Lec6 Flashcards
Talk about traumatic diseases of ME
(4)
1- aetiology:
Direct:
- self inflected
- iatrogenic : ear wash , picking a FB
- fracture base of skull ( temporal bone)
Indirect :
- slap : trauma of drum by palm of hand
- otitic barotrauma
- blunt trauma ( explosion)
2- clinical picture
Symptoms: history of trauma
- pain : at the time
- bleeding : slight ( except for fracture of skull)
- deafness , tinnitus
- whistling sound when blowing the nose
Signs
Tuning fork : chl
Otoscope :
Perforted area :
• central in pars tensa
• thin irregular edges
• surronded by blood clots
EAC : may show blood clots
3- dd
Traumatic
History : trauma
Bleeding : present.
Discharge : absent
Perfortion
-type : central
- site : pars tensa
- size : small
- shape : irregular
- edge : thin irregular surrounded by blood
ME MUCOSA : normal
Pathological
History : OM
Bleeding : may be present ( granulation tissue bleeding on touch ).
Discharge : present
Perfortion
-type : central , marginal or attic
- site : anywhere
- size : any size
- shape : regular
- edge : thick edges
ME MUCOSA : may be congested
If the traumatic is infected مع السلامة
4- treatment
Medical
Avoid 2
- getting it wet
- blowing the nose ( extends it)
Give 2
- systemic antibiotics
- decongestant nasal drop ( no retraction after healing )
Sugical
Myringoplasty if medical treatment failed within 3:6 months ( it is expected to heal spontaneously in about 1 month except if infected )
Talk about otitc barotrauma ?
(5)
1- def : trauma of drum caused by changes of atmospheric pressure in relation to ME pressure
2- predisposing factors :
ET is closed by either ) قفلة سودة
1- allergic rhinitis
2- nasal polyps
3- common cold
4- deviated septum
5- adenoid
3- mechanism
Normally ET allows the air to enter ME cleft equalizing the pressure along the drum
When the ET is closed ~> retraction of drum due -ve pressure ~> mild case
During the fast descent of airplane , the atmospheric pressure + while me pressure - ( relative to atmospheric one ) ~> ME effusion and sometimes bleeding ( hemotympanum) ~> moderate case
When the ME pressure decreases severly ~> rupture of drum ~> severe case
(((During airplane or deep diving )))
4- clinical picture
Symptoms
1- sensation of ear fullness
2- pain : at the time
3- bleeding : at the time in severe cases
4- deafness , tinnitus
Signs
Tuning fork : CHL
Otoscope:
Mild : retraction ( 5 characters)
Moderate : ME effusion , hemotympanum
Severe : perforted drum and bleeding
Rarely , inner ear is involved ,oval, round window are ruptured ~> perilymph fistula leading to SNHL , vertigo
5- treatment
Prophylactic
Avoid 2
- flying when nasal obstruction
- sleeping while flying
Give 2
- decongestant nasal drop when nasal obstruction
- chewing gum
- valsalva manuveur
Curative
Mