1. Diseases of Inner ear الدكتور سعد يونس سليمان
بسم الله الرحمن الرحيم
Diseases of Inner ear
الدكتور
سعد يونس سليمان

2. Lecture Objectives Deafness (Hearing loss) Hearing Aids
Otosclerosis (Otospongiosis)
Sudden Sensorineural Hearing Loss
Drug ototoxicity
Presbycusis (Senile hearing loss)
Deafness and Noise
Non-Organic Hearing Loss
Tinnitus

3. Deafness (Hearing loss)
Conductive
Congenital
Acquired
EAM ME
Otic capsule
SNHL
Cochlear
Retrocochlear

4. Hearing Aids
A hearing aid is an electro-acoustic device used to amplify sounds.
Design
The basic components of any hearing aid are:
Receiver ( microphone)
Amplifier
Sound transmitter (Ear phone)
Power supply

6. Types of hearing aid Behind-The-Ear (BTE)
In-The-Ear and In-The-Canal Aids:
Body-worn aids
Bone conduction HA: sound is transmitted from a vibrator that fit on mastoid bone

7. Bone-anchored hearing aids (BAHA)

8. Cochlear implant:
an electronic device that can provide useful hearing for persons who have severe SNHL who cannot benefit from HA. It is composed of:
1- External component: which consist an external speech processor and transmitter.
2- Internal component: is surgically implanted and comprises the receiver / stimulator package with an electrode array.

10. OTOSCLEROSIS

11. DEFINITION
Is hereditary localized disease of the otic capsule in which new spongy bone cause ankylosis of the foot plate of stapes leading to conductive deafness. Cochlear involvement with SNHL may also occur.

12. HISTOPATHOLOGY Resorption of bone by osteocytes
Formation of new vascular spongy bone

13. Fissula ante fenestram (80% to 90%)
AREAS OF PREDILECTION
Fissula ante fenestram (80% to 90%)

14. COCHLEAR INVOLVEMENT

15. AETIOLOGY
Hereditary factors: (50%) / autosomal dominant pattern with incomplete penetration.
Racial distribution:
white races (Caucasian) > coloured.
Age: years of age.
Sex: females: male= 2:1.
Pregnancy: may accelerate the condition but NEVER cause it.

16. CLINICAL PRESENTATION
Hearing loss of gradual onset at years
Slowly progressive course
80% are bilateral
Accelerates with pregnancy (30-40%)
Tinnitus (75%)
Paracusis Willisii
Change of the speech pattern

17. PHYSICAL EXAMINATION Normal tympanic membrane
Schwartze sign (Flamingo flush)
* seen through the membrane due to hyperaemia of the promontory
* indicates rapid progression of the disease.
Tuning fork tests

19. PURE TONE AUDIOMETRY Conducive deafness.
Carhart’s notch: is an increase in bone conduction threshold with a peak at 2,000 Hz. Explanation is not known
Reverses following successful surgery
In advanced cases there may be SNHL

20. Treatment Hearing aids Medical: sodium fluoride?!
Surgical: stapedectomy which is total or partial removal of the foot plate of the stapes and replacement by prosthesis.
Complication: perilymph fistula which is characterized by sudden SNHL and vertigo. It is liable to occur after sudden changes of pressure, so the patient should avoid diving and only fly in pressurized aircrafts.

21. Sudden Sensorineural Hearing Loss
Aetiology
Idiopathic: in 2/3 of cases
Vascular: spasm, thrombosis or haemorrhage of the internal auditory artery.
Viral infection: mumps, measles, rubella or Herpes zoster.
Head injury with temporal bone fracture, blast injury, and ear surgery as stapedectomy.
Tumors: acoustic neuroma.

22. Clinical Picture Hearing Loss
Tinnitus: 80% --a good prognostic sign and means that hair cell still functioning.
Vertigo: is common in those with vascular aetiology and caries a bad prognosis.
Examination
The TM is usual normal.
Tuning fork test
PTA: hearing loss in high frequency.

23. Treatment Prognosis Bed rest and sedation. Steroids in tapering dose.
Vasodilators: Betahistine (Betaserc).
Low molecular weight dextran
Prognosis
In 1/3 quick recovery. If there is no recovery within 3 weeks it is unlikely to occur spontaneously.
In 1/3  partial recovery
In 1/3 have none.
Unfavorable prognostic features are severe HL and vertigo

24. Drug ototoxicity
Damage to the cochlear and/or vestibular part of the inner ear by certain drugs.
Ototoxic drugs include:
Aminoglycosides
Loop diuretics
Salicylates.
Quinine.
Antiepileptics; phenytoin.
B-blockers.
Cytotoxic; cisplatin.
Synergistic effect….
The dangers are especially great if excretion is impaired as in renal failure.

25. Presbycusis (Senile hearing loss)
A symmetrical, progressive, bilateral SNHL
age > 65 years
no underlying cause.
The degenerative changes occur as a result of aging process and vascular insufficiency
Treatment
Lip reading
Hearing aids

26. Deafness and Noise Excessive sound stimulation  two types of SNHL
Acoustic trauma…very brief exposure…
Noise-induced hearing loss..excess of 85dB for 8 hours/day
PTA
Treatment
Preventive:
Therapeutic:
Rest and avoidance of future trauma.
Hearing aids

27. Non-Organic Hearing Loss
Psychogenic (hysterical)
Malingering.
Diagnosis
History
Examination
Audiometry; repeated audiograms give different results on each occasion.

28. Fracture base of the skul
The longitudinal is more common than transverse.
Deafness
Tinnitus and Vertigo
Tympanic membrane.
Facial nerve palsy is seen more often in transverse fracture
X-ray and CT scan of the base of skull

30. Treatment:
Bleeding from the ear, with or without facial nerve palsy, after head injury means fracture base of skull until prove other wise.
Never syringe the ear.
No instrumentation of the ear.
No caloric test.
Systemic antibiotic…
Facial nerve paralysis...

31. Tinnitus subjective sensation of noise Aetiology Central
Peripheral (ear):
External and middle ear.
Cochlear:
Retrocochlear
It is usually more noticeable in bed at night when background noise is at its quietest.
Investigation
CBC, FBS and lipid profile.
CT scan, MRI (acoustic neuroma).
MRA and angiography (glomus jugulare).
PTA.

32. Treatment
Treatment of underlying cause and reassurance. Avoid smoking and caffeine.
Drugs: I.V. lidocaine, antidepressants and anxiolytics like alprazolam.
Ginkgo biloba improves brain function by increasing blood flow and oxygenation.
3. Tinnitus masking
4. Hearing aids