Professional Documents
Culture Documents
Patch test
X-ray mastoid: B/L 300 lateral oblique (Schuller)
Uses of Audiometry
Presence of hearing loss Degree of hearing loss Type of hearing loss Hearing of other ear Record to compare hearing post-operatively Medico legal purpose
Patch Test
Done when deafness = 40-50 dB Do pure tone audiometry: for hearing threshold Put Aluminum foil patch over T.M. perforation Repeat pure tone audiometry: Hearing improved = ossicular chain intact & mobile Hearing same / worse = oss. chain broken or fixed
Uses of E.U.M.
Confirmation of otoscopy findings Epithelial migration at perforation margin Cholesteatoma & granulations Adhesions & tympanosclerosis Assesment of ossicular chain integrity Collection of discharge for culture sensitivity
2. Type of pneumatization:
a. Cellular (80%): plenty of air cells b. Sclerotic (20%): small antrum, air cells absent c. Diploetic (<1%): bone marrow within few air cells 3. Cholesteatoma (cotton wool appearance) 4. Bone destruction: presence & extent 5. Mastoid cavity
Cellular mastoid
Sclerotic mastoid
Diploetic mastoid
Coalescent mastoiditis
Malignancy Eosinophilic granuloma Mega-antrum Large emissary vein
Mastoid cholesteatoma
Non-surgical Treatment
Precautions
Aural toilet
Antibiotics: Systemic & Topical
Precautions
Encourage breast feeding with childs head raised. Avoid bottle feeding. Avoid forceful nose blowing Plug E.A.C. with Vaseline smeared cotton while bathing & avoid swimming Avoid putting oil & self-cleaning of E.A.C.
Aural Toilet
Done only for active stage
Antibiotics
Topical Antibiotics: Antibiotics: Ciprofloxacin, Gentamicin, Tobramycin Antibiotics + Steroid: for polyps, granulations
Neosporin + Betamethasone / Hydrocortisone
Chlorpheniramine
Cetirizine
Pseudoephedrine
Phenylephrine
Fexofenadine
Loratidine Levo-cetrizine Azelastine (topical)
Topical decongestants
Oxymetazoline Xylometazoline Hypertonic saline
Surgical Treatment
Indicated in inactive or quiescent stage Myringoplasty Tympanoplasty Indicated in active stage
Cortical Mastoidectomy
Aural polypectomy
Chemical cautery
Hearing Restoration
Myringoplasty:
surgical closure of tympanic membrane perforation
Ossiculoplasty:
surgical reconstruction of ossicular chain
Tympanoplasty:
Surgical removal of disease + reconstruction of
hearing mechanism without mastoid surgery
Myringoplasty
Aims
Permanently stop ear discharge: dry, safe ear
Contraindications
Purulent ear discharge
Otitis externa
Respiratory allergy
Age < 7 yr (Eustachian tube not fully developed)
Methods
Techniques: Underlay: graft placed medial to fibrous annulus Overlay: graft placed lateral to fibrous annulus Grafts used: Temporalis fascia, Tragal perichondrium, Vein graft, Fascia lata, Dura mater
Underlay myringoplasty
Overlay myringoplasty
Placement of graft
Onlay
Graft cholesteatoma Blunting of anterior tympanomeatal angle Lateralization of graft
Underlay
No No
No 3-4 weeks
Possible Easier & quicker
immediately
No complications of General anesthesia
Tympanoplasty
Types
Type
I II III IV V VI
Pathology
Ear drum perforation only Malleus handle eroded Malleus + Incus eroded Only footplate remains: mobile Only stapes remains: fixed Only footplate remains: mobile
Graft placed on
Malleus handle Incus Stapes head Footplate exposed Lateral SCC opening Footplate exposed
Thank You