External & Middle Ear (Exam 2)

Layers of Tympanic Membrane

-Lateral squamous epithelial

-Middle Fibrous

-Inner mucous membrane

Which layer of the Tympanic Membrane will not reform if perforated?

-Fibrous layer

How do the ossicles amplify sound?

-The size difference between the long process of the malleus and incus

-Difference in areas of the ear drum and small oval window

Loss mainly in higher tones; AC & BC affected equally, usually in presbycusis

What would this graph indicate?

Pure conduction loss; uncomplicated otosclerosis

What would this graph indicate?

Cerumen

-Presents commonly with hearing loss

-Usually complicated when pt uses a q-tip and impacts it onto the ear drum

Cerumen Management

-May use loop or forceps

-Debrox or Peroxide (5 drops) can be curative

-Irrigation with body temp water

Foreign Bodies in the Ear

-Treat individually

-may use forceps for non-living objects

-If an insect is present; kill it first

Treatment for Cauliflower ear

-IND

-If left untreated, the cartilage will shrivel and die

Bacterial Otitis Externa "Swimmer's Ear"

-Agents: P. Aeruginosa; S. Aureus

-TX: Analgesics; topical- Cortisporin or Ofloxacin; Systemic- Phenoxymethyl PCN or Augmentin

Fungal Otitis Externa

-More common in DM

-Black thick debris

-Agents: Aspergillus Niger is MC

-TX: Acetasol plain; or Antifungal drops; Do not use steroid drops; may also mechanically remove

Image shows Acute Otitis Media

-What is this dx of the following image?

Acute Otitis Media

-Agents: Pneumococcus, haemophilus influenza, Streptococcus

-TX: culture if ear drum ruptured; PCN; Macrolides if PCN sensitive; myringotomy

When is a myringotomy indicated for acute otitis media?

-When symptoms don't resolve after ABX usually after 24 hours

Image shows Bullous Myringitis

What does the image indicate?

Bullous Myringitis

-Blisters and small lumps on eardrum

-May be partial hearing loss for 2-3 days

-Agents: Mycoplasma & S. Pneumonia

-TX: Oral macrolides; oral or ear drop analgesics; lancing may be necessary

Acute Mastoiditis

-Complication of Acute Otitis Media

-Spreads to antrum of mastoid

-Agents: MC is S. Pneumo

-Symptoms: Hx of AOM; post-auricular pain; erythema; fever

-CT findings: Coalescence of mastoid air cells due to bone destruction

Acute Mastoiditis Treatment

-Based on culture; IV Vanco; if recurrent AOM- Ceftriaxone + Clindamycin

-Surgery

-Myringotomy

-Mastoidectomy: Simple- posterior canal preserved; Radical- Posterior canal sacrificed

Eustachian Tube Function

-Equalization of pressure across TM

-Protects middle ear from infection

-Clearance of middle ear secretions

-Generally closed-opens via tensor vili palatini in yawning

Eustachian Tube Dysfunction (ETD)

-Aural fullness, hearing loss, discomfort with pressure changes, Refraction of TM, Decreased TM mobility, popping sounds, tympanometric eval may be normal

ETD Treatment

-Decongestants

-Systemic steroids

-Nasal steroids (Fluticasone, Beclomethasone)

-Autoinflation

ETD Surgical Procedures

-Tympanostomy

-Balloon Tuboplasty

Barotrauma

-Ear pain/damage to the eardrum/middle ear caused by rapid changes in air pressure

-EX: during descent of airplane or deep sea dive

Treatment of Middle Ear Effusion or Hemotympanum

-Maneuvers to relieve pressure

-Pressure decreasing: Breathing through mouth, yawning, chewing, or swallowing

-Pressure increasing: pinch nose shut, hold mouth closed, blow out gently through nose

Secretory Otitis Media

-Can develop from AOM that hasn't cleared or blacked Eustachian tube

-Causes: Allergies & enlarged adenoids MC; tumors are rare; unilateral effusion in Chinese individual should raise concern

-Can occur at any age but is common in children

-Symptoms: Aural fullness, Hearing loss, lack of pain in absence of infection

-DX: Otoscopy, Tympanometry, Head & Neck exam

Treatment of Secretory Otitis Media

-Decongestants Not effective

-Autoinflation

-Steroids indicated in adult; intranasal for children and DM adults

-Myringotomy and tubes

Types of Perforation

-Central

-Marginal

Etiologies of Perforation

-Traumatic

-Result of Infection

-Acute will spontaneously close in 80% of time

Treatment of TM Perforation

-Tympanoplasty if it does not spontaneously heal

-Avoid water

Otosclerosis

-4& of population

-Occurs in families

-Manifest after puberty, pregnancy or menopause

-Symptoms: Conductive hearing loss bone impeding stapes movement

-May result in sensorineural hearing loss

Treatment of Unilateral Otosclerosis

-Do nothing, cheapest, but still have hearing loss

-Hearing aide

-Surgery: highly successful

Treatment of Bilateral Otosclerosis

-Hearing Aides

-Stapedectomies

Chronic Otitis Media Simplex

-Result of AOM which resulted in unhealed perforation of the Pars Tensa

-Perforation increases, recurring discharge

-Gradual hearing loss due to necrosis

-TX: Tympanoplasty

Chronic Adhesive Otitis Media

-if Serous otitis media not treated, drum becomes retracted

-Partial vacuum results in thinning and stretching of the TM

-TX: Myringotomy & tube

Chronic Otitis Media With Cholesteatoma

-If pars flaccida is drawn by negative pressure, it tends to form a pocket lined by squamous epithelium

-Sheds skin like onion; false tumor expands secreting acid eroding the bones

-Also from perforation of the TM of pars flaccida growing inward

-TX: surgery with mastoidectomy

Neoplasms of the ear

-SCC, BCC, melanoma

-TX: excisions