Middle Ear Pathologies

Tympanic membrane perforation

Tympanic membrane perforation

• q-tip

• flying with a bad cold

• acoustic trauma

• middle ear infection (pressure build-up)

TM Perforation

• otoscopy may reveal perforation

• may or may not have hearing loss

• flat, high ear canal volume with absent acoustuc reflexes

If hearing loss is present in TM perforation…

• it is likely to be mild, conductive hearing loss

TM perforation treatment

• heal by themselves, but recurrent perforations can weaken TM’s ability to hear

• surgery may be necessary

  • myringoplasty (graft used to close the perforation)

  • tympanoplasty (surgical reconstruction of the middle-ear system)

tympanosclerosis

• white plaques on the TM

• stiffens the TM

• often no hearing loss, but enough plaque can cause a mild conductive hearing loss

What is Otitis Media?

• inflammation or infection of the middle ear

• caused primarily by Eustachian tube dysfunction

  • Manual blockage from allergies

  • bacteria

  • viral

serous otitis media

• thin liquid free of bacteria

secretory otitis media

• thick liquid free of bacteria

purulent or suppurative otitis media

• fluid that contains cellular debris and bacteria

Otitis media prevalence

• highest with the first 2 years of age

• earlier episode, the more likely to have more

Otitis Media can occur when…

• bottle-fed more than breast fed

• day care more than home care

• infants are in a cigarette smoking environment

development of otitis media

• TM retraction

Otitis Media otoscopy

• vascularization of the MN

• fluid behind the TM

• bulging TM

• discharge

Otitis Media tymp

• flat tymp, with normal ear canal volume

otitis media treatment

• antibiotics

• PE tubes if it is a chronic condition

• tonsillectomy and adenoidectomy, because large adenoids can lead to Eustachian tube blockage

Otitis Media and language development

• attenuation of sounds creates an auditory deprivation

• miss critical milestones

• huge economic costs

otosclerosis

• growth of spongy bone around the ossicular chain and stapes flootplate

• Immobilizes the footplate at the oval

  window and can result in ankylosis, where

  the footplate becomes fixed

otosclerosis audiogram

• rising or flat configuration and as more fixation occurs, the flatter the hearing loss

• carhart notch- worsening of bone conduction thresholds by 10-15 dB at 2000 Hz

• shallow or flat tymp

otosclerosis treatment

• surgical

  • stapes mobilization - loosening of the stapes with a chisel-like instrument

  • stapedectomy - replacement of all or part of the stapes with a prosthesis

otosclerosis may…

• create a leak in the cochlea

ossicular discontinuity

• usually caused by trauma or disease

• dislocations occur at the incudostapedial joint

• large, flat conductive hearing less

cholesteotoma

• a cyst filled with keratin that grows within the middle ear

• occurs as a result of chronic otitis media

• growth may be infectious

• may restrict movement of the ossicles and possibly lead to erosion of the ossicular chain

cholesteatoma audiogram

• displays as an air bone gap

• progressive conductive hearing loss