Internal Medicine

0521779407-17 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:18

1122 Otitis Media Paget Disease

complications and prognosis

Complications

■Perforated TM & purulent otorrhea, speech delay, cholesteatoma,

tympanosclerosis, ossicular discontinuity/fixation, sensorineural

hearing loss, coalescent mastoiditis, petrositis, labyrinthitis, facial

nerve paralysis, meningitis, extradural abscess, subdural empyema,

brain abscess, sigmoid sinus thrombosis, otic hydrocephalus, &

death

■Complications of OM should be referred to a specialist.

Prognosis

■10% of children w/ OME will continue to have effusion at 3 mo after

episode of AOM & will require tympanostomy tubes.

■Children not treated for OM have been found to have significantly

greater incidence of speech delay & hearing loss in addition to other

complications.

PAGET DISEASE

ROBERT A. MARCUS, MD

history & physical

History

■Family history of Paget disease, rarely

Signs & Symptoms

■Bone aches, involving skull, spine, pelvis, femur, tibia

■Hearing loss

■May be asymptomatic

■Incidental radiographic finding

■Local increase in skin temperature at involved sites

■Gross deformity of affected bones after long-term untreated disease

■Swelling, deformity of skull

tests

Laboratory

■Basic blood studies:

➣Serum alkaline phosphatase elevated in most patients

➣Serum calcium normal unless patient immobilized, then ele-

vated