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__NOTOC__
{{Otalgia}}
{{Otalgia}}
{{CMG}} {{AE}} {{RT}}
{{CMG}} {{AE}} {{RT}}


==Overview==
==Overview==
Surgery forms the main stay of treatment for major ear pathologies like [[Otitis media]] (OM), [[Otitis externa]], [[Cholesteatoma]], [[Mastoiditis]] etc., and some non-ear pathologies like [[TMJ]] disorder, [[Retropharyngeal abscess]] etc.
Surgery forms the main stay of treatment for major ear pathologies like [[otitis media]] (OM), [[otitis externa]], [[cholesteatoma]], [[mastoiditis]], etc., and some non-ear pathologies like [[TMJ]] disorders and [[retropharyngeal abscess]]es.


==Surgical treatment for Primary Otalgia==
==Surgery==
===Primary Otalgia===


<u>'''[[Otitis media]]'''</u>: Surgical options for Otitis media include :
====Otitis Media====
Surgical options for [[otitis media]] include:
*[[Tympanocentesis]] - early intervention
*[[Tympanocentesis]] - early intervention
*[[Myringotomy]] and [[Tympanostomy tube]] insertion to drain the pus from the middle ear.
*[[Myringotomy]] and [[Tympanostomy tube]] insertion to drain the pus from the middle ear.
*[[Adenoidectomy]]
*[[Adenoidectomy]]


Indications for Tympanocentesis include:
Indications for tympanocentesis include:
*Severe [[Otalgia]], seriously ill, or appearing toxic.
*Severe [[otalgia]], seriously ill, or appearing toxic.
*Unsatisfactory response to antimicrobial therapy.
*Unsatisfactory response to antimicrobial therapy.
*Onset of AOM in a patient receiving antimicrobial therapy.
*Onset of AOM in a patient receiving antimicrobial therapy.
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*OM in a newborn, sick neonate, or patient who is immunologically deficient.
*OM in a newborn, sick neonate, or patient who is immunologically deficient.


Indications for Myringotomy and Tympanostomy tube insertion:
Indications for myringotomy and tympanostomy tube insertion:
*Chronic Otitis media with effusion
*Chronic otitis media with effusion
*Recurrent Acute [[Otitis media]]
*Recurrent acute [[otitis media]]
*Recurrent Otitis media with effusion
*Recurrent otitis media with effusion
*[[Eustachian tube]] dysfunction
*[[Eustachian tube]] dysfunction
*[[Barotrauma]]
*[[Barotrauma]]


Intratemporal and intracranial complications of [[Otitis media]] requires surgical consultation. Patients with [[Cleft palate]]<ref name="pmid22796197">{{cite journal |author=Klockars T, Rautio J |title=Early placement of ventilation tubes in cleft lip and palate patients: Does palatal closure affect tube occlusion and short-term outcome? |journal=Int J Pediatr Otorhinolaryngol |volume= |issue= |pages= |year=2012 |month=July |pmid=22796197 |doi=10.1016/j.ijporl.2012.06.028 |url=}}</ref>, [[Down syndrome]], or other craniofacial abnormalities, may require early surgical intervention to prevent Otitis Media.<ref name="pmid21045692">{{cite journal |author=Hartzell LD, Dornhoffer JL |title=Timing of tympanoplasty in children with chronic otitis media with effusion |journal=Curr Opin Otolaryngol Head Neck Surg |volume=18 |issue=6 |pages=550–3 |year=2010 |month=December |pmid=21045692 |doi=10.1097/MOO.0b013e32833febc4 |url=}}</ref>
Intratemporal and intracranial complications of [[otitis media]] requires surgical consultation. Patients with [[cleft palate]],<ref name="pmid22796197">{{cite journal |author=Klockars T, Rautio J |title=Early placement of ventilation tubes in cleft lip and palate patients: Does palatal closure affect tube occlusion and short-term outcome? |journal=Int J Pediatr Otorhinolaryngol |volume= |issue= |pages= |year=2012 |month=July |pmid=22796197 |doi=10.1016/j.ijporl.2012.06.028 |url=}}</ref> [[Down syndrome]], or other craniofacial abnormalities, may require early surgical intervention to prevent otitis media.<ref name="pmid21045692">{{cite journal |author=Hartzell LD, Dornhoffer JL |title=Timing of tympanoplasty in children with chronic otitis media with effusion |journal=Curr Opin Otolaryngol Head Neck Surg |volume=18 |issue=6 |pages=550–3 |year=2010 |month=December |pmid=21045692 |doi=10.1097/MOO.0b013e32833febc4 |url=}}</ref>


<u>'''[[Otitis externa]]'''</u>: Surgery is now reserved for local debridement, removal of bony sequestrum, or abscess drainage.
====Otitis Externa====
Surgery is now reserved for local debridement, removal of bony sequestrum, or abscess drainage.


