Anomalies of the Middle Ear Flashcards
What is the most commonly seen middle ear anomaly?
Otitis media. (middle ear infection)
How do we classify otitis media?
Can present with or without effusion (fluid presence), and then by fluid type- serous (fluid without infection) or suppurative otitis media (infected). Finally, acute, recurrent, or chronic.
What are the symptoms of otitis media?
If not cleared, thickened fluid will cause blockage and hearing impairment, otalgia…
What are acquired middle ear disorders?
Otitis media Tympanic membrane perforations Atelectasis of the middle ear space Cholesteatoma Tympanosclerosis Trauma Tumors Otosclerosis
How is otitis media classified?
- With or without effusion
- Fluid type
- -Serous-no infection
- -Suppurative-purulent or infected (usually bacterial)
- Duration
- -Acute- with onset of fever, rapid onset
- -Recrurrent- several episodes in short period
- -Chronic- persistent effusion in the middle ear
What type of otitis media is associated with thick fluid, longterm blockage, and hearing impairment?
Chronic otitis media
How does OME progress?
Eustachian tube is blocked by swelling/won’t open
Middle ear is anaerobic- mucus membrane uses oxygen and cells die- creates negative pressure in middle ear
Middle ear fills with fluid from dead cells and negative pressure= fluid filled middle ear
Fluid either does or doesn’t become infected
If Eustachian tube doesn’t open, fluid thickens, it worsens…
OR it opens on own to drain
How does fluid become infected?
Through bacteria from Eustachian tube into middle ear
Can you always see fluid in the ear?
No, not if it’s too low
How does acute media otitis improve? Are antibiotics beneficial? What can we use if it is chronic?
Usually spontaneously! Not always beneficial- only suppurative will benefit. PE tubes if chronic.
Who is most likely to suffer from middle ear infections?
Males Fam history Bottle fed babies Day care Palate abnormalities People near cigarette smoke Poor immune systems/chronic respiratory diseases
What can happen if OME untreated?
Tympanic membrane could burst from pressure Ossicles may be eroded from fluid -mastoid cells- mastoiditis -tegmen tympani- brain abcess Thick fluid can cause atelectasis to occur, causing TM to retract/wrap around ossicles Dizziness, pain, Polyps Facial nerve problems Cholesteatoma
What can cause tinny taste in food?
Facial nerve problems in chords tympani- untreated OME
What types of PE tubes are used?
Button type for children
Larger deeper tubes for permanency- keeps ear drained
What can happen with buttons/PE tubes
They can fall out- get stuck in canal
What is tympani sclerosis? What often causes it? What do we do?
Caused by calcification of the tissues of tympanic membrane
Essentially scarring of TM
Crescent shaped white tissue
Can be caused by PE tubes-minimal hearing loss, no surgery usually needed
What are the types of cholesteatoma?
Congenital- not as common
Acquired- chronic OME
Congenital cholesteatoma
Develops due to entrapment of embryonic structure in epitympanic space
Structure adhered to mucous membrane of middle ear and grows
Acquired cholesteatoma
Squamous epithelium trapped behind TM
Appears as white mass behind TM
Must be removed surgically
Causes conductive loss- usually HF, but can stiffen system and affect LF- possible need to reconstruct TM and ossicles
What is Barotrauma?
Caused by change in pressure- scuba, shock wave, more flaccid TM
What other trauma can cause ME disorder?
Burns, fractures of temporal bone, qtips
What tumors can affect middle ear? What does glom us j arise from?
Glom us tympanicum in middle ear space
Glomus jugulare from jugular fossa. Arises from glom us bodies of IX and X nerves (glospharyngeal, vagus)
Otosclerosis- Where does it develop? What can it result in?
Temporal bone disease where normal bone is reabsorbed and replaced with spongy bone that can harden. Usually develops in oval window and stapes footplate. Ankylosis which is fixation of stapes in oval window- prog hearing loss
What is incidence of Otosclerosis?
Autosomal dominant with 25-40 percent pen
20s between 40s
Twice as common in women
Prog in hormonal lay active periods such as preg, men
