence that over usage of antimicrobial therapy has led to an increased incidence of bacterial resistance in common pathogens related to otitis media. Most notably, St. pneumoniae, H. influenzae, and M. caterrhalis.15 Children frequently presenting to primary physicians with viral upper respiratory tract infections may be treated with antimicrobials, whether or not the patient has simultaneously developed otitis media.4 We know from prior microbiologic studies13,14 that a significant number of middle ear effusion cultures contain predominantly viruses that would not benefit from antimicrobial therapy. It is apparent from these prior studies that many children with otitis media may not benefit from antimicrobial agents, as the cause of otitis media in many cases is nonbacterial, or some cases of bacterial otitis media may resolve without pharmacologic therapy....

Diagnosis of Otitis Media Related to Treatment

Important in the decision to treat or not treat otitis media, the clinician must appreciate the diagnostic differences between acute otitis media and otitis media with effusion, as the latter condition is usually not treated unless it becomes chronic (Table 78-1). Acute otitis media is characterized by the rapid, brief onset of signs and symptoms of infection in the middle ear. One or more of the following are present otalgia (or pulling of the ear in the infant), fever, or irritability of recent onset. The tympanic membrane is full or bulging, opaque, and has limited or no mobility to pneumatic otoscopy. After an episode of acute otitis media, the middle ear may have fluid that remains for weeks to months, which has been termed persistent middle ear effusion. Otitis media with effusion is a relatively asymptomatic middle ear effusion. Pneumatic otoscopy frequently shows either a retracted or concave tympanic membrane, the mobility of which is limited or absent. However, fullness, or...

Diagnostic Similarities and Differences between Acute Otitis Media and Otitis Media with Effusion

Acute otitis media Present Present Present Present Present Present Otitis media with effusion Absent Present May be absent Usually absent Present Usually In contrast to acute otitis media, bacteria considered to be potentially pathogenic can be isolated from only one-third of middle-ear aspirates from patients who have otitis media with effusion. Similar to isolates from acute otitis media, the most common are S. pneumoniae, H. influenzae, and M. catarrhalis, but the latter two organisms are more commonly isolated than pneumococcus.4 Resistance rates of these organisms are similar to rates found when these bacteria cause acute otitis media. Recently, these three bacteria have been detected by polymerase chain reaction (PCR) in approximately 70 of chronic middle ear effusions at the time of myringotomy and tympanostomy tube insertion only about one-third of the organisms were identified using traditional culture methods.5'6

Evidence That Antimicrobial Agents Are Indicated for Treatment of Acute Otitis Media

Microbiologic Outcome Howie et al.7 evaluated the microbiologic efficacy with various therapeutic regimens, including a placebo. Although these studies suggest that many cases of infection of the middle ear resolve spontaneously or with the assistance of spontaneous drainage, the data indicate that the most important bacterial pathogens responsible for otitis media will not resolve clinically or microbiologically without medical intervention. A proportion of middle ear effusions that have a positive culture clear the organism without drug intervention (spontaneous clearance). However, in about 20 of infections due to S. pneumoniae, and in 50 of infections due to H. influenzae, administration of an antimicrobial agent to which these organisms are susceptible results in sterilization of the effusion in almost all the ears. Symptomatic Outcome Rosenfeld et al.8 conducted a metaanalysis of 5400 children from 33 randomized trials that addressed the question of efficacy of antimicrobial...

Recurrent Acute Otitis Media

When attacks of acute otitis media are frequent and close together (e.g., three or more episodes in 6 months, or four or more attacks in 12 months, with one being recent), prevention is desirable. The parents caretakers should be advised to avoid placing the child in a day-care center, or if this is not feasible, a facility should be chosen that has the fewest number of children possible. Also, they should be counseled about the increased risk of recurrent acute otitis media associated with smoking in the household. Although not effective in infants, the administration of the currently available pneumococcal vaccine is also recommended for children above the age of 2 years the influenza vaccine is also advocated and can be administered to infants. There is no general agreement today on the other nonsur-gical and surgical methods of prevention. Amoxicillin, 20 mg kg in one dose (given at bedtime), has proved effective.25 If the child is allergic to the penicillins, a daily dose of...

Antimicrobial Agents Available for Treatment of Otitis Media

* Includes the oral agents and one parenteral drug available for treatment on an ambulatory basis, whereas there are other parenteral antimicrobial agents effective for treatment of otitis media, usually on an inpatient basis. azithromycin or clarithromycin, is advocated as an alternative, one of the newer cephalosporins (e.g., cefuroxime-axetil, cef-podoxime, loracarbef, ceftriaxone) could be used, if the patient does not have hypersensitivity to these agents, and does not have an immediate hypersensitivity reaction to the penicillins. Trimethoprim-sulfamethoxazole is not a desirable alternative, as it has had an unacceptable safety record. A single parenteral dose of ceftriaxone is the most recent antimicrobial agent approved for treatment. The quinolones, such as ciprofloxacin, are not indicated in children below 18 years of age, and efficacy of these antimicrobial agents has not been reported in adults with acute otitis media. Most cases of acute otitis media improve significantly...

Acute Otitis Media

Stapedectomy Prosthetic Diagram

Earache with conductive hearing loss and fever accompanying a head cold characterize acute otitis media. The drum is red and the landmarks are obscured drum distension and pulsation may be seen. Otitis media is common in children, probably due to their short, wide eustachian tube and the presence of adenoids which may be infected near the orifice. Rupture of the tympanic membrane in acute otitis media is not uncommon and muco-purulent otorrhea ensues with a pulsatile discharge. Penicillin is invariably curative, and complications are rare. The middle-ear infection frequently settles without otorrhea, but if the drum does rupture, a pulsating muco-purulent discharge filling the meatus is diagnostic of otitis media. A swab for culture and sensitivity is taken in these cases, although the ear usually becomes dry within 48 hours of penicillin therapy, and the perforation closes in most cases with little or no scarring. Acute mastoiditis, previously serious and common, is almost unheard of...

