Middle Ear Disorders

Functions of the ET

Equalize ME pressure

Protection from nasopharynx

Clearance of secretions of the ME

Abnormally open ET

Patulous tube

ET normally open or closed?

closed

What if ET fails to open

Obstructive ET → negative ME pressure

Causes of patulous ET and sx

extensive weight loss

pregnancy

sx: autophony

Causes of obstructive ET and sx

Intrinsic inflammation within the nasal cavity

sx: sensation of pain and aural fullness, popping sounds, difficulty hearing 

Patulous ET

Otitis media

inflammation of the ME, can lead to mastoid

Otitis media with effusion (OME)

otitis media with effusion

fluid in the middle ear space without signs/symptoms of acute ear infection 

acute otitis media (AOM)

acute otitis media

rapid onset, with signs/sx of inflammation of ME, most often with otalgia and bulging TM

OME, bubbles

acute OM

Causes of OM

ETD

Complications of chronic OME

TM perf

mastoiditis

cholesteatoma

tympanosclerosis

eroded ossicles

damaged inner ear

brain abscess 

mastoiditis

glomus tumor and sx

Benign, slow growing vascular tumor

sx: pulsatile tinnitus, otalgia, aural fullness

otosclerosis

Abnormal spongy-bone growth over the footplate of the stapes caused by abnormal metabolic bone remodeling

sx: CHL, Carhart’s notch

Temporal bone trauma

Longitudinal and transverse fracture

Otic capsule sparing fracture

Longitudinal fracture

CHL, ossicular separation, TM perf, hemotympanum, bloodyotorrhea

Otic capsule violating fracture

Transverse fracture

severe SNHL, vertigo

Hemotympanum

Traumatic TM perf

Ossicular chain discontinuity causes

Temporal bone trauma, congenital, surgical interventions

Ossicular chain discontinuity sx

Maximum CHL

Ad tymps

Increased stiffness in ME system

Effects low frequencies, making more difficult for low freq sounds to pass through

possible dx: otosclerosis, tympanosclerosis, OM

Increased mass in the ME system

effects high frequencies

possible dx: cholesteatoma, partial ossicular chain discontinuation, OM

What would the audio look like for someone with OME

Flat audio

increased mass and stiffness

What would the audio look like for someone with Otosclerosis

Low freq CHL

Progressive loss of high freq

Completely fixed stapes = maximum CHL

What would the audio look like for someone with ossicular chain discontinuity?

High freq CHL

Complete ossicular chain discon. = maximum CHL