Medical Audiology Week 2

Define microtia/anotia

Malformation or absence of the Pinna - smaller ears or no ear at all

How many grades of Microtia are there?

I-IV

What is aural atresia?

The ear canal is abnormally closed or absent. Can be congenital or acquired.

What are different reasons for aural atresia?

EAC may be shallow and blunted

Can be acquired by trauma or chronic infections

T or F - Microtia is always present with aural atresia

False, most microtia is present with aural atresia, but many patients have normal pinnas

What is stenosis?

The narrowing of a canal, the canal isn’t absent or blocked it’s just a really tiny hole

SOME visibility

What can stenosis lead to?

Ear canal cholesteatoma may be caused epithelial skin cells collecting since the canal isn’t large enough for wax and dead skin cells to move out of the ear.

What can ear canal cholesteatoma result in?

Inflammation, pain, and/or aural discharge (otorrhea)

What is the main anomaly to focus on for congenital anomalies with aural atresia or microtia?

Craniofacial anomalies like a cleft palate

What’s the probability of congenital aural atresia occurring in live births?

1 out of 10-20k live births.

More likely to be males than females

T or F - Unilateral atresia is 3x more likely to be common than bilateral atresia

True

T or F - Left ear is typically more frequently involved than the right

False, right ear is more involved typically

How would you report a patient that seems to have microtia?

No traditional landmarks of the pinna and/or conchagul (i.e. cupping of pinna is noted)

What determines the grade of a microtia?

The surgical plan for the patient

Describe a grade III microtia

There seems to have some bumps, but no traditional landmarks of a pinna is noted

Describe a grade I microtia

Most landmarks are seen, but the entrance to the external auditory canal is noted to be smaller

Describe a grade II microtia

There is more decomposition, may have no entrance to the external auditory canal, the scaphas are noted to not be as present.

Describe a grade IV microtia

There may be a small bump and an indent of where the pinna should be, but no distinguishable pinna is visible.

What are the types of deformities for ears?

Stahl’s ear

Prominent ear

Helical rim

Cryptotia

Lidding

Cup ear

Conchal crus

Combo

What does stahl’s ear look like

Like the helix is pinned back, there’s no fold. Transverse crus extends outward from antihelix.

What does prominent ear look like

Like the ears are facing forward and projects outward. Ears need to be pulled back a bit more with tape.

AKA bat ear or dumbo ear

What is helical rim?

The helix is folded or outlined weird

What’s cryptotia

The helix and the antihelix is very prominent and appears to be buried under skin at the more medial anterior portion of the ear

No meeting point between ear and skull

What is lidding

Helical rim folds downward, AKA lop ear

What is cup ear

More advanced prominent ear, the opening isn’t complete, it’s like cupped like you cupped the back of your ears with your hands

Cartilage is really still

What is conchal crus

Another cartilage that cuts across mid portion of the ear (through the concha)

What is ear molding

A treatment for the malformation to reverse condition right after birth (must be done asap)

What does an ear mold look like

It has the mold, retractors, and tape to hold parts of the ear in the shape it needs to be.

How long does an ear mold have to be on for?

4-8 weeks depending on the degree of ear deformity

When is an adult shaped ear typically seen?

Roughly around 8 years old

When are surgeries recommended age wise?

Around 5 years old or 8 years old, when the ear is fully or mostly developed to minimize unnecessary surgeries.

What are the audiometric results of atresia?

CHL - up to 60dB HL air bone gap

REFER for NBHS

Shallow EAM/Pinna if present, looking for tags or ear parts

Tymp - Small ECV, no compliance, no peak pressure

Blocked probe tip

OAEs - absent, maybe bad probe fit

ABR - bone conduction WNL, air conduction elevated, no significant wave forms

What’s the audiological management for congenital atresia?

Softband BAHA

FM system for better SNR

BAHA + FM → speech language development

Repeat follow up testing for hearing acuity

More hearing device checks

Collaborate with educational audiologist and DHH teacher

What’s the medical management of congenital atresia/stenosis

ENT physical exam for diagnosis, sedated ABR, CT scan for severity, monitor closely for debridement of stenotic, narrow, pocketed area to avoid cholesteatoma (keratin pocket, cyst, skin cells accumulated)

Medical clearance needed for amplification

When is surgery for microtia/anotia or atresia/stenosis is done if both are present

Surgery for microtia/anotia first - 5-7 years old

Surgery for atresia/stenosis - 2 years after

• It may vary depending on condition severity, amplification compliance, or recurrent issues/infections if present

How is aural atresia or stenosis acquired? What are the types?

Trauma to the ear - Cauliflower ear or Boxer’s ear, Exostoses, cerumen impaction

How is cauliflower ear formed?

Blunt force trauma to the ears, blood vessels to the ears are torn, leading to hematomas and cartilage growth from death of old cartilage mishaping the cartilage

What is perichondrium?

The connective tissue around the cartilage, essentially the cartilage

How can cauliflower ear be prevented?

Protective headgear for sports, limited use of blood thinners (ibuprofen), and ice therapy after activities

What’s the treatment for a person who has cauliflower ear?

Excision/drainage - scar tissue is still there but it can prevent bulging in the beginning

Surgery

Ice packs 15min on 15min off

What are the audio patterns of cauliflower ear

Mixed HL (noise induced + outer ear deformity)

Ossicular chain discontinuity, TM perf (trauma) → 60dB ABG

OAE/Immittance can’t be measured bc of swelling

T or F - Supraaural threshold headphoens are best for cauliflower ear

False, circumaural is best bc of comfort

What is exostosis?

Surfer’s ear, abnormal benign bony growths in the EAM

What causes exostosis

Cold water and wind, or long walks on the beach on the west coast by cold water

What are the symptoms of exostosis?

Ear pain, aural fullness, ear infections/blockages (fungal infection or cerumen)

What are the treatment options? for mild and severe

Mild cases - no treatment necessary, ear plugs, hats, or earmuffs (counseling)

Severe cases - surgery

How are the bumps in exostosis formed then treated surgically?

Superior, anterior, and posterior bony bumps. Drilled away in surgery

What’s cerumen impaction?

Accumulation of ear wax, leading to acute ear infection if untreated.

How can wax impaction be treated?

Removal, ear drops or eNT suction if wet

What causes wax impaction?

Swimmer’s ear - water causing fungal infection or wax accumulation (water trapped with wax)

Autoimmune disease - dry/itchy skin

Derm conditions - skin cell accuulation

Stenotic ear canal - narrow ear canal - exostosis

Unnecessary ear cleanings - q tips

Why do some people need more ear canal cleanings than others?

Stenotic ear canals, pediatric ear canals, or exostoses are more difficult for wax to naturally move out

What are treatments OTC for cerumen impaction?

Ear softening drops

Homemade irrigations with syringe to soften - peroxide + water

Ear irrigation sprayers

Video attachments for iPhone

When should an audiologist NOT remove cerumen?

Legal proceedings - Workers comp example, send to ENT

Only hearing ear or better hearing ear - don’t risk injury

PT on blood thinners and prone to bleeding

PT has diabetes - prone to infections (can pull on skin and cause rips, highly vascularized pack to stop bleeds and ENT cauterizes it)

Pt exhibits discomfort at initial attempt for removal (give softening drops and have them come back)

Foreign body removal (caveat, cotton, domes)

Surgical ear history

What’s an example of an OTC treatment that’s good

Ear drops - Debrox ear wax removal aid