Otitis Eksterna

Chalk Patches Otitis Eksterna

Fig. 2.72 Otitis media with effusion with minimal drum change. The drum may look only slightly different, with a brown color and some hyperemia. A confident diagnosis of middle-ear fluid can only be made if reduced mobility is demonstrated and impedance audiometry (Figs. 1.30, 1.31) is needed for confirmation. Fig. 2.73 Otitis media with effusion ( glue ear ). a The color change in this condition is often diagnostic, as well as the reduced mobility. The golden-brown color showing through the translucent drum is readily apparent in the inferior part of the tympanic membrane. Fig. 2.73 Otitis media with effusion ( glue ear ). a The color change in this condition is often diagnostic, as well as the reduced mobility. The golden-brown color showing through the translucent drum is readily apparent in the inferior part of the tympanic membrane. Fig. 2.74 Otitis media with effusion Fig. 2.75 A vesicle on the drum (arrow) Fig. 2.74 Otitis media with effusion Fig. 2.75 A vesicle on the drum...

Referred Ear Pain

Siegle Speculum

If examination of the drum and meatus is normal in a patient complaining of earache, the pain is referred. Referred ear pain may be from nearby structures such as the temporo-mandibular joint, neck muscles, or cervical spine. It may also be from the teeth, tongue, tonsils, or larynx. Cranial nerves V, IX, and X which supply these sites have their respective tympanic and auricular branches supplying the ear. Earache also frequently precedes a Bell's palsy.

Otitis Externa

Otitis Externa Bullosa

Eczema of the meatus and pinna (see Fig. 2.41) may be associated with eczema elsewhere, particularly in the scalp, or it may be an isolated condition affecting only one ear. Itching is the main symptom, with scanty discharge. The eczematous type of otitis externa usually settles with the use of a topical corticosteroid and antibiotic drop. Cleaning of the meatus may also be necessary, either with cotton wool on a probe, or suction and the Zeiss microscope. Otitis externa tends to recur. The patient should avoid over-diligent cleaning of the meatus, or scratching the ear with the finger, probes, or cotton wool buds. Cotton wool buds, if used, should only be used to the orifice of the meatus. Water entering the ear during washing or swimming also predisposes to the recurrence of otitis externa. Fig. 2.42 A furuncle in the meatus is the other common type of otitis externa. It is characterized by pain pain on movement of the pinna or on inserting the auriscope is diagnostic of a furuncle....

Otoscopy Facial Nerve

External Auditory Meatus Squamous

While otoscopy alone can establish the diagnosis in some cases, parameters such as history, or audiolog-ical and neuroradiological evaluation are required in others. An important aspect of this atlas is that it juxtaposes, when appropriate, the clinical picture, radiological diagnosis, and intraoperative findings with the otoscopic findings of the patient. Needless to say, every patient should be considered as a whole and in some particular cases, the otoscopic findings might only be the tip of the iceberg. Otalgia, otorrhea, and granulations in the external auditory canal are manifestations of otitis externa, but when they persist, particularly in the elderly, they should arouse suspicion of malignancy. Otitis media with effusion can be a simple disease when seen in children, whereas unilateral persistent otitis media with effusion in an adult may be the only sign of a nasopharyngeal carcinoma. A small attic perforation in the presence of facial nerve paralysis and sensorineural...

Examination of the

Furunculosis Due Skin Lymphomas

To see the drum more clearly, therefore, the pinna is retracted backwards and outwards. The index finger may be used to hold the tragus forward. If this step of straightening the meatus accentuates the pain in someone presenting with an earache, one can be virtually certain that the diagnosis is either a furuncle or furunculosis (see Fig. 2.43).

Discharge And Home Healthcare Guidelines

During pregnancy, C. trachomatis may be transmitted from mother to fetus, which may cause premature rupture of the membranes, premature labor, and increased fetal morbidity and mortality. Pregnant women who deliver vaginally or by cesarean section can transmit the bacteria to their infants. These newborns can develop otitis media, conjunctivitis, blindness, meningitis, gastroenteritis, respiratory infections, and pneumonia. Because mothers are often asymptomatic, medical personnel are unaware that the maternal-infant transmission has occurred until infants become very ill.

Classification Antibiotic penicillin

Uses For beta-lactamase-producing strains of the following organisms Hemophilus influenzae and Moraxella catarrhalis causing lower respiratory tract infections, otitis media, and sinusitis Staphylococcus aureus, Escherichia coli, and Klebsiella, causing skin and skin structure infections E. coli, Klebsiella, and Enterobacter, causing UTI. Note Mixed infections caused by organisms susceptible to ampicillin and organisms susceptible to amoxicillin potassium clavulanate should not require an additional antibiotic. Contraindications Hypersensitivity to pencillins. Clavulanate K-asso-ciated cholestatic and or liver dysfunction.

Oral Suspension Chewable Tablets Tablets

Adults One 875-mg tablet q 12 hr or one 500-mg tablet q 8 hr. Children over 3 months old 45 mg kg day of amoxicillin in divided doses q 12 hr or 40 mg kg day in divided doses q 8 hr (these doses are used in children for otitis media, lower respiratory tract infections, or sinusitis). Treatment duration for otitis media is 10 days.

