The Child’s Ear

Normal? Abnormal? And what do we do next?

Anatomy of the Ear:

Outer (External) Ear

External Ear:

Middle Ear:

Inner Ear:

Inner Ear: Cochlea

Inner Ear: Semicircular Canals

Why do we care?

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

Examining the Ear:

Techniques/Equipment:

Otoscope/ Insufflator

Managing Difficult Exams:

Examining the Ear:

External ear: PinnaPreauricular areaPostauricular area including

lymph nodes, mastoid process Ear canal

External Ear!

Cleaning Ears:

Best Way to Clean Ears At Home……

Other Ways:

Debrox drops Gentle lavage with bulb suction and warm

water

And in the Office:

Middle Ear:

Normal Tympanic Membrane

TM Landmarks:

Which side?

Disorders of the External Ear:

Discharge

Displacement

Discoloration

Deformity

Discharge:

Otitis Externa or”Swimmer’s Ear”

Can also be caused by foreign bodies:

Or Trauma:

Otitis Externa:

Symptoms

Signs

Treatment

Prevention

Displacement: Mastoiditis

Discoloration:

“Battle Sign”

Basilar skull fracture – also often associated with hemotympanum

Deformity: Congenital- minor to

extensive May indicate other

organ malformations Microtia/auricle

malformations Preauricular

sinuses/pits/cysts Preauricular tags

Preauricular Pit/ Sinus

Preauricular Tags:

Infected/Retained earrings

Middle Ear Disorders:

Normal Tympanic Membrane

Otitis Media:

Definitions of Otitis Media:

Acute Otitis Media : 1. history of acute onset of signs and

symptoms2. the presence of middle ear effusion3. signs and symptoms of middle ear

inflammation

Acute Otitis Media

Signs and Symptoms

A Little Note on Ear Pulling…

Acute Otitis Media:

Acute Otitis Media:

Bullous Myringitis

Acute Otitis MediaAAP/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

To treat or not to treat?

“I want the bubblegum medicine”

Age Certain Dx Uncertain Dx

<6 months Antibacterial therapy

Antibacterial therapy

6 mo to 2 y 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

Complications of Untreated Otitis Media:

Tympanosclerosis

Complications of Untreated Otitis Media: Tympanic membrane perforation

Complications of Untreated Otitis Media:

Mastoiditis

Cholesteatoma:

Perforation with Cholesteatoma

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

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

Otitis Media with Effusion

Otitis Media with Effusion:

Otitis Media with EffusionAAP/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.

Tympanostomy Tubes

So…

Lets protect our children’s wonderful ears