DISEASES OF THE MIDDDLE EAR (AB) Flashcards
What is the air-filled space in the temporal bone medial to the tympanic membrane?
Middle ear cavity
What are the three divisions of the middle ear relative to the tympanic membrane?
Epitympanum, Mesotympanum, Hypotympanum
What structure forms the medial wall of the middle ear cavity?
Cochlear promontory
What structure marks the medial wall of the middle ear posteriorly?
Oval window superiorly occupied by the stapes and round window inferiorly
What structure extends posterior to the oval and round windows and medial to the vertical facial nerve?
Sinus tympani
What structure transmits the stapedial tendon to the stapes superstructure?
Pyramidal eminence
What structure is marked by the inferior rim of the tympanic annulus and limited inferiorly by the jugular bulb posteriorly?
Hypotympanum
What is almost completely partitioned from the mesotympanum by the ossicular chain and mucosal folds?
Epitympanum
What bones articulate in the epitympanum to form an ossicular mass?
Body of the incus and head of the malleus
What is the most common infection of the middle ear?
Acute otitis media
What is the duration of acute otitis media?
3 weeks
What seasonal variation increases the incidence of acute otitis media?
Colder months due to upper respiratory tract infections
Why does upper respiratory tract infection predispose to acute otitis media?
Due to Eustachian tube dysfunction
What two muscles open the Eustachian tube?
Tensor veli palatini and levator veli palatini
Why does cleft palate predispose an individual to acute otitis media?
Lack of midline muscle union prevents Eustachian tube opening
What age group has the highest incidence of acute otitis media?
6 to 24 months
What factor has been shown to reduce the risk of acute otitis media in children?
Extended breastfeeding
What is the most common tympanic membrane finding in acute otitis media?
Opaque, bulging, erythematous or congested TM
What test assesses TM mobility in acute otitis media?
Pneumatic otoscopy
What is a common symptom in infants with acute otitis media?
Irritability, vomiting, diarrhea
What bacterial pathogens are commonly associated with acute otitis media?
Streptococcus pneumoniae, Haemophilus influenzae, Branhamella catarrhalis
What is the most common type of otitis media?
Bacterial otitis media
What type of otitis media occurs in severely ill children with systemic disease?
Necrotic otitis media
What are the five stages of otitis media?
Hyperemia, Exudative, Suppurative, Coalescence, Complications and resolution
What is the first-line antimicrobial therapy for acute otitis media?
Amoxicillin (oral) / Ampicillin (IV)
What surgical procedure involves aspirating middle ear fluid for culture?
Tympanocentesis
What procedure involves an incision and drainage of the TM for pain relief?
Myringotomy
What is the purpose of a ventilation tube in the ear?
To continuously drain fluid and equalize pressure in the middle ear
What characterizes chronic otitis media?
Long-standing inflammation with possible irreversible damage
How long must suppuration persist for chronic otitis media to be diagnosed?
More than 6 weeks
What is the hallmark symptom of chronic otitis media?
Foul-smelling otorrhea
What type of hearing loss is associated with chronic otitis media?
Conductive hearing loss
What bacteria commonly cause chronic otitis media?
Pseudomonas aeruginosa, Proteus species, Staphylococcus aureus
What is a cholesteatoma?
An epidermal inclusion cyst of the middle ear or mastoid
What is a key otoscopic finding of cholesteatoma?
Retraction pocket along the posterosuperior TM (Attic cholesteatoma)
What are two types of TM perforations in cholesteatoma?
Central perforation and marginal perforation
Which TM perforation type has a lower healing propensity?
Marginal perforation
What is the primary imaging modality for diagnosing cholesteatoma?
High-resolution CT
What are the two types of ear classification in otitis media?
Safe ear and Unsafe ear
What are intratemporal complications of otitis media?
Mastoiditis, petrous apicitis, labyrinthitis, facial paralysis
What are intracranial complications of otitis media?
Meningitis, brain abscess, lateral sinus thrombosis
What conservative treatments are available for cholesteatoma?
Saline irrigation, removal of entrapped keratin
What are the surgical options for cholesteatoma?
Atticotomy, mastoidectomy (canal wall-up or down procedures)
What determines the treatment approach for cholesteatoma?
Extent of disease, complications, hearing status, Eustachian tube function
What is the definition of otitis media with effusion (OME)?
Inflammatory effusion behind an intact tympanic membrane without signs of acute otologic symptoms or systemic illness.
What is the main characteristic of otitis media with effusion (OME)?
Effusion without infection.
What is the most common symptom of OME in children?
Hearing loss.
What are the different classifications of OME based on duration?
Acute (<3 weeks), Subacute (3 months), Chronic (≥6 months).
What otoscopic findings are diagnostic of OME?
Opaque, thickened, retracted tympanic membrane; pale, reddish, yellowish, bluish; decreased mobility on pneumatic otoscopy.
What is the first-line treatment for acute and subacute OME?
Conservative treatment with decongestant nose drops, hygienic measures, and topical steroids.
What is the treatment for chronic OME?
Surgical intervention: Myringotomy with ventilation tube insertion.
What is a good prognostic sign in OME?
Presence of air bubbles in the middle ear, indicating Eustachian tube function.
What is the prognosis of OME if the tympanic membrane is thickened and opaque?
Requires surgical treatment (myringotomy).
What symptom of OME is rarely present in adults?
Pain.
What are the common symptoms of OME in adults?
Ear fullness, sloshing/popping sound, conductive hearing loss.
What is a common preceding factor for OME in adults?
History of colds.
What are the otoscopic findings in OME in adults?
Thickened tympanic membrane, air bubbles, complete effusion.
What is the expected audiometric finding in OME?
Conductive hearing loss.
What is the Weber test result in OME?
Lateralizes to the affected ear.
What is the Rinne test result in OME?
Negative (bone conduction is better than air conduction).
What should be done if OME persists for more than 3 weeks?
Endoscopic examination of the nose and nasopharynx to rule out tumor growth.
What condition should be suspected in unilateral OME with normal ear structures?
Nasopharyngeal etiology (e.g., nasopharyngeal carcinoma, persistent adenoid, juvenile nasopharyngeal angiofibroma in males).
What conservative treatments are recommended for acute and subacute OME in adults?
Relieve nasal obstruction, treat nose/paranasal sinus infections, perform regular Valsalva maneuver, Toynbee maneuver, Eustachian tube rehabilitation exercises (chewing gum).
What surgical treatment is recommended for chronic OME?
Myringotomy.
What complication can arise if bacterial infection ascends in OME?
Acute otitis media with its complications.
What is the prognosis for unilateral OME?
Good; should resolve within 6 weeks.
What are the two types of middle ear injuries?
Direct and Indirect.
What is the most common cause of indirect middle ear injury?
Slap on the ear causing air pressure rupture of the tympanic membrane.
How long does a severe indirect middle ear injury take to heal?
9 weeks.
What sports-related activities can cause indirect middle ear injuries?
Diving and boxing.
What are common causes of direct middle ear injuries?
Ear manipulation with cotton buds or cerumen spoons, foreign bodies like small twigs or welder’s slag.
What more violent traumas can affect both the middle and inner ear?
Fractures from vehicular accidents, falls, or mauling.
What can disintegration or dissociation of ossicular joints lead to?
Chronic hearing loss.
What symptom occurs if the labyrinthine capsule is fractured?
Vertigo.
What nerve can be affected by middle ear trauma, leading to facial paralysis?
Facial nerve.
What are common symptoms of middle ear injuries?
Brief pain, sensation of ear fullness, minimal otorrhea, air escape on Valsalva.
What symptoms suggest involvement of the inner ear in middle ear injuries?
Vertigo, nausea, disequilibrium, and facial nerve paralysis.
What is the otoscopic finding in middle ear injury?
Slit-like or triangular (peripheral) perforation.
What type of hearing loss occurs with tympanic membrane damage?
Mild conductive hearing loss (30 dB).
What audiometric finding suggests ossicle involvement in middle ear injuries?
More severe hearing loss.
What is the expected Weber test result in middle ear injuries?
Lateralizes to the affected ear.
What is the Rinne test result in middle ear injuries?
Weakly negative or sometimes positive.
What is the primary treatment for tympanic membrane perforation?
Conservative management; it heals on its own.
When is a paper patching used in middle ear injuries?
For larger tympanic membrane perforations.
What should be avoided in cases of tympanic membrane perforation?
Water and soap entering the ear.
What is Teed’s Classification used for?
Classifying barotrauma of the ear.
What are the stages of Teed’s Classification?
I: Erythema of pars flaccida, II: Erythema of entire tympanic membrane, III: Hematoma of tympanic membrane, IV: Hemotympanum, V: Ruptured tympanic membrane.
What causes barotrauma of the ear?
Rapid changes in pressure, such as airplane landings and diving.
What symptoms are associated with barotrauma?
Severe pain, hearing loss, vertigo, disequilibrium, nystagmus.
What diagnostic findings confirm barotrauma?
History of pressure changes, otoscopic findings like effusion or tympanic membrane rupture.
What are complications of barotrauma?
Water entering perforation causing vertigo, secondary bacterial infection, inner ear involvement.
What is the primary treatment for barotrauma?
Tympanocentesis to relieve negative pressure, NSAIDs for pain relief.
What are preventive measures for barotrauma?
Avoid diving if predisposed, ensure good nasal breathing during flights.
Why are peanuts given to airline passengers?
To help open the Eustachian tube by encouraging chewing.
What is otosclerosis?
A disease of the bony otic capsule causing fixation of the stapes and hearing loss.
What are the symptoms of otosclerosis?
Slowly progressing hearing loss (unilateral or bilateral), tinnitus (rare), sensorineural hearing loss in cochlear form.
What audiometric finding is pathognomonic for otosclerosis?
Carhart’s notch (decrease at 2000 Hz).
What is the Weber test result in otosclerosis?
Lateralizes to the affected ear.
What is the Rinne test result in otosclerosis?
Negative.
What imaging finding supports the diagnosis of otosclerosis?
CT scan showing circumscribed areas of decalcification.
What is a severe complication of otosclerosis?
Cochlear hearing loss leading to deafness.
What are the treatment options for otosclerosis?
Surgical rehabilitation, ossicular chain reconstruction, cochlear implantation, hearing aids.
What other bone diseases can lead to stapes fixation?
Osteogenesis imperfecta, Paget’s disease, acromegaly.
What is patulous Eustachian tube?
A permanently open Eustachian tube.
What are the symptoms of patulous Eustachian tube?
Aural fullness, vague hearing loss with no objective findings, roaring tinnitus, autophony.
What is the treatment for patulous Eustachian tube?
Reassurance of the patient.