<u>'''[[Cholesteatoma]]'''</u>: Surgery is the definitive form of treatment. Two kinds of procedures exist for treatment of Cholesteatoma. They are
====Cholesteatoma====
Surgery is the definitive form of treatment. Two kinds of procedures exist for treatment of cholesteatoma. They are:


*Canal-wall-down operations - for those who has had several recurrences and is willing to avoid future episodes. Have the advantage of permanently ridding the patient of Cholesteatoma
*Canal-wall-down operations - for those who has had several recurrences and is willing to avoid future episodes. These procedures have the advantage of permanently ridding the patient of cholesteatoma.


*Canal-wall-up procedures - for those who are unwilling or unable to return for a second-look procedure. Have the advantage of maintaining normal appearance. But have the disadvantage of high probability of recurrences.
*Canal-wall-up procedures - for those who are unwilling or unable to return for a second-look procedure. These procedures have the advantage of maintaining a normal appearance, but they have the disadvantage of having a high probability of recurrence.


<u>'''[[Mastoiditis]]'''</u>:  Surgical procedures may be performed (while continuing the medication) if the condition does not quickly improve with antibiotics. The most common procedure is a [[myringotomy]], a small incision in the [[tympanic membrane]] (eardrum), or the insertion of a [[tympanostomy tube]] into the eardrum. These serve to drain the pus from the middle ear, helping to treat the infection. The tube is extruded spontaneously after a few weeks to months, and the incision heals naturally. If there are complications, or the mastoiditis does not respond to the above treatments, it may be necessary to perform a [[mastoidectomy]] in which a portion of the bone is removed and the infection drained.
====Mastoiditis====
Surgical procedures may be performed (while continuing the medication) if the condition does not quickly improve with antibiotics. The most common procedure is a [[myringotomy]], a small incision in the [[tympanic membrane]] (eardrum), or the insertion of a [[tympanostomy tube]] into the eardrum. These serve to drain the pus from the middle ear, helping to treat the infection. The tube is extruded spontaneously after a few weeks to months, and the incision heals naturally. If there are complications, or the mastoiditis does not respond to the above treatments, it may be necessary to perform a [[mastoidectomy]] in which a portion of the bone is removed and the infection drained.


<u>'''[[Furunculosis]] of ear'''</u>: Incision and drainage may be necessary if disease is extensive and abscess formation takes place.
====Furunculosis of Ear====
Incision and drainage may be necessary if the disease is extensive and abscess formation takes place.


==Surgical treatment for Referred Otalgia==
===Referred Otalgia===


*  <u>'''[[Temporomandibular joint]] disorders'''</u>: Surgical options include
====Temporomandibular Joint Disorders====
**[[Arthrocentesis]]
Surgical options include:
**[[ Arthroscopic surgery]]
*[[Arthrocentesis]]
**[[Hemijoint replacement]]
*[[Arthroscopic surgery]]
**[[Total alloplastic replacement]] ([[Arthroplasty]])
*Hemijoint replacement
*Total alloplastic replacement ([[Arthroplasty]])


* <u>'''[[Retropharyngeal abscess]]'''</u>: Treatment depends upon the size of the abscess as visualized on [[CT scan]] or [[Ultrsound]] of neck. If the abscess is of small size, needle aspiration can be done to completely evacuate the pus. For extensive abscesses which spread deep into the fascial planes of neck, open surgery proves to be the best option to prevent further spread and ensure complete removal of the abscess.
====Retropharyngeal Abscess====
Treatment depends upon the size of the abscess as visualized on [[CT scan]] or [[ultrasound]] of neck. If the abscess is of small size, needle aspiration can be done to completely evacuate the pus. For extensive abscesses, which spread deep into the fascial planes of the neck, open surgery proves to be the best option to prevent further spread and ensure complete removal of the abscess.


* <u>'''[[Peritonsillar abscess]]'''</u>: Two invasive procedures have been recommended for treating Peritonsillar abscess. They are
====Peritonsillar Abscess====
**[[Needle aspiration]] - can be used both as diagnostic and therapeutic procedure.
Two invasive procedures have been recommended for treating a peritonsillar abscess. They are:
**[[Incision and drainage]] - Intraoral incision and drainage is performed by incising the mucosa overlying the abscess, usually located in the supratonsillar fold.  
*Needle aspiration - can be used both as diagnostic and a therapeutic procedure.
*[[Incision and drainage]] - Intraoral incision and drainage is performed by incising the mucosa overlying the abscess, usually located in the supratonsillar fold.


