Websites relating to ear pain in children

Websites related to this week's Clinical Review selected by Dr Keith Barnard.

ACUTE OTITIS MEDIA

I like Bandolier because of its pithy no-nonsense style. This short article summarises the findings of a meta-analysis of the use of antibiotics in acute otitis media (OM) in children.

Occasionally I get the impression that it is considered by some to be a heinous crime to give amoxicillin to a screaming child with a red bulging ear drum, but it is funny how it defuses the situation, placates the parents, and so often, anecdotally of course, seems to help the child.

This research points out that six out of seven children do not need antibiotics for OM, but how can you tell at 2am? The authors give a qualified yes to the question of whether antibiotics should be part of the initial empirical therapy for OM in children. There are elegantly dissected qualifications, but I felt no need to read further.

Why go there: A reliable source.

Downside: Probably needs updating.

Information from: Bandolier

Address: www.jr2.ox.ac.uk/bandolier/band16/b16-3.html

BAROTRAUMA AND DIVING

As an experienced scuba diver I have a special interest in this, but as the sport continues to expand, GPs are likely to come across this condition more frequently.

And because children as young as 12 can now dive, it is not just a problem for adults.

These pages have some good line drawings, explain how to manage the condition and how to advise the diver about future diving.

If you are a non-diving doctor and do diving medicals, elsewhere on the site you will find useful information about the examination of the ear to assess fitness for diving.

However, I don't agree with the advice that you should always descend feet first.

If you're dropping into murky visibility onto a wreck, I like to see where I'm going and adopt a horizontal position. There might be some spiky bits that could give you a nasty prang.

Why go there: Accurate.

Downside: None.

Information from: Scubadoc's Diving Medicine Online.

Web address: www.scuba-doc.com/Midearbt.html

RAMSAY HUNT SYNDROME

It's easy to miss this diagnosis, but getting it right is important.

This brief account is really all you need to refresh your memory, and it reminds us that partial facial weakness can also occur, causing confusion with Bell's palsy. The patient described obtained short-term relief of the worst of the symptoms by instilling lidocaine in the external auditory meatus.

Why go there: Succinct.

Downside: Poor quality image.

Information from: Harvard Medical School.

Address: www.shingles.mgh.harvard.edu/ramsay_hunt.htm

PATIENT INFORMATION

I had not come across this site before but it is one of the better ones for providing patient information.

There is a coloured line drawing of the anatomy of the ear, and the site has an excellent picture of mastoiditis.

Ear infections in children often settle without treatment with no ill effects.

The consultant ENT surgeon authors say that infections of the ears that do not settle down within a couple of days should precipitate a visit to your GP. I think most of us will agree that ear pain usually precipitates an encounter within a matter of hours, but the writers are hospital-based and so perhaps do not realise what goes on in the real world.

Why go there: Good images.

Downside: Complex in places.

Information from: British Association of Otorhinolaryngologists.

Address: www.entuk.org/patient_info/ear/infections_html

- Dr Barnard is a former GP in Fareham, Hampshire

- Clinical Review, page 41

WEBSITE OF THE WEEK

This is not exactly your conventional site for images illustrating ear pain, but I bet you won't be able to resist a quick visit.

All manner of ear pathology is included here, and all of them could occur in children, and certainly can cause pain.

The images are good quality and can be enlarged for a better view. But why will it prove irresistible? Because among such conditions as fungal infections, granulomas and foreign bodies, there is a series of photographs entitled 'ear maggots'. Now I know this is a rare situation, but this insect crawled into someone's ear and laid eggs, which hatched.

I bet you're squirming already, but now if you have the courage, and you're not about to have your lunch, click on the 'view video' button, and see them wriggling away in the external auditory meatus.

Eating witchetty grubs in 'I'm a celebrity, get me out of here' has nothing on this.

Why go there: You'll gain more than just the squirm factor.

Downside: None.

Information from: Otology Online.

Address: www.entusa.com/external_ear_canal.htm

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