Reliability of the otoscopic tympanic membrane findings in the diagnosis of middle ear effusion

OBJECTIVE

To estimate the reliability of otoscopic findings to predict the presence of middle ear effusion.

METHODS

The cross-sectional study was conducted at Al-Yarmouk Teaching Hospital, Baghdad, Iraq, from April 1, 2019, to January 1, 2020, and comprised patients of either gender aged 3-70 years complaining of ear problems. The patients were randomly assigned to two specialist otolaryngologists who checked the presence of retraction of the tympanic membrane and other features suggesting middle ear effusion. All the patients underwent tympanometric impedance measurement to compare the results with the otoscopic findings. Data was analysed using SPSS 25.

RESULTS

The study comprised 369 ears of 203 patients. There were 98(48.3%) male and 105(51.7%) female patients. The overall mean age was 19±17.45 years. In 141(38%) ears, middle ear effusion was confirmed by tympanometric finding type B flat impedance curve, while 187(51%) ears had impedance curve type C and 41(11%) ears had impedance curve type A. The positive predictive value of otoscopic appearance in the diagnosis of middle ear effusion was 38%. History of recent hearing loss or upper respiratory tract infection had no significant association with the condition (p>0.05).

CONCLUSIONS

Otoscopic tympanic membrane findings were found poor predictors of the existance of middle ear effusion.

Pott's puffy tumour of the frontal and Parietal bones with subgaleal abscess as a complication of acute sinusitis - a case report

Acute sinusitis is a frequent medical condition that can affect any age group and may lead infrequently to very serious life-threatening complications. These complications include the spread of infection to frontal and other cranial bones, meninges, and other intracranial structures that require urgent medical actions to prevent mortality and morbidity. We report the case of acute frontal sinusitis in a 14 years old male who presented with fever, severe headache, and fluctuant swelling of the nasal root, and right supraorbital and frontoparietal regions. Imaging studies demonstrated signs of left-sided sinusitis, osteomyelitis of the frontal bones, and right parietal bone. Urgent surgery was performed with drainage of the abscesses and samples were sent for culture and sensitivity. Bilateral antral washout and trephination of the left frontal sinus was performed and pus was evacuated. Growth of Staphylococcus aureus and Peptostreptococcus micros was reported and according to the sensitivity report, the patient was kept on intravenous meropenem, 1500 mg per day and vancomycin 1500 mg per day was added on the 7th postoperative day. The patient was discharged from the hospital in good health on the 25th postoperative day and kept on oral vancomycin for one month.