1. 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

2. 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 http://www.ent-usa.com/eardrum_and_middle_ear.htm Facial palsy: If erosion of bone occurs, facial nerve may be exposed. Facial palsy: 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

3. 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.

4. 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

5. 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.

6. 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.

7. 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

8. 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