Recognition of paediatric otopathology by General Practitioners
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摘要
Otoscopy is one of the fundamental steps in assessing a patient consulting for an ear infection. The newborn's ear differs from the ear of an older child and this fact should be taken into account for otoscopy; the external auditory canal is narrower, the tympanic membrane appears to be in a more horizontal position, and there is a high incidence of middle ear space-occupying cellular elements to modify otoscopy. Adequate otoscopy requires perfect positioning of the patient and the new endoscopic instrumentation, such as oto-endoscopy, which allows for the inspection of the external auditory canal and the tympanic membrane. The pathological tympanic membrane is described in cases of middle ear effusion and acute otitis media. Assessment of otoscopy results, cloudiness, bulging, impaired mobility of the tympanic membrane, are analysed.

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ss="h3">Resume

L'examen otoscopique est l'étape essentielle dans l'exploration des maladies de l'oreille. Chez l'enfant et plus particulièrement chez le nouveau-né, cet examen est rendu difficile car il se heurte à des variations constitutionnelles qui contribueront à rendre malaisé l'examen des tympans. Ces variations se caractérisent par un conduit auditif externe dont la direction est oblique en bas et en avant, avec des parois souples et collabées, et par une membrane tympanique épaisse se positionnant selon un axe d'autant plus horizontal que l'enfant est petit. Une otoscopie performante passe par une contention parfaite de l'enfant et l'utilisation de moyens d'optique moderne comme l'oto-endoscopie qui permet avec une très grande précision l'analyse de la totalité du conduit auditif externe et de la membrane tympanique. L'otoscopie pneumatique est d'un apport essentiel dans les cas difficiles pour dilater le conduit auditif externe et pour juger de la mobilité tympanique. A l'occasion d'une description des signes tympaniques rencontrés au cours de l'otite moyenne aiguë et de l'otite séromuqueuse, ceux ayant une bonne valeur diagnostique, tels que le bombement, la diminution de mobilité et le caractère terne de la membrane tympanique, sont analysés.

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International Journal of Pediatric Otorhinolaryngology
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International Journal of Pediatric Otorhinolaryngology, Volume 69, Issue 3, March 2005, Pages 393-397
Ryan T. Boone, Charles M. Bower, Patti F. Martin

Abstract
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ss="h3">Summary

ss="h4">Objectives:

Evaluate the prevalence of middle ear disease in infants failing a newborn hearing screening program. Review the outcomes of those infants diagnosed with or without middle ear disease after failed hearing screen.

ss="h4">Design:

Retrospective chart review of 76 patients referred to a tertiary care institution for evaluation of a failed newborn hearing screening test.

ss="h4">Setting:

Arkansas Children's Hospital, Little Rock, Arkansas.

ss="h4">Results:

Seventy-six patients were referred for failed OAEs and complete otolaryngology evaluation. Mean age at the time of referral was 3 months (0.25 years) old. OME was identified in 64.5%of the patients. ABR confirmed a suspected hearing loss in 15 patients (78.9%) without middle ear disease. Effusion resolved without surgical intervention in 65.3%of infants, while 17 (34.7%) of the infants required tubes. SNHL was subsequently identified in 11%of infants after resolution of the effusion.

ss="h4">Conclusions:

OME is a common cause of failed infant hearing screens, and should be looked for prior to definitive diagnostic hearing testing. OME resolves in the majority of infants, but tube insertion is necessary to allow for diagnostic testing in nearly one third of infants. The majority of infants without OME had SNHL confirmed. SNHL was also identified in 11%of infants with OME after resolution of the effusion.


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Otolaryngology - Head and Neck Surgery
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Otolaryngology - Head and Neck Surgery, Volume 137, Issue 2, Supplement 1, August 2007, Page P257
Shin-ichi Kanemaru, Hiroo Umeda, Masaru Yamashita, Koichi Omori, Juichi Ito

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