The major symptoms are purulent anterior or posterior nasal discharge, nasal con

gestion, facial pain or pressure, and fever. Minor symptoms are cough, headache
(not otherwise specified), halitosis, and earache (Shapiro and Rachelefsky 1992)
.
SNHL
Symptoms may include:
Some sounds seem too loud.
You have problems following conversations when two or more people are talking.
You have problems hearing in noisy areas.
It is easier to hear men's voices than women's voices.
It is hard to tell high-pitched sounds (such as "s" or "th") from one another.
Other people's voices sound mumbled or slurred.
You have problems hearing when there is background noise.
Other symptoms include:
Feeling of being off-balance or dizzy (more common with Meniere's disease and ac
oustic neuromas)
Ringing or buzzing sound in the ears (tinnitus)
SIEGEL OTOSCOPY
Pneumatic otoscopy is an examination that allows determination of the mobility o
f a patient s tympanic membrane (TM) in response to pressure changes. The normal t
ympanic membrane moves in response to pressure. Immobility may be due to fluid i
n the middle ear, a perforation, or tympanosclerosis, among other reasons.[1] Th
e detection of middle ear effusion by pneumatic otoscopy is key in establishing
the diagnosis of otitis media with effusion (OME).[2]
The predictive value of visible eardrum characteristics for OME ranges widely.[3
] Therefore, pneumatic otoscopy is important, as it can indicate the presence of
effusion even when the appearance of the eardrum otherwise gives no indication
of middle ear pathology. Pneumatic otoscopy has been found to have a high sensit
ivity and specificity for diagnosing middle ear effusion.[4, 5, 6, 7] It has als
o been shown to do as well as or better than tympanometry and acoustic reflectom
etry, and it is especially useful in a setting in which tympanometry is not read
ily available.[8] Other advantages are that it is cheap and easy to perform with
appropriate training.
Relevant Anatomy
The primary functionality of the middle ear (tympanic cavity) is that of bony co
nduction of sound via transference of sound waves in the air collected by the au
ricle to the fluid of the inner ear. The middle ear inhabits the petrous portion
of the temporal bone and is filled with air secondary to communication with the
nasopharynx via the auditory (eustachian) tube.

GROMMET
Bluestone and Klein (2004) came out with revised indications for grommet inserti
on which took into consideration the prevailing antibiotic spectrum.
chronic otis media with effusion not responding to antibiotic medication and has
persisted for more than 3 months when bilateral or 6 months when unilateral.
Recurrent acute otitis media especially when antibiotic prophylaxis fails. The m
inimum episode frequency should be 3/4 during previous 6 months / 4 or more atta
cks during previous year.
Recurrent episodes of otitis media with effusion in which duration of each episo
de does not meet the criteria given for chronic otitis media but the cumulative

duration is considered to be excessive (6 episodes in the previous year)

Suppurative complication is present / suspected. It can be identified if myringo
tomy is performed.
Eustachean tube dysfunction even if the patient doesnt have middle ear effusion.
Symptoms are usually fluctuating (dysequilibrium, tinnitus, vertigo, autophony
and severe retraction pocket).
Otitis barotrauma inorder to prevent recurrent episodes.
Long term studies have called the necessity of routine ear tube surgery into que
stion,[1][2] but current guidelines for American otolaryngologists indicate tube
placement in the following conditions:
Chronic otitis media with persistent effusion for 6 months (one ear) or 3 months
(both ears).
Recurrent acute otitis media: 3 ear infections in 6 months or 4 infections in a
year.
Persistent eustachian tube dysfunction
Barotrauma: Especially for prevention of recurrent episodes (e.g., after air tra
vel, hypobaric chamber treatment).
RHEESE METHOD
Optic canal & foramen visible at end of sphenoid ridge in inferior & lateral qua
drant of orbit
Entire orbital rim
Supraorbital margins lying in same horizontal plane
Close beam restriction top the orbital region
Bezold's Abscess is an abscess in the sternocleidomastoid muscle where pus from
a mastoiditis escapes into the sternocleidomastoid. It is a rare complication of
acute otitis media
The tympanic membrane (TM) is an oval, thin, semi-transparent membrane that sepa
rates the external and middle ear (tympanic cavity). The TM is divided into 2 pa
rts: the pars flaccida and the pars tensa. The manubrium of the malleus is firml
y attached to the medial tympanic membrane; where the manubrium draws the TM med
ially, a concavity is formed. The apex of this concavity is called the umbo. The
area of the TM superior to the umbo is termed the pars flaccida; the remainder
of the TM is the pars tensa.