Professional Documents
Culture Documents
Middle ear
Learning Objectives
Pertinent Anatomy and Physiology
Diagnostic approach to hearing loss
Common disorders of the external and
middle ear
Summary
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How do we hear?
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Diagnostic Approach to
Diseases of the External and
Middle ear
History
Examination
Investigations
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Hearing loss
Ear Discharge (Otorrhoea)
Tinnitus
Vertigo
Ear Ache (Otalgia)
Facial Paralysis
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Otorrhoea
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Tinnitus
Perception of sound in the absence of
an acoustic stimulus
Common symptom with hearing loss
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Vertigo
A hallucination of movement
Symptom of a vestibular disorder
(peripheral or central)
Dizziness is a broader term referring to
a disorder of balance. It includes light
headedness, giddiness, unsteadiness,
vertigo etc
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Examination
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Otoscopy
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Tympanic Membrane
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Assessment of Hearing
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Whisper test
Normal Conversational voice
Shouting
Tests performed 2ft/6inchs from
subject
Masking of contra-lateral ear
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Rinn Test
Compares Air
Conduction (AC)
with
Bone Conduction
(BC) in the same ear
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Rinn Test
Positive Rinn
AC > BCNormal
Negative Rinn
BC > AC.Conductive HL
Reduced Rinn
AC > BC but shortened
duration...Sensorineural HL
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Weber Test
Central.normal
hearing
Localised to
affected ear
conductive hearing
loss
Localised to normal
earsensorineural
hearing loss
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Tympanometry
Ear canal probe alters
pressure in ear canal
Ear canal volume,
middle ear pressure
and volume is
measured
Stapedial reflex can
be tested
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Tympanogram
Type A
Demonstrates
normal (eardrum) &
middle ear compliance
Normal ranges
Child 0.4/0.7 ml
Adult 0.7/1.2 ml
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Tympanogram
Type B
Flat tympanogram,
associated with
Otitis Media with
effusion
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Audiometer 3
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Congenital Anomalies
Aural atresia
Conductive or
mixed hearing loss
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Otitis Externa
Otorrhoea (purulent)
Itching
+ Otalgia
Oedema of ear canal
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Caused by HZ virus
Vesicles in Concha
Sensorineual hearing loss
Facial paralysis
Dizziness
Treated with Acyclovir +/oral steroids
Necrotising(Malignant)
Otitis Externa
Caused by pseudomonas
species +/- Anaerobes
Elderly
immunpcopromised
patients e.g. Diabetic
Pain a prominent feature
Treatment with long term
antibiotics including i.V.
Triple therapy to avoid
drug resistance
Traumatic TM Perforation
Direct or Indirect
Trauma
(e.g. slap on the ear)
Usually heals
spontaneously
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Otitis Media-Classification
Otitis media is an inflammation of the
middle ear cleft.
1. Acute Otitis Media
2. Chronic Otitis Media
a) Non-Suppurative: Glue Ear, Otitis
media with effusion (OME)
b) Suppurative: Mucosal Disease
Cholesteatoma
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Treatment of AOM
No evidence to support the routine use of
antibiotics
Analgesia
Rehydration
Antibiotics with increasing pain despite
conservative measures and with
complications
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Treatment of OME
Watchful waiting for 3
months
Hearing aids
Ventilatio tubes (grommet
insertion)
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Myringoplasty/Tympan
oplasty
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Tympanomastoidectomy
Combined Approach
(CAT)
Modified radical
Tympanosclerosis
A sequel of
otitis media
or
grommet insertion
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Otosclerosis
Fixation of the footplate of the stapes in
the oval window
Normal ear drum
Conductive or mixed hearing loss
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Stapedectomy
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Discussion
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