An 11-year-old boy with a history of chronic otitis media with effusion presented wit

Discussion in 'Plab 1 and 2 forum' started by Neha Gupta, Jun 8, 2013.

  1. Neha Gupta

    Neha Gupta Active Member

    Q. An 11-year-old boy with a history of chronic otitis media with effusion presented with a 10-day history of fever, right otalgia and occipital headache. Examination of his right ear revealed a thickened, but intact tympanic membrane. Postauricular fluctuance was evident. The remainder of the physical examination, including a neurological exam, was normal. White blood cell count was 18.7 cells/mm3 with a left shift. The most appropriate management would be:

    a) No treatment

    b) Amoxicillin for 10 days

    c) Removal from child care center

    d) CT scan

    e) myringotomy

    f) radical mastoidectomy

    g) tympanometry

    h) topical neomycin

    i) trimethoprim/sulfamethoxazole
  2. Neha Gupta

    Neha Gupta Active Member

    Tympanostomy tubes are indicated for chronic otitis media with effusion, recurrent acute otitis media, tympanic membrane atelectasis, and complications of acute otitis media in children. they are a treatment option for otitis media with effusion that persists for three months with associated hearing loss. If the effusion persists four to six months despite other treatments, then tympanostomy tubes should be inserted at that time. Recurrent acute otitis media (5-6 episodes/year) with persistent middle ear effusion is best treated with tympanostomy tubes. Children with recurrent otitis media without persistent effusion may be treated with antibiotic prophylaxis or tympanostomy tubes. Children who fail antibiotic prophylaxis are candidates for tympanostomy tubes. Once the infections clears, fluid may remain in the middle ear for several months. Middle-ear fluid that is not infected often disappears after three to six weeks. Neither antihistamines nor decongestants are recommended as helpful in the treatment of otitis media at any stage in the disease process. If the fluid persists for more than three months or is associated with a loss of hearing, many physicians suggest the insertion of tubes in the affected ears. This operation, called a myringotomy, can usually be done on an outpatient basis by a surgeon, who is usually an otolaryngologist (a physician who specializes in the ears, nose and throat). While the child is asleep under general anesthesia, the surgeon makes a small opening in the child\'s eardrum. A small metal or plastic tube is placed into the opening in the eardrum. The tube ventilates the middle ear and helps keep the air pressure in the middle ear equal to the air pressure in the environment. The tube normally stays in the eardrum for six to twelve months after which time it usually comes out spontaneously

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