BMJ 2011: 343: 103 – 62 (16th July)

Otitis media with effusion (glue ear)

Red flag features are:

  1. Atypical otoscopy with persistent foul-smelling discharge suggestive of cholesteatoma
  2. Excessive hearing loss/examination findings that indicate additional sensorineural hearing deficit.

Both of these need urgent ENT referral, ‘urgent’ meaning within 2 – 3 weeks.

Examination findings in OME include dull grey tympanic membrane, possibly a prominent stapes bone, and mouth-breathing (the latter being due to large adenoids, which frequently co-exist).

No medical treatment is clearly effective.  This includes antibiotics, steroids (topical or systemic), decongestants, mucolytics, and antihistamines.  So don’t bother.  Depending on impact on daily life, you can either wait and see or refer.  Referral is quite likely also to involve waiting to see, but with the benefit of pure tone audiometry.  If you’re going for ‘wait and see’, three months is a reasonable time period.  The condition will often resolve spontaneously within 6 – 10 weeks.

Practical advice (speaking directly to the child face-to-face, sitting the child at the front at school, and minimising background noise where possible) should be given.  Cigarette smoke makes matters worse.  Treatment options are temporary hearing aids or grommets.

Clostridium difficile

Not just a nuisance: risks include colitis, toxic megacolon, and death.  Stool frequency is not actually a very good indicator of severity.  It’s not terribly clear what is, but severe abdominal pain, a temperature >38.5, a WCC >15, creatinine rising by >50% above baseline, and raised serum lactate, have all been cited as indicators of more severe infection.

Tests for C. difficile vary in their sensitivity and specificity, and if a test is negative in a patient in whom suspicion persists then it’s worth submitting a second specimen and possibly discussing with a microbiologist which test to try.

 

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About Dr Sarah

I'm a GP with a husband and two young children.
This entry was posted in ENT, Gastroenterology, Infectious Diseases. Bookmark the permalink.

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