1. Middle Ear Disorders Lecture 13

2. Outline Anatomy – ME Development Changes due to Mass/Stiffness Disorders Otitis Media Mastoiditis Cholesteatoma Otosclerosis

4. Embryonic Development of ME 1 st month: formation of ossicles starts 6 weeks: oval window formed 3 rd month: ossicles fully developed but still cartilaginous tissue 5-6 months: ossification of ossicles

5. Development of ME

6. Resonant Frequency of Ear

7. MASS vs STIFFNESS Mass – Changes in Mass occur with ME Stiffness Changes in Stiffness occur with ME

8. MASS vs STIFFNESS When you increase stiffness of ME, you decrease the low frequencies on audio This results in a slight increase in the resonant frequency of the ear

9. MASS vs STIFFNESS When you increase Mass of ME, you will see a decrease the high frequencies This results in a slight lowering of the resonant frequency of the ear

10. Otitis Media 70% of children under age 3 have at least 1 episode (Winskel, 2008) 50% of children will have 1 st infection before age 1 (ASHA, 2004) and 9/10 before age 5. 35 % of these will have recurring OM (ASHA, 2004) Most common cause of HL in children under age 3, which occurs while developing language OM and language development OM and academic ability OM and literacy

11. Impact of OME NOT a relationship between OME and cognitive function (Roberts et al, 1995) Presence of fluid/infection causes ____________ HL Fluid may take ___________________to resolve Hearing loss may continue to be present after ________________

12. Otitis Media Acute Otitis Media: fluid in the middle ear with signs of infection (bulging eardrum, ear pain, drainage, perforation) Otitis Media with effusion: fluid in the middle ear without signs of infection (sometimes called serous effusion)

13. OM Sequence Organisms access ME via Eustachian Tube (ET) ET becomes swollen and blocked ME pressure drops (vacuum results) Infection spreads to mucous lining of ME space Tympanic Membrane retracted

14. OM Sequence (cont.) Fluid accumulates in the ME space Bulging observed Fluid becomes infected Rupture of TM or Bleeding possible

15. From:http://www.rcsullivan.com 1. Serous Effusion (no infection) 2. Acute OM – Bulging TM 3. Resolving OM

16. Untreated OM - Mastoiditis invasion of the fluid into mastoid bone

17. OME Symptoms Fever Ear Pain Hearing Loss Irritability Pulling on ear Poor sleep Drainage

18. Audiometric Results Degree of HL: Type: Tympanogram: OAEs: ABRs: IWI: Absolute latency of wave V Absolute threshold of wave V

19. Interventions (Pediatrician, ENT) Watchful Waiting Antibiotics PE Tubes Myringotomy Politzerization Valsalva maneuver

20. fromhttp://www.rcsullivan.com

21. Interventions Politzerization blowing air with a special syringe into one nostril while blocking the other, and at the same time swallowing. Force air into the ET and the ME “Ear-Popper” The Valsalva maneuver: forcibly blowing air into the middle ear while holding the nose. Should not be done if there is a cold and nasal discharge.

22. Prevention of OM

23. Cholesteatoma Non malignant tumor in ME space Condition where skin has entered the ME space Small sac like tumor made up of proteins, fats and tissue As it grows – damage the bones in the ME

24. Most common cholesteatomas from OM

25. From: http://www.earsurgery.org/cholest Congenital cholesteatoma

26. Etiology/Symptoms Etiology: Perforations: skin enters ME Retraction of TM Symptoms: HL, drainage with foul odor, ear pressure, dizziness, facial weakness Left untreated - can spread to inner ear or brain

27. Audiometric Results with Cholesteatoma Degree: Type: Tympanogram: Reflexes: OAE: ABR: IWI Lowest level of wave V Overall latencies of wave V

28. Intervention ENT: Mastoidectomy needs frequent follow-up keep ear dry antibiotics: both oral and ear drops CT-Scan/MR imaging: determines extent Audiological: post-op results

29. Bell’s Palsy Incidence of 13-18 per 100,000 Family tendency for onset Damage to the facial nerve Unilateral facial paralysis Etiology: from viral or bacterial infection, tumor, swelling, injury

30. Facial Nerve – VII Cranial Nerve Innervates 7000 nerve fibers Crosses the wall of the middle ear space Carries impulses also to tongue, saliva glands, tear glands, stapes

31. Symptoms Twitching, weakness, tearing, numbness on one side Changes in taste – Chorda tympani nerve- branch of the facial nerve Not a disease Rarely causes HL alone Differentiate from acoustic neuroma

32. Intervention ENT: Steroids esp within week after onset Recovery in 4-6 weeks may take up to 4 months for full recovery Eye patch at night Keep eye from drying out Permanent Facial Nerve paralysis: surgical interventions PT- facial retraining

33. Audiometric Results with Bell’s Palsy Degree: Type: Tympanogram: Reflexes: OAE: ABR: IWI Lowest level of wave V Overall latencies of wave V

34. Otosclerosis Abnormal bone growth occurs in the middle ear around the footplate of the stapes. prevents ossicular chain from moving properly Footplate of stapes becomes “fixed” at the oval window

35. Otosclerosis Progressive More common in adults, rare in children Higher prevalence in females: adolescence through middle age (2:1) Genetic Hereditary: Accounts for 70 % of cases Autosomal Dominant 25% chance if one parent carrier 50% chance if both parents carriers

36. Symptoms Gradual HL: initial onset after puberty Increased HL after pregnancies Tinnitus Dizziness Paracusis Willisi

37. Audiogram – Otosclerosis

38. Medical Interventions Sodium Fluoride Treatment – reduces bone absorption and enhances calcium development of bones Stapedectomy: removal of stapes and replacement with prosthesis (Shea, 1957) BAHA implantable device

39. Audiometric Results with Otosclerosis Degree: Type: Tympanogram: Reflexes: OAE: ABR: IWI Lowest level of wave V Overall latencies of wave V