Action Kinetics Peak serum levels

Uses Otitis media due to Streptococcus pneumoniae, Hemophilus influenzae, Streptococcus pyogenes, and staphylococci. Upper respiratory tract infections (including pharyngitis and tonsillitis) caused by S. pyo-genes. Lower respiratory tract infections (including pneumonia) due to S. pneumoniae, H. influenzae, and S. pyogenes. Skin and skin structure infections due to Staphylococcus aure-us and S. pyogenes. UTIs (including pyelonephritis and cystitis) caused by Escherichia coli, Proteus mirabilis, Klebsiella, and coagulase-negative staphylococci. Extended-release tablets Acute bacterial exacerbations of chronic bronchitis due to non- -lac-tamase-producing strains of H. in-fluenzae, Moraxella catarrhalis (including -lactamase-producing strains), or S. pneumoniae. Secondary bacterial infections of acute bronchitis due to H. influenzae (non- -lactamase-producing strains only), M. catarrhalis (including -lactamase-producing strains), or S. pneumoniae. Pharyngitis or tonsillitis due to S....

Classification Cephalosporin

Uses Acute bacterial exacerbations of chronic bronchitis due to Haemophilus influenzae (including beta-lacta-mase-producing strains), Moraxella eatarrhalis (including beta-lacta-mase-producing strains), and penicillin-susceptible strains of Strepto-eoeeus pneumoniae. Acute bacterial otitis media due to H. influenzae, M. eatarrhalis, and Staphylococcuspyo-genes. Pharyngitis and tonsillitis due to S. pyogenes. Children pharyngitis, tonsillitis, acute bacterial otitis media. 9 mg kg, up to a maximum of 400 mg daily, for a total of 10 days. Give children over 45 kg the maximum daily dose of 400 mg.

Management of the Draining Pressure Equalization Tube

Measures useful in diminishing tympanostomy tube otor-rhea are widely discussed and debated among otolaryngologists. The safety and effectiveness of these measures are controversial. Factors considered, at least by some physicians, to decrease the incidence of postoperative tympanostomy tube otorrhea include control of environmental and behavioral risk factors for otitis media, antiseptic preparation of the ear during tympanostomy tube insertion, tube material, topical antibiotics at tube insertion, and perhaps for a few days later, and water precautions (i.e., keeping water out of the ear).

Clinical and Surgical Pitfalls and Tips for Canal WallUp and Canal Wall Down Approaches

Inadequate surgical objectives Despite total elimination of cholesteatoma, persistent or recurrent otorrhea may ensue. In cases of chronic active otitis media with cholesteatoma, the principal focus of the operating surgeon may be the cholesteatoma itself. However, it should be recognized that the surrounding reaction, including granulation, suppuration, or sequestration of air cells, in both the mastoid and the middle ear, may result in persistent or recurrent drainage.22 Analysis of failed mastoid tympanoplasty, particularly those without cholesteatoma, provide insight to common locations for residual disease.11'23-25 In my experience, residual suppurative disease occurs commonly in sequestrated tegmental and sinodural cells, mastoid tip, facial recess, and the hypotympanum.23,24 2. Remember the hypotympanum A common cause for failure of tympanomastoidectomy may be residual disease in the hypotympanum. Despite the name chronic otitis media, it is commonly assumed that the principal...

The Tympanic Membrane and Middle

Tympanosclerosis And Grommet Scar

White areas of tympanosclerosis (arrows) are common findings on examination of the drum. They are of little significance in themselves, and the hearing is often normal. A past history of otorrhea in childhood or grommet insertion is usual. Chalk patches do occur with no apparent past otitis media. Extensive tympanosclerosis with a rigid drum is a sequela of past otitis media, and the ossicles, too, may be fixed or noncontinuous. b Scarring of the drum with retraction onto the round window, promontory, and incus (arrows) is also evidence of past otitis media. It is sometimes difficult to be sure whether this type of drum is intact a thin layer of epithelium indrawn onto the middle-ear structures may seal the middle ear, and examination with the operating microscope may be necessary to be certain of an intact drum. b Scarring of the drum with retraction onto the round window, promontory, and incus (arrows) is also evidence of past otitis media. It is sometimes...

Bacterial infection affecting a child less than 13 years of age

Laboratory diagnosis of multiple or recurrent bacterial infections (any combination of at least two within 2 years) of the following types septicemia, pneumonia, meningitis, bone or joint infection, abscess of an internal organ or body cavity (excluding otitis media or superficial skin or mucosal abscesses) caused by Haemophilus spp., Streptococcus pneumoniae or other pyogenic bacteria. Lymphoid interstitial pneumonia and or pulmonary lymphoid hyperplasia affecting a child younger than 13 years of age

Cholesteatoma Hearing Loss

Polyp Tympanic Membrane

Figure 3.40 Another example of chronic suppurative otitis media with cholesteatoma that manifests with an aural polyp. Though cholesteatoma presents frequently in this manner, it is absolutely essential to abstain from taking a biopsy of the polyp in the outpatient clinic without performing a CT scan of the temporal bone (see Fig. 3.41). Figure 3.40 Another example of chronic suppurative otitis media with cholesteatoma that manifests with an aural polyp. Though cholesteatoma presents frequently in this manner, it is absolutely essential to abstain from taking a biopsy of the polyp in the outpatient clinic without performing a CT scan of the temporal bone (see Fig. 3.41). Basal cell carcinoma is more frequent in the auricle, particularly in subjects with long exposure to the sun. On the other hand, squamous cell carcinoma accounts for about three quarters of invasive tumors of the external auditory canal and the middle ear. In about 11 of cases, cervical lymph node metastases are...

Inner Ear Visible In

Hyperemic Tympanic Membrane

A carcinoma arising from the external auditory canal is frequently confused with suppurative otitis. Because of the high incidence of otitis externa and media and because these pathologies are frequently chronic, the diagnosis of carcinoma of the external auditory canal is almost always late. Diagnosis is made by biopsy. A high-resolution CT scan and MRI are necessary for proper evaluation. A high-resolution CT scan determines the osseous erosion caused by the tumor, whereas MRI is superior to CT for the evaluation of soft tissues. MRI shows the presence of dural invasion, intracranial extension, as well as extracranial soft-tissue involvement. Until now there has been no universally accepted system of staging, which is the basis for planning therapy and proper treatment evaluation. 4 Secretory Otitis Media (Otitis Media with Effusion Secretory otitis media is characterized by the presence of middle ear effusion composed of a transudate exudate of the mucosa of the middle ear cleft...

