Common complaints include otalgia, otorrhoea, headache, fever, and systemic upset. In chronic otitis media patients can present with conductive hearing loss, tinnitus, vertigo, or persistent pain.
A mixture of factors predispose to otitis media, but Eustachian tube dysfunction is thought to be one of the most important factors. Congenital palate defects, host immunity, and viral or bacterial infection may all be contributing factors.
Imaging is not usually required in cases of acute otitis media as the diagnosis is clinical. However, patients with chronic otitis media that present with hearing loss in whom the tympanic membrane cannot be visualised may require imaging. Exact imaging features vary dependent on the form but in general includes
High resolution temporal bone CT is routinely performed and may show:
- soft tissue density in the middle ear cavity
- thickened tympanic membrane
- bulging tympanic membrane
- tympanic perforation
Features seen in chronic rather than acute otitis media include:
- air-fluid level in the middle ear (effusion)
- bony erosion (less than 10%)
- adjacent sclerosis and hypopneumatisation of the mastoid
- fluid signal in the middle ear cavity and mastoid antrum.
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