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Hearing disorders of the middle ear Tympanic membrane: Tympanic membrane: 1. Perforations 2. Tympanosclerosis: Thickening/Scarring

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Presentation on theme: "Hearing disorders of the middle ear Tympanic membrane: Tympanic membrane: 1. Perforations 2. Tympanosclerosis: Thickening/Scarring"— Presentation transcript:

1 Hearing disorders of the middle ear Tympanic membrane: Tympanic membrane: 1. Perforations 2. Tympanosclerosis: Thickening/Scarring

2

3 TM Perforation

4 TM Perforation

5 Consequences Consequences Mild hearing loss Mild hearing loss Treatment Treatment In some cases, spontaneous recovery (depends on location) In some cases, spontaneous recovery (depends on location) Myringoplasty: Surgical reconstruction Myringoplasty: Surgical reconstruction

6 Middle ear cavity Otitis media: Very common (~70% of children in the U.S.) Otitis media: Very common (~70% of children in the U.S.) Infection of the mucous membrane lining the middle ear Infection of the mucous membrane lining the middle ear Predisposing factors: Poorly functioning Eustachian tubes Poorly functioning Eustachian tubes Barotrauma Barotrauma Abnormal functioning of mucous membrane cilia Abnormal functioning of mucous membrane cilia Anatomical deformities Anatomical deformities Gender and demographic factors Gender and demographic factors Exposure to toxic fumes Exposure to toxic fumes

7 TM Retraction

8 Acute OM

9 Acute OM

10 Acute OM

11 Possible mechanisms Through ruptured tympanic membrane Through ruptured tympanic membrane Through Eustachian tube Through Eustachian tube Through blood Through blood

12 Characteristics of otitis media infection Two types: Acute and chronic Two types: Acute and chronic Rapidly progressive Rapidly progressive Negative pressure in middle ear because of ET malfunction Negative pressure in middle ear because of ET malfunction TM is retracted and appears red TM is retracted and appears red Pain, high temperature, pus accumulates in middle ear mucosa Pain, high temperature, pus accumulates in middle ear mucosa In severe cases, TM ruptures due to pressure. In severe cases, TM ruptures due to pressure. If left untreated, can progress to mastoid air cells and cause mastoiditis. If left untreated, can progress to mastoid air cells and cause mastoiditis.

13 Consequences Flat conductive hearing loss (degree depends on the amount of fluid) Flat conductive hearing loss (degree depends on the amount of fluid) Low static compliance Low static compliance Type B tympanogram Type B tympanogram Absent reflexes Absent reflexes Absent OAEs Absent OAEs High latencies for all ABR peaks High latencies for all ABR peaks

14 Treatment Antibiotics Antibiotics Surgery Surgery Myringotomy and suction Myringotomy and suction Mastoidectomy (if infection has spread to mastoid region) Mastoidectomy (if infection has spread to mastoid region) Tympanoplasty Tympanoplasty

15 PE Tubes

16 Complications of otitis media Cholesteotoma: Sac-like growth due to presence of skin in the middle ear. Cholesteotoma: Sac-like growth due to presence of skin in the middle ear. Dangerous, progressive, highly erosive Dangerous, progressive, highly erosive Foul-smelling discharge (otorrhea) Foul-smelling discharge (otorrhea) Treatment: Surgical removal Treatment: Surgical removal

17 Cholesteatoma

18 Cholesteatoma

19 Cholesteatoma

20 Facial palsy If erosion of bone occurs, facial nerve may be exposed. If erosion of bone occurs, facial nerve may be exposed. Partial/Full paralysis of one side of the face. Partial/Full paralysis of one side of the face. Treatment: Surgery Treatment: Surgery

21 Eustachian tube problems Cause: Infections, allergies, blockage due to overgrown adenoids, structural problems. Cause: Infections, allergies, blockage due to overgrown adenoids, structural problems. Consequences: Negative middle ear pressure, retracted TM. Consequences: Negative middle ear pressure, retracted TM. Audiometric findings: Mild conductive hearing loss, normal static compliance, type C tympanogram. Audiometric findings: Mild conductive hearing loss, normal static compliance, type C tympanogram.

22 Methods to open ET Valsalva: Close nostrils and cheek and blow out. Valsalva: Close nostrils and cheek and blow out. Toynbee: Close nostrils and swallow Toynbee: Close nostrils and swallow Complications of ET malfunction: Complications of ET malfunction: Serous effusion Serous effusion Mucous otitis media Mucous otitis media

23 Otosclerosis Causes: Hereditary in 70% of cases. Causes: Hereditary in 70% of cases. Progressive in nature Progressive in nature Higher incidence in women, adults. Higher incidence in women, adults. Clinical manifestation: Spongy bone formation over the stapes footplate. Footplate becomes fixed in the oval window. Clinical manifestation: Spongy bone formation over the stapes footplate. Footplate becomes fixed in the oval window.

24 Other clinical signs Progressive hearing loss Progressive hearing loss Tinnitus Tinnitus Difficulty hearing while chewing Difficulty hearing while chewing Very vascular promontory, rosy glow through TM (Schwartze sign) Very vascular promontory, rosy glow through TM (Schwartze sign) Paracusis willisii: Speech easier to understand in the presence of background noise. Paracusis willisii: Speech easier to understand in the presence of background noise.

25 Audiometric findings Low frequency conductive hearing loss with air- bone gap. Low frequency conductive hearing loss with air- bone gap. As disease progresses, hearing loss spreads to high frequencies. As disease progresses, hearing loss spreads to high frequencies. Bone conduction is affected, primarily at 2000 Hz (called Carhart’s notch). Bone conduction is affected, primarily at 2000 Hz (called Carhart’s notch). Type A s tympanogram, absent reflexes Type A s tympanogram, absent reflexes

26 Treatment Earlier: Surgery to free immobilized stapes footplate. Not very successful. Earlier: Surgery to free immobilized stapes footplate. Not very successful. Fenestration (new window created in lateral semicircular canal). Fenestration (new window created in lateral semicircular canal). Effects of fenestration: ~ 25 dB hearing loss to total hearing loss, vertigo, tinnitus, poor word recognition scores, facial paralysis, repeated infections of cavity Stapes mobilization: Middle ear cavity exposed through incision in TM. Stapes mobilization: Middle ear cavity exposed through incision in TM. Effects: Immediate improvement in hearing, however, refixation of stapes often occurred. Most successful treatment: Stapedectomy. Replaced with prosthesis Most successful treatment: Stapedectomy. Replaced with prosthesis Modification: Stapedotomy

27 Inner ear Series of interconnecting canals or ‘labyrinths’ in the temporal bone Series of interconnecting canals or ‘labyrinths’ in the temporal bone Two types: Two types: Osseous Osseous Bony Bony Bigger cross-sectional area Bigger cross-sectional area Contains fluid called perilymph Contains fluid called perilymph Membraneous Membraneous Soft tissue Soft tissue Situated within the bony labyrinth Situated within the bony labyrinth Contains fluid called endolymph Contains fluid called endolymph


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