What is the Diagnosis of Chronic Otitis Media Cholesteatoma and Mastoiditis?
‘Chronic Otitis Media Cholesteatoma’ and ‘Mastoiditis’ are disorders associated with the Ear, specifically, the middle ear. These include infections and liquid drainage from the ear as well as those issues created when the eardrum is perforated or damaged.
‘Otitis media’ is best regarded as a spectrum of disease. The most important conditions associated with the disease are:
- acute otitis media without perforation
- acute otitis media with perforation
- otitis media with effusion(liquid pouring out)
- chronic suppurative otitis media.
In case of any problems associated with the ear, a clinical diagnosis by a medical expert is a must. The doctor or specialist will examine the affected ear clinically before asking a detailed list of questions in order to understand the medical history of the problem.
Usually, the questions will be with regards to the following:
- history of the ear problem
- treatments used: if the patient has begun care on his/her own, details of drugs such as dosage, type and length of treatment
- details of any prior ear surgery.
In the clinical examination, the doctor may suspect chronic ‘otitis media’ based on the oral history evaluation done with the patient. If there has been a history of infections and/or persistent ear drainage (milky liquid coming out of the ear, the doctor will look inside the ear to confirm the diagnosis. This is done with a special instrument with a light called an ‘Otoscope’, and the process is termed an ‘Otoscopy’.
Sometimes, the examination of the eardrum may not be able to confirm the diagnosis if for example, the ear canal is small or there is wax obstructing the view.
Therefore, making an extremely diagnosis is not easy. Studies show that ear pain is naturally the most useful symptom, but not reliable.
If there is liquid effusion, the doctor may also take a sample of the drainage fluid for further tests to be done in a laboratory.
If the patient has already been using antibiotics, the culture sample results from the fluid may prove negative in some cases, so it is always recommended to see a doctor before administering drugs oneself.
It has been noted that in some cases, a doctor may refer the patient to an ‘Otolaryngologist’, who specializes in treating ear, nose and throat (ENT) problems. If the otolaryngologist may recommend the following:
- Computed Tomography (CT) scan
- Magnetic Resonance Imaging (MRI) scan
If there is any concern about hearing loss, a test called an Audiogram is conducted to measure it.
Often, the typical symptoms seem to overlap with other conditions and the clinical history provided by the patient is not enough. Examination should also be complemented by visualization of the tympanic membrane, known as the eardrum. Typically, this requires a good view of the whole tympanic membrane and the use of either pneumatic otoscopy or tympanometry (to confirm the presence of a middle ear effusion).
If upon conducting an otoscopy, the tympanic membrane is found to be bulging, displaying redness, looking opaque and immobile, it is predictive of a more acute otitis media. If it looks normal in its pearly grey colour, it is unlikely to be acute otitis media.
According to the American Academy of Family Physicians, handheld tympanometer records compliance of the tympanic membrane and gives one quantitative knowledge on the structural function and presence of effusion.
The instrument records readings in the form of graphs and medical experts read these to determine the exact nature of the problem i.e if there is effusion, retraction or bulging of the tympanic membrane etc. Moreover, it specifies that the diagnostic criteria for this chronic or acute otitis media include:
- a rapid onset of symptoms
- effusion from the middle ear
- signs and symptoms of middle ear inflammation.
Nonspecific symptoms such as fever, aches, cough, pulling at the ear, irritability etc are quite common in infants and young children.
Sometimes, it is hard to differentiate acute otitis media from upper respiratory tract infections on the basis of symptoms and therefore, detailed examining and testing is essential.
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Source: Onlymyhealth editorial team Dec 18, 2012
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