* <u>'''[[Dental caries]]'''</u>:Treatment options include removal of decayed part of the tooth and preforming dental restoration, [[Root canal therapy]] and dental extraction.
====Dental Caries====
Treatment options include removal of the decayed part of a tooth and performing dental restoration, [[root canal therapy]], and dental extraction.


==References==
==References==
{{reflist|2}}
{{reflist|2}}


 
[[Category:Otolaryngology]]
 
[[Category:Emergency medicine]]
[[Category:Grammar]]
[[Category:Pediatrics]]
 
 


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Latest revision as of 12:49, 11 June 2015

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2]

Overview

Surgery forms the main stay of treatment for major ear pathologies like otitis media (OM), otitis externa, cholesteatoma, mastoiditis, etc., and some non-ear pathologies like TMJ disorders and retropharyngeal abscesses.

Surgery

Primary Otalgia

Otitis Media

Surgical options for otitis media include:

Indications for tympanocentesis include:

  • Severe otalgia, seriously ill, or appearing toxic.
  • Unsatisfactory response to antimicrobial therapy.
  • Onset of AOM in a patient receiving antimicrobial therapy.
  • Potential suppurative complication.
  • OM in a newborn, sick neonate, or patient who is immunologically deficient.

Indications for myringotomy and tympanostomy tube insertion:

Intratemporal and intracranial complications of otitis media requires surgical consultation. Patients with cleft palate,[1] Down syndrome, or other craniofacial abnormalities, may require early surgical intervention to prevent otitis media.[2]

Otitis Externa

Surgery is now reserved for local debridement, removal of bony sequestrum, or abscess drainage.

Cholesteatoma

Surgery is the definitive form of treatment. Two kinds of procedures exist for treatment of cholesteatoma. They are:

  • Canal-wall-down operations - for those who has had several recurrences and is willing to avoid future episodes. These procedures have the advantage of permanently ridding the patient of cholesteatoma.
  • Canal-wall-up procedures - for those who are unwilling or unable to return for a second-look procedure. These procedures have the advantage of maintaining a normal appearance, but they have the disadvantage of having a high probability of recurrence.

Mastoiditis

Surgical procedures may be performed (while continuing the medication) if the condition does not quickly improve with antibiotics. The most common procedure is a myringotomy, a small incision in the tympanic membrane (eardrum), or the insertion of a tympanostomy tube into the eardrum. These serve to drain the pus from the middle ear, helping to treat the infection. The tube is extruded spontaneously after a few weeks to months, and the incision heals naturally. If there are complications, or the mastoiditis does not respond to the above treatments, it may be necessary to perform a mastoidectomy in which a portion of the bone is removed and the infection drained.

Furunculosis of Ear

Incision and drainage may be necessary if the disease is extensive and abscess formation takes place.

Referred Otalgia

Temporomandibular Joint Disorders

Surgical options include:

Retropharyngeal Abscess

Treatment depends upon the size of the abscess as visualized on CT scan or ultrasound of neck. If the abscess is of small size, needle aspiration can be done to completely evacuate the pus. For extensive abscesses, which spread deep into the fascial planes of the neck, open surgery proves to be the best option to prevent further spread and ensure complete removal of the abscess.

Peritonsillar Abscess

Two invasive procedures have been recommended for treating a peritonsillar abscess. They are:

  • Needle aspiration - can be used both as diagnostic and a therapeutic procedure.
  • Incision and drainage - Intraoral incision and drainage is performed by incising the mucosa overlying the abscess, usually located in the supratonsillar fold.

Dental Caries

Treatment options include removal of the decayed part of a tooth and performing dental restoration, root canal therapy, and dental extraction.

References

  1. Klockars T, Rautio J (2012). "Early placement of ventilation tubes in cleft lip and palate patients: Does palatal closure affect tube occlusion and short-term outcome?". Int J Pediatr Otorhinolaryngol. doi:10.1016/j.ijporl.2012.06.028. PMID 22796197. Unknown parameter |month= ignored (help)
  2. Hartzell LD, Dornhoffer JL (2010). "Timing of tympanoplasty in children with chronic otitis media with effusion". Curr Opin Otolaryngol Head Neck Surg. 18 (6): 550–3. doi:10.1097/MOO.0b013e32833febc4. PMID 21045692. Unknown parameter |month= ignored (help)

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