Tympanic Membrane Perforation

Retracted Normal Tympanic Membrane

Granulomatous otitis media. A roundish mass fills the middle ear. Serous otorrhea is present. Figure 7.28 Right ear. Granulomatous otitis media. A roundish mass fills the middle ear. Serous otorrhea is present. Figure 7.32 Right ear. Posterior perforation. The residues of the tympanic membrane appear whitish and bulging. During surgery, the middle ear was occupied by granulomatous tissue that proved to be tuberculosis (TB) on histopathological examination. This patient had a past history of pulmonary TB. Tuberculous otitis media should be suspected in cases of pulmonary TB presenting with otorrhea. Figure 7.32 Right ear. Posterior perforation. The residues of the tympanic membrane appear whitish and bulging. During surgery, the middle ear was occupied by granulomatous tissue that proved to be tuberculosis (TB) on histopathological examination. This patient had a past history of pulmonary TB. Tuberculous otitis media should be suspected in cases of pulmonary TB...

Capsules Oral Suspension

Dose may be doubled in more severe infections or those caused by less susceptible organisms. Total daily dose should not exceed 4 g. Children 20 mg kg day in divided doses q 8 hr. Dose may be doubled in more serious infections, otitis media, or for infections caused by less susceptible organisms. For otitis media and pharyngitis, the total daily dose may be divided and given q 12 hr. Total daily dose should not exceed 1 g.

Pasteurella pneumotropica

Pasteurella Pneumotropica

The organism is a Gram-negative bipolar staining rod. It is a pathogen of low virulence, and most infections are clinically inapparent. There are few reports of Pasteurella pneumotropica as a primary pathogen, causing pneumonia, otitis media, and conjunctivitis. It is a co-pathogen with Mycoplasma and Sendai virus, resulting in pneumonia and otitis media.

Anspor Velosef [Rx Classification Cephalosporin firstgeneration

Uses Infections of the respiratory tract (including lobar pneumonia, tonsillitis, pharyngitis), urinary tract (including prostatitis and enterococcal infections), skin, skin structures, and bone. Otitis media, septicemia, prophylaxis in surgery, following cesar-ean section to prevent infection. In severe infections, therapy is usually initiated parenterally. Contraindications Hypersensitiv-ity to cephalosporins. Special Concerns Safe use during pregnancy, of the parenteral form in infants under 1 month of age, and of the PO form in children less than 9 months of age have not been established. Hypersensitivity to penicillins. Use in renal impairment. Side Effects See also Cephalosporins. Drug Interactions See also Cepha-losporins.

What Is Chronic Pediatric Sinusitis

Whereas most clinicians would easily accept that a chronic sinus condition exists when a single process persists for more than several months, there is little evidence to suggest that this occurs in young children at a rate beyond rarely. By contrast, the pediatric sinus is frequently, and sometimes continually, assailed by the multitude of respiratory pathogens typical of the day-care flora. It appears that a number of clinicians have extrapolated certain diagnostic and therapeutic approaches from otitis media to the assessment and management of pediatric sinusitis. At first glance, the rationale appears sound the same organisms, similar respiratory epithelium, closed-space infections, and the like. The two major inconsistencies relate to the

Classification Cephalosporin secondgeneration

Action Kinetics Sixty percent is recovered in the urine unchanged. Uses Pharyngitis and tonsillitis due to Streptococcus pyogenes. Acute bacterial sinusitis due to Streptococcus pneumoniae, Staphylococcus aure-us, Haemophilus influenzae, and Moraxella catarrhalis. Otitis media

Complications Of Plfs

Meningitis is an infrequent but potentially life-threatening complication of PLFs.41, 90-93 The abnormal opening between the sterile inner ear and an infected middle ear potentially allows bacteria and viruses to enter the inner ear space. Since peri-lymph is continuous with the CSF, invading organisms can infect the CSF, meninges, and brain, causing meningitis and cerebritis. Because meningitis and cerebritis are life-threatening,94 PLFs from any cause should be closed, through either conservative or surgical means, without delay. Patients with active PLFs should also be instructed to seek medical treatment immediately if they develop symptoms or signs of an upper respiratory or middle ear infection.

Biofilm and Medical Devices

Biofilm, as a matter of fact, is involved in acute and chronic infectious diseases and has been described in human and experimental pathology such as native valve endocarditis, otitis media, bacterial chronic rhinosinusitis, COPD, chronic urinary infections, bacterial prostatitis, osteomyelitis, dental caries, biliary tract infections, Legionnaire's disease and amyloidosis.

Sensory Deficits Introduction

Auditory disorders are classified as conductive, sensorineural or mixed conductive-sensorineural hearing loss. Causes include damage to the inner ear structures or the auditory nerve from congenital defects, infection, ototoxic drugs, long-term excessive exposure to noises (sensorineural) or middle ear infection such as otitis media (conductive).

Alternative Medical Treatment Options

Other medical modalities recommended for the treatment of otitis include corticosteroids, administered orally or intra nasally 33-36 antihistamines and or decongestants. Although there is evidence that orally administered corticosteroids may help clear chronic middle ear effusion, there is no evidence that this provides a long-term benefit in patients with chronic otitis media with effusion.35 In addition, there is the risk of potential side effects from utilization of cortocosteroids. Intranasal steroids may play a role in patients with chronic middle ear effu-sion.36 However, there is no evidence of efficacy in the treatment of acute otitis media. Antihistamine decongestant preparations have been used in the past for treatment of otitis media with effusion. However, there is no evidence that this accelerates clearance of middle ear effusion and there appears to be no role for these medications in the treatment of acute otitis media.37 In children who have significant symptoms of...

Surgical Management Options

The primary surgical therapy for chronic otitis media remains placement of tympanostomy tubes for pressure equalization and drainage of the middle ear space. Numerous publications have demonstrated the efficacy of tympanostomy tubes for the treatment of chronic otitis media with effusion and recurrent otitis media.38,40-43 The Academy of Otolaryngology, in its 1995 Clinical Indicators Compendium,44 listed the following indications for placement of tympanostomy tubes (1) middle ear effusion present for 3 months or more (2) otitis media with effusion associated with hearing loss of 30 db (3) chronic severe tympanic membrane retraction (4) impending intracranial complications associated with otitis media and (5) recurrent otitis media with more than three episodes within a 6-month period, or more than four episodes within a 12-month period. It should be emphasized that these indications are guidelines and a decision to place tympanostomy tubes should be individualized for each patient,...

Microbiologic Etiology Related to Treatment

Related to an accurate diagnosis, there is a difference in the prevalence of bacterial pathogens that are isolated from ears of patients with acute otitis media compared to aspirates of otitis media with effusion. This, in turn, has an impact on the decision to recommend or not recommend antimicrobial therapy. Pathogenic bacteria are present in approximately 70 of the middle ears of patients who have acute otitis media, and are similar in type in both children and adults.2'3 Streptococcus pneumoniae (40 ), Haemophilus influenzae (25 ), and Moraxella catarrhalis (12 ) are the most common pathogens isolated. Group A b-hemolytic streptococcus and Staphylococcus aureus also cause this infection in both children and adults, but not as frequently as pneumococcus and H. influenzae. Respiratory viruses have been cultured from as many as 20 of acute effusions.

To Treat or Not to Treat with Antibiotics

Many question the need to treat otitis media with effusion, because the effusion will resolve in most children without active treatment in 2 or 3 months. Nevertheless, treatment may be indicated in some children, because there are possible complications and sequelae associated with this condition. Since hearing loss of some degree usually accompanies a middle ear effusion, treatment may be warranted when longstanding impairment in hearing is present. Although the significance of this hearing loss is still uncertain, such a loss may impair cognitive and language function and result in disturbances in psychosocial adjustment. Important factors that should be considered when deciding to treat or not to treat are listed in Table 78-5.

Hivaids Introduction

Infants with perinatal acquired AIDS are normal at birth but may develop symptoms within the first 18 months of life. Clinical manifestations in children include fever decreased CD4 count anemia decreased WBC count (less than 3,000 cells mm3) neutropenia (absolute neutrophil count of less than 1,500 cells mm3) thrombocytopenia myelosuppression vitamin K deficiency hepatitis pancreatitis stomatitis and esophagitis meningitis retinitis (common with low CD4 counts) otitis media and sinusitis (chronic or recurrent) lymphadenopathy hepatosplenomegaly recurrent bacterial infections (especially, Streptococcus pneumoniae and Haemophilus influenzae) Mycobacterium infections (MAC) or tuberculosis cytomegalovirus (CMV) failure to thrive (in infants) chronic diarrhea neurologic involvement, (developmental delays and microcephaly in infants, or loss of motor skills in the older child) and pulmonary infections (Pneumocystis carinii PCP , lymphocytic interstitial pneumonitis LIP , and pulmonary...

Parasitic Diseases Diagnoses

Once the Salmonella bacterium is ingested, it multiplies rapidly in the mucosal layers of the stomach and small intestine. The greater the number of organisms ingested, the shorter the incubation period typically, incubation is 8 to 48 hours after ingestion of contaminated food or liquid, and symptoms usually last for 3 to 5 days. An inflammatory response in the tissues produces gastroenteritis. The infection may stop there, or the salmonella organisms may travel via the lymph and vascular system throughout the body. The dissemination of organisms produces lesions in other organs or, possibly, sepsis. Systemic lesions may result in appendicitis, peritonitis, otitis media, pneumonia, osteomyelitis, or endocarditis. Symptoms of intermittent fever, chills, anorexia, and weight loss indicate sepsis.

Polycyclic Halogenated Hydrocarbons

Polycyclic halogenated hydrocarbons (PHH) are persistent synthetic or man-made chemicals that are or were heavily used in industry or are by-products of industrial processes. The PHHs of highest concern are halogenated aromatic hydrocarbons, including polychlorinated biphenyls (PCBs) and polychlorinated dibenzo-p-dioxins (dioxins). Both PCBs and dioxins have been shown to be highly toxic to many organ systems in animal studies and are potent fetotoxins (Carpenter 1998 Mukerjee 1998). PCB dioxin immunotoxicity has been recently reviewed in two studies (Tryphonas 1998 Weisglas-Kuperus 1998). Occupational and transient highlevel exposure from industrial accidents show some immunomodulations in humans, however, only one study has examined endpoints indicative of hypersensitivity, rather than immunosuppression. In 2001, Karmaus and Kruse (Karmaus et al. 2001) conducted an epidemiological study of 340 children that investigated associations between exposures to several persistent...

Face and Head Neuralgias

Paroxysmal deep ear pain with a trigger point in the ear of unknown etiology. It may be related to varicella zoster virus infection Continuous pain in the first and second divisions of cranial nerve V, with associated sensory loss, deafness, and sixth cranial nerve palsy. It particularly affects patients with inflammatory lesions in the region of the petrous apex after otitis media

Factors Related to Tympanostomy Tube Otorrhea

The development of otorrhea after tympanostomy tube insertion is probably of multifactorial etiology. These factors can be considered to overlap those for otorrhea in chronic otitis media patients. Preoperatively recognizable patient characteristics and comorbidities, the surgeon's operative findings, the surgeon's operative choices, and the postoperative management may all influence the development of drainage through the tube. Infants have a greater propensity to develop post-tympanos-tomy otorrhea than do older children and adults. In addition, there may be a difference in the bacteriology of the otorrhea when comparing younger with older patients. Pathogens of acute otitis media seem to be more common in patients less than 3 years of age compared with those older than 3 years, where Pseudomonas aeruginosa and Staphylococcus aureus are more common. Tympanostomy tube otorrhea in cleft palate children is such a problem (68 of patients with open clefts otorrhea of at least 1 month's...

