Middle Ear Disease

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Middle ear disease is common in children

Upper respiratory tract viral infections in children are frequently accompanied by the changes of acute inflammation in the lining of the middle ear, and in the inner lining of the tympanic membrane.

Secondary bacterial infection may supervene, increasing the risk of a central perforation of the tympanic membrane. Children are particularly prone, probably because the narrow Eustachian tube can become obstructed by the hyperplastic sub-mucosal lymphoid tissue at its lower end (adenoids).

The main complications of acute otitis media include persistent perforation of the eardrum, tubotympanic chronic suppurative otitis media, otitis media with effusion (OME or 'glue ear'), and acute mastoiditis.

In the pre-antibiotic era, secondary bacterial infection of a viral otitis media was common, leading to acute suppurative otitis media and the risk of bacterial infection spreading to the mastoid air cells. From the mastoid air cells, suppuration could extend into the brain to cause meningitis and brain abscess. This is now rare.

Infection of the external ear in children is frequently the result of the presence of an unsuspected foreign body.

There are many minor congenital malformations of the ear

There are many minor variations in the structure of the pinna, such as the presence of a small spur (Darwin's tubercle) on the helix, or prominent forward-facing ears due to a poorly formed antihelix (bat ears); such conditions may require surgical treatment for cosmetic reasons, but they are not associated with significant morbidity.

In the skin immediately in front of the ear a small, raised nodule or polyp may arise, situated in front of the tragus. This common malformation, which is termed an accessory lobule, often contains a small island of cartilage.

Pre-auricular sinus is a persistent, minute pit, usually situated in the skin immediately in front of the top of the helix. They sometimes contain a small plug of keratin, causing symptoms particularly when infected, with swelling and tenderness, often associated with a persistent watery or blood-stained discharge. The pit may be the only visible surface feature of a fairly extensive branched system, and surgical eradication may be difficult.

Severe pinnal malformations (e.g. congenital absence, or the presence of only rudimentary structures) are usually associated with abnormalities of the external auditory meatus and structures within the middle ear, as a result of maldevelopment of the first and second branchial arches. The inner ear is usually normal.
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