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We also gather from the history that the child has had numerous cases of Chronic Otitis Media. Acute/ Chronic Otitis Media is known to lead to hearing loss if it is not well treated when it occurs, if it recurs over time or if it occurs and goes unnoticed hence untreated for a long time.
Patients of Chronic Otitis Media have their Eustachian tubes blocked hence the pressure in the ear is not balanced. The Eustachian tube is normally blocked by a mass of secretions in the middle ear. As the ear cannot perform normally, the patient loses the sense of sound gradually.
An anatomical diagram showing the area of the lesion
In the New England Journal of medicine, Stephen Berman, M.D. writes on Chronic Otitis Media in children. In the journal, he writes that due to increased cases, the medical fraternity is looking for the most cost-effective method of treating the condition. He explains that by the time they reach two years, 9.3 million children of the United States will have suffered the condition. Out of these, 7% will have it recur three or more times within six months. Dr. Berman further gives an algorithm that summarizes the diagnosis and management of the condition. In the treatment, there are a number of errors that could lead to overdiagnosis or underdiagnosis of the condition. They are biased by the physician or the parents in treating the child with antibiotics. He explains that the physician could be tempted
“To make the diagnosis without removing enough cerumen to visualize the tympanic membrane adequately and a mistaken belief that a red membrane with normal mobility establishes the diagnosis”
He admits that the use of antibiotics to correct this condition is controversial but advises that the child could be treated using trimethoprim, sulfamethoxazole, and Amoxicillin or erythromycin, and sulfisoxazole.
In conclusion, he writes
“The diagnosis and management of Otitis Media in children remain challenging and controversial. The differing ability of families to cope with a child with recurrent or persistent Otitis Media and the lack of data that show a causal relation between conductive hearing impairment and subsequent behavior problems or delays in language development (or both) require the clinician to solicit and to consider parental preferences in treatment.”
In relation to the case, Dr. Berman’s journal is of much help since the medication he prescribes should be used and he also raises the unseen factor of bias that will be catered for. The patient’s history suggests that the family has a problem in dealing with the child’s hearing loss and the delay in acquiring language skills. As such as he puts it in his conclusion, the clinician should solicit and consider parental preferences in the treatment.
Renowned Pediatric otolaryngologist and professor, Dr. Charles D. Bluestone, M.D. have written five books on Otitis Media. The books, Otitis Media in Infants and Children, Evidence-Based Otitis Media, Targeting therapies in otitis media and otitis externa and Advanced Therapy of Otitis Media. His is an intellectual literary crusade to create awareness on the disease, its symptoms, diagnosis, treatment, and therapy. Dr. Bluestone is a professor of otolaryngology at St. Pittsburgh School of Medicine. He has dedicated more than 30 years of his life researching and treating children ENT. He started the Children's Hospital's Pediatric Otolaryngology Department in 1975 and served as its director. He also initiated a fellowship in pediatric otolaryngology at the hospital. He was the first subspecialist in otolaryngology to receive accreditation as a Leading Scientists of the World in 2005 by the International Biographical Centre.
The condition is one of conductive hearing loss, not sensorineural. Following the different criteria used to discern the type of hearing loss. Using the anatomical site criteria, the loss is in the middle ear as in conductive hearing loss, not the inner ear as in sensorineural loss.