Management of the Unilateral Atretic

Both clinical and animal research have shown evidence of auditory brainstem abnormalities in the setting of unilateral conductive hearing loss. For example, Moore et al.6 have experimentally induced unilateral conductive hearing losses in ferrets during critical periods. Various abnormalities in the development of binaural neural elements in the auditory brainstem pathways were noted. Clinical studies of adults with unilateral conductive hearing loss using auditory brain stem responses (ABR) and the masking-level difference (MLD) have also documented abnormalities in brain stem auditory processing.7 Specifically, delays in wave V and in I to V and III to V interwave intervals were noted. The MLD, a behavioral test that measures the sensitivity of the auditory system to interaural differences of time and amplitude, was reduced, and they correlated significantly with the ABR abnormalities. These changes were similar to those observed in children with chronic otitis media with effusion.

Seborrheic Dermatitis Dandruff

Dandruff and seborrheic dermatitis are often mentioned together. Dandruff is the mildest manifestation of seborrheic dermatitis and it cannot be separated from seborrheic dermatitis. Therefore, what is mentioned in the literature for seborrheic dermatitis is also true for dandruff and vice versa. Seborrheic dermatitis is characterized by inflammation and desquamation in areas with a rich supply of sebaceous glands, namely, the scalp, face, and upper trunk (1). It is a common disease and the prevalence ranges from 2 to 5 in different studies. It is more common in males than in females. The disease usually starts during puberty and is more common around 40 years of age. Seborrheic dermatitis is characterized by red scaly lesions predominantly located on the scalp, face, and upper trunk. The skin lesions are distributed on the scalp, eyebrows, nasolabial folds, cheeks, ears, pre-sternal and interscapular regions, axillae, and groin. Around 90 to 95 of all patients have scalp lesions and...

Recommended Indications for Tympanocentesis Myringotomy

Otitis media in patients who have severe otalgia, are seriously ill, or appear toxic 3. Onset of otitis media in a patient who is receiving antimicrobial therapy 4. Otitis media associated with a confirmed or potential suppu-rative complication 5. Otitis media in a newborn, sick neonate, or immunologically deficient patient, any of whom might harbor an unusual organism Patients who still have a middle ear effusion present at the 4- to 6-week visit should be reevaluated 3 to 4 months after the onset of the infection those without effusion at 4 to 6 weeks can be discharged. Management of persistent middle ear effusion is similar to that described below for patients who have otitis media with effusion.

NOC Risk Control Hearing Impairment

Assess history of chronic otitis media, brain infection, use of ototoxic drugs, rubella or other intrauterine infections (viral), congenital defects of ear or nose, presence of deafness in family members, hypoxemia and increased bilirubin levels in low-birth weight infants.

Surgical Myringotomy with Tube Insertion Age 017

Otitis media, the most common cause of antibiotic prescription in the United States, is an infection of the middle ear that can occur in several forms. Acute otitis media (AOM) is a suppurative (pus-forming) effusion of the middle ear with acute onset, presence of middle ear effusion (MEE), and signs of middle ear inflammation. Bullous myringitis is AOM that leads to bullae formation between the middle and the inner layers of the tympanic membrane. Persistent otitis media occurs when an acute infection does not resolve after 4 weeks of treatment. Recurrent otitis media occurs in children with three separate bouts of AOM within a 6-month period, six within a 12-month period, or six episodes by 6 years of age. Ostitis media is common, and at least half of children have their first epidose prior to their first birthday.

Trigeminal Neuropathy

This causes severe ear pain and a combination of lesions in nerves VI, VII, VIII, and V, and is known as Gradenigo's syndrome Tsementzis, Differential Diagnosis in Neurology and Neurosurgery 2000 Thieme All rights reserved. Usage subject to terms and conditions of license.

Hemifacial Spasm

Spasmmuscle Disorder Images

INTRODUCTION Hemifacial spasm is characterized by involuntary unilateral hyperkinetic tonic and clonic spasms of muscles innervated by the seventh cranial nerve. In contrast with essential blepharospasm, in hemifacial spasm muscle contractions continue during sleep. An anatomic cause appears to be responsible in most cases. In 85 to 90 of cases an abnormal ectatic vascular loop of the vertebral-basilar arterial tree can be seen on MRI compressing the seventh nerve exit root in the cerebellopontine cistern. Most frequently the anteriorinferior cerebellar artery is involved. Rarely, bilateral cases have been described, but the two sides are typically not involved synchronously or to the same degree. In very rare instances compression of the seventh nerve by tumor, aneurysm, or other mass lesions may be the cause. Peripheral seventh nerve injury from trauma or Bell's Palsy can also result in hemifacial spasm following axonal regeneration. A case of hemifacial spasm associated with otitis...

Acute Drainage

Frequently, the cause of acute drainage is either a recent viral upper respiratory infection (URI) or water contamination into the ear canal. Of these two, viral URI is far more common because a small amount of water in the canal is rarely harmful. Note that most URIs are viral whereas most middle ear drainage is bacterial. It is well known that acute bacterial otitis media most often results from a viral URI, usually within 2 weeks of onset. Inflammation and swelling of the eustachian tube and middle ear mucosa impair the protective mucociliary clearance and aeration of the middle ear, encouraging bacterial infection. In the same way, viral URI can initiate bacterial purulent discharge through a PE tube. The point is that drainage through a PE tube is presumed bacterial, even though it often results from a viral URI. The bacteria are similar to those of acute otitis media Streptococcus pneumoniae, Hemophilus influenzae, and Moraxella catarrhalis. Treatment consists of broad-spectrum...

