Download Hearing disorders of the outer ear

Treatment

Antibiotics
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Surgery

Myringotomy and suction

Mastoidectomy (if infection has spread to mastoid
region)

Tympanoplasty
Complications of otitis media

Cholesteotoma: Sac-like growth due to presence of skin in the
middle ear.

Dangerous, progressive, highly erosive

Foul-smelling discharge (otorrhea)

Treatment: Surgical removal
http://www.ent-usa.com/eardrum_and_middle_ear.htm
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Facial palsy: If erosion of bone occurs, facial nerve may be exposed.
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Partial/Full paralysis of one side of the face.
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Treatment: Surgery
Eustachian tube problems

Cause: Infections, allergies, blockage due to
overgrown adenoids, structural problems.

Consequences: Negative middle ear pressure,
retracted TM.

Audiometric findings: Mild conductive hearing
loss, normal static compliance, type C
tympanogram.
Methods to open ET


Valsalva: Close nostrils and cheek and blow out.

Toynbee: Close nostrils and swallow
Complications of ET malfunction:

Serous effusion

Mucous otitis media
Otosclerosis

Causes: Hereditary in 70% of cases.

Progressive in nature

Higher incidence in women, adults.

Clinical manifestation: Spongy bone formation
over the stapes footplate. Footplate becomes
fixed in the oval window.
Other clinical signs

Progressive hearing loss

Tinnitus

Difficulty hearing while chewing

Very vascular promontory, rosy glow through TM
(Schwartze sign)

Paracusis willisii: Speech easier to understand in the
presence of background noise.
Audiometric findings

Low frequency conductive hearing loss with airbone gap.

As disease progresses, hearing loss spreads to
high frequencies.

Bone conduction is affected, primarily at 2000
Hz (called Carhart’s notch).

Type As tympanogram, absent reflexes
Treatment

Earlier: Surgery to free immobilized stapes footplate. Not very successful.

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.
Effects: Immediate improvement in hearing, however, refixation of
stapes often occurred.

Most successful treatment: Stapedectomy. Replaced with prosthesis
Modification: Stapedotomy