Disorders Of Tympanic Membrane

Question 1

What are the affected sites in central perforation?

Answer 1

In pars tensa
- some part of pars tensa is intact
- annulus is not involved
- doesn’t reach up to bone

Question 2

What is the site of central anterior perforation?

Answer 2

Anterior to handle of malleus

Question 3

What is the site of central posterior perforation?

Answer 3

Posterior to handle of malleus

Question 4

What is the site of central inferior perforation?

Answer 4

Inferior to handle of malleus

Question 5

What is small perforation?

Answer 5

Only 1 quadrant is involved

Question 6

What is medium perforation?

Answer 6

2 quadrants are involved

Question 7

What is large perforation?

Answer 7

3 quadrants involved

Question 8

What is subtotal perforation?

Answer 8

4 quadrants involved (rim of pars tensa present)

Question 9

What is marginal perforation?

Answer 9

Annulus of TM eroded -> reaches up till bone
(Pars flaccida doesn’t have annulus)

Question 10

Central perforation could lead to

Answer 10

Mucosal type of COM/CSOM

Question 11

Marginal perforation could lead to

Answer 11

Squamous type of COM/CSOM as squamous epithelium from EAC migrates to middle ear

Question 12

What is the C/F of traumatic perforation?

Answer 12

• h/o pressure changes/blow/trauma
• sudden blocked feeling
• pain
• ringing (tinnitus)
• bleeding

Question 13

Subjective tinnitus is heard by

Answer 13

Patient only

Question 14

Which conditions is subjective tinnitus heard?

Answer 14

• perforation
• wax
• fluid in middle ear
• inner ear conditions

Question 15

Objective tinnitus is heard when

Answer 15

Examined with a stethoscope

Question 16

Which conditions is objective tinnitus heard?

Answer 16

Vascular conditions

Question 17

What are the examination findings in traumatic perforation?

Answer 17

• perforation of TM
• blood clots

Question 18

What is the conservative management for traumatic perforation?

Answer 18

1. Reassure (can heal on its own within 3 months)
2. Keep ear dry & free from infection
3. Ears drops (ciprofloxacin) only if infected
4. Prevent URTIs

Question 19

Indication of myringoplasty for traumatic perforation

Answer 19

If TM doesn’t heal after 3 months

Question 20

When is paper patch used for traumatic perforation?

Answer 20

• done for large perforation as it provides scaffold for epithelium to grow

Question 21

What are the layers of TM?

Answer 21

1. Epithelial layer
2. Fibrous layer
3. Mucosal layer

Question 22

Which layer of TM doesn’t regenerate?

Answer 22

Fibrous layer

Question 23

What are the complications of traumatic perforation?

Answer 23

1. Permanent perforation
   - not healed by 3 months -> margins epithelialized
2. Tympanosclerosis
   - hyalinization & calcification of fibrous layer of TM -> chronic inflammation of middle ear

Question 24

What is the pathogenesis of TM retraction?

Answer 24

ET obstruction -> -ve pressure in middle ear -> TM retraction

Question 25

What happens to the cone of light in pars tensa retraction?

Answer 25

It’s distorted/absent

Question 26

What happens to the TM in pars tensa retraction?

Answer 26

Appears dull

Question 27

What happens the handle of malleus in pars tensa retraction?

Answer 27

It’s shorter and more horizontal (foreshortened)

Question 28

What happens to the lateral process of malleus in pars tensa retraction?

Answer 28

Becomes more prominent

Question 29

What happens to the anterior or posterior malleolar fold in pars tensa retraction?

Answer 29

Becomes sickled

Question 30

Describe stage 1 of pars tensa retraction according to Sade’s classification

Answer 30

Retraction of TM but not in contact with incus

Question 31

Describe stage 2 of pars tensa retraction according to Sade’s classification

Answer 31

Retracted & touching incus on stapes

Question 32

Describe stage 3 of pars tensa retraction according to Sade’s classification

Answer 32

- atelectasis = TM touching the promontory

Question 33

Describe stage 4 of pars tensa retraction according to Sade’s classification

Answer 33

Adhesive otitis media TM adherent to promontory

Question 34

What’s the purpose of doing a siegelisation/pneumatic otoscopy in pars tensa retraction?

Answer 34

To differentiate btwn stage 3 & 4 Pressure changes in EAC - if TM doesn’t move = adherent - if some movement seen = touching

Question 35

Describe stage 1 of pars flaccida retraction according to Tos classification

Answer 35

Pars flaccida retracted more than normal but not adherent to malleus

Question 36

Describe stage 2 of pars flaccida retraction according to Tos classification

Answer 36

Retraction pocket adherent to neck of malleus

Question 37

Describe stage 3 of pars flaccida retraction according to Tos classification

Answer 37

Part of retraction pocket is out of view with possible partial erosion of outer attic wall

Question 38

Describe stage 4 of pars flaccida retraction according to Tos classification

Answer 38

Definite erosion of outer attic wall with full extent of retraction pocket not visible