Treatment Strategies

My strategy for managing PTO is based on a condition driven escalation of therapeutic invasion. I try to reserve complicated solutions for complicated problems. In most cases, PTO can be successfully managed by topical or systemic antibiotics, or both. In children younger than age 3 years, bacteriology is similar to that of acute otitis media (AOM). For minor cases, the application of steroid-containing antibiotic drops (SCAD), 3 drops in the affected ear on a t.i.d. schedule is effective. As a general rule, my endpoint is 7 days or at any time the child reacts to drop application as if it were painful. Even with the milder ophthalmic preparations, the pH can elicit pain when it comes in contact with normal mucosa. MeyerhofPs 1983 study16 in chinchillas clearly demonstrated drop ototoxicity when applied through tubes in ears with normal eustachian tubal function and middle ear mucosa. Infected mucosa offers a barrier to this ototoxicity, the absence of which is heralded by the pain...

Authors Perspective

(1) addressing patient characteristics, comorbidities, and behaviors (2) considering practical ear characteristics (mesotympanic fluid and mucosa, and eustachian caliber) and (3) antiseptic ear cleansing, and irrigating until accessible mesotympanic fluid is cleared. In infants with cleft palate, assuming that behavioral audiometry has not revealed worse than a mild loss (in the better-hearing ear), we like to defer tympanostomy tube placement until the anesthetic at which the cleft is repaired, typically at 9 to 12 months of age. In acquired immunodeficiency syndrome (AIDS) patients, and in patients with immotile cilia syndrome, we try to avoid placing tympanostomy tubes for persistent non-suppurative fluid with clinically significant bilateral hearing loss, amplification seems appropriate. Bottle feeding in the supine position is discontinued before tympanostomy tube insertion. Graduation from the bottle by the first birthday is encouraged. The otitis-exaggerating effects of day...

Venous Thrombosis

Drainage from the confluence of sinuses (secondary to otitis media and mastoiditis) Pain, especially behind the ear (coinciding with acute or chronic otitis or mastoiditis) Increased intracranial pressure Extension ofinfection into the veins draining the lateral surface of the hemisphere may cause the following Jacksonian seizures Hemiplegia Gradenigo's syndrome CNs IX, X, XI (jugular foramen distension)


The incidence of squamous cell carcinoma of the temporal bone is approximately six cases per million in the general population, with most patients more than 50 years of age.4 The main risk factor is a long, often two or more decade history of chronic suppurative otitis media.5 Other potential inciting factors include chronic dermatitis,6 cholesteatoma,7 history of employment as a radium dial painter,8 and intracranial irradiation.9

Middle Ear Effusion

Myringotomy Grommet

A marked and persistent hearing loss, interfering with schooling, necessitates surgery. Episodes of transient otalgia are common with glue ears, and frequent attacks of acute otitis media may occur. The drum may also become retracted and flaccid with prolonged middle-ear fluid. These features may necessitate insertion of a grommet to reventilate the middle ear. Fig. 2.76 Blue drum. The middle-ear effusion alters in composition, and at some stages in otitis media with effusion the drum appears blue in color the so-called blue drum. Otitis media with effusion often settles spontaneously. Fig. 2.77 Myringotomy. If otitis media with effusion with poor hearing persists for over three months, myringotomy (under general anesthetic in children) with aspiration of the fluid is often necessary. Fig. 2.77 Myringotomy. If otitis media with effusion with poor hearing persists for over three months, myringotomy (under general anesthetic in children) with aspiration of the fluid is often necessary....


Retracted Normal Tympanic Membrane

Adhesive otitis media or grade IV atelectasis associated with a mild epitympanic retraction pocket. The thin and atrophic tympanic membrane completely covers the promontory. The tympanic membrane retraction has caused erosion of the long process of the incus with a subsequent spontaneous myringostapedopexy As the patient does not complain of hearing loss, surgery is not indicated. Figure 6.18 Left ear. Adhesive otitis media. This case represents the long-term sequela of persistent secretory otitis

Antimicrobial Issues

There have been no recent clinical trials pitting one antibiotic versus another for pediatric sinusitis. The major reason has to do with the perceived need to obtain bacteriologic data by means of maxillary antral taps. Still, the lack of direct comparative evidence does not diminish the compelling evidence from other sources about the relative efficacy of available antimicrobials against the pathogens of interest. Young children with persistent bacterial rhinosinusitis often harbor multiple relatively resistant pathogens, making empirical therapy with a single agent problematic. Even the more potent agents (e.g., amoxicillin-clavulanate, cefuroxime axetil, cefpodoxime proxetil) will fail against some of strains of S. pneumoniae and H. influenzae. Resistance to sulfa drugs and the macrolides (including azithromycin and clarithromycin) is relatively common among those same organisms. Even pneumococcal resistance to clindamycin is increasing. However, if a given strain is isolated and...

Surgical Options

We know from the otitis media literature that almost two-thirds of infants and children identified as prone to otitis on historic grounds no longer continue that pattern, with placebo providing dramatic improvement. Pediatric rhinosinusitis should be no different. In a study of chronic pediatric maxillary opacification, almost all resolved spontaneously.19

NOC Fluid Balance

Assess for presence of associated symptoms diarrhea, fever, ear pain, UGI symptoms, vision changes, headache, seizures, high pitched cry, polydipsia, polyuria, polyphagia, anorexia, and so forth record intake and output, including all body fluid losses, IVs and oral fluids (specify frequency).


Special Concerns Use with caution, if at all, during lactation. Give a lower initial dose in liver impairment. Safety and efficacy have not been determined in children less than 2 years of age. Side Effects Most commonly, headache, somnolence, fatigue, and dry mouth. GI Altered salivation, gastritis, dyspepsia, stomatitis, tooth ache, thirst, altered taste, flatulence. CNS Hypoesthesia, hyperkinesia, migraine, anxiety, depression, agitation, paroniria, amnesia, impaired concentration. Ophthalmologic Altered lacrimation, conjunctivitis, blurred vision, eye pain, blepharo-spasm. Respiratory Upper respiratory infection, epistaxis, pharyngitis, dyspnea, coughing, rhinitis, sinusitis, sneezing, bronchitis, bronchospasm, hemoptysis, laryngitis. Body as a whole Asthenia, increased sweating, flushing, malaise, rigors, fever, dry skin, aggravated allergy, pruritus, purpura. Musculoskeletal Back chest pain, leg cramps, arthralgia, myalgia. GU Breast pain, menorrha-gia, dysmenorrhea, vaginitis....

Patient Selection

Although audiometric criteria can be defined quantitatively, the true art of patient selection is centered on computed tomographic (CT) evaluation of the middle ear and mastoid. Hypoplasia of the middle ear space, ranging from mild to severe, occurs in most cases of aural atresia, and ossicular development can be expected to correlate directly with middle ear size. The risk of surgical complications will be minimized and the chances for a successful hearing result increased if the middle ear and mastoid are aerated and at least two-thirds of the normal size, and if all three ossicles (although deformed) can be identified. Rarely, a well-developed middle ear mastoid containing fluid will be encountered. To rule out a resolving otitis media or temporary eustachian tube dysfunction, a repeat scan 6 to 12 months later is recommended. Persistent middle ear fluid is a contraindication to surgery, although reassessment when the child is a teenager is reasonable.

Specific History

Ramsay-Hunt syndrome The classic description includes the following triad of findings (1) zoster lesions on the pinna (see Photo 16), meatus, and canal or tympanic membrane of one ear, (2) severe ear pain, and (3) an ipsilateral facial nerve palsy (see Photo 17). Vestibular symptoms and sensorineural hearing loss may also occur. The facial paralysis is usually complete and the recovery rate is low. Taste and lacrimation may also be affected.

Future Research

Revision Tympanomastoidectomy

The entire landscape of surgery for chronic otitis media will change significantly with new insights in restoration of normal eustachian tube function. In addition, most reconstructive procedures that are done in the middle ear are based more on intuition than scientific proof. Research in the area of middle ear mechanics and reconstruction34,35 is most welcome and will undoubtedly provide better methods of reconstruction in the future. 10. Vartiainen E, Kansanen M. Tympanomastoidectomy for chronic otitis media without cholesteatoma. Otolaryngol Head Neck Surg 1992 106 230-234 11. Veldman JE, Braunius WW. Revision surgery for chronic otitis media a learning experience. Report on 389 cases with long-term follow-up. Ann OtolRhinol Laryngol 1998 107 486-491 14. Vartiainen E, Vartiainen J. Hearing results of surgery for chronic otitis media without cholesteatoma. Ear Nose Throat J 1995 74 165-166, 169 18. Jokipii AMM, Karma P, Ojala, K, et al. Anaerobic bacteria in chronic otitis media....

Chronic Drainage

Probably 80 of acutely draining PE tubes clear with initial treatment, and another 80 of chronically draining tubes clear with anti-Pseudomonas treatment with or without tube removal. The remaining few patients, probably less than 5 of all patients with chronic draining PE tubes, have underlying localized mucosal or temporal bone disease, or upper respiratory immunologic, allergic, or bacterial disease that perpetuates tube drainage. A careful history and examination at the first office visit usually identifies these patients. Does the patient have allergy or sinus disease, especially inhalant allergy with rhinitis and sinusitis Does the patient have frequent bronchitis or pneumonia, perhaps associated with sinusitis and recurrent otitis Consider immunoglobulin G (IgG) subclass deficiency, immotile cilia syndrome, iatrogenic immuno-suppression, human immunodeficiency virus (HIV) infection, tuberculosis, and Wegener's granulomatosis. Does chronic ear pain suggest neoplasm, particularly...

Cefuroxime axetil

Action Kinetics Cefuroxime axetil is used PO, whereas cefuroxime sodium is used either IM or IV. Uses PO (axetil). Pharyngitis, tonsillitis, otitis media, sinusitis, acute bacterial exacerbations of chronic bronchitis and secondary bacterial infections of acute bronchitis, uncomplicated UTIs, uncomplicated skin and skin structure infections, uncomplicated gonorrhea (urethral and endocervical) caused by non-penicillinase-producing strains of Neisseria gonorrhoeae. Early Lyme disease due to Borrelia burgdorferi. The suspension is indicated for children from 3 months to 12 years to treat pharyngitis, tonsillitis, acute bacterial otitis media, and impetigo. Contraindications Hypersensitivity to cephalosporins. Use in infants 1 month. Acute otitis media. Children 250 mg b.i.d. for 10 days. Acute otitis media, impetigo. Children, 3 months to 12 years 30 mg kg day in 2 divided doses, not to exceed 1,000 mg total dose day, for 10 days.

Cefixime oral

Uses Uncomplicated UTIs caused by E. coli and P. mirabilis. Otitis media due to H. influenzae (beta-lacta-mase positive and negative strains), Moraxella catarrhalis, and S. pyogenes. Pharyngitis and tonsillitis caused by S. pyogenes. Acute bronchitis and acute exacerbations of chronic bronchitis caused by S. pneumoniae and H. influenzae (beta-lactamase positive and negative strains). Uncomplicated cervical or urethral gonorrhea due to N. gonorrhoeae (both penicillinase- and non-penicillinase-producing strains). Contraindications See also Ce-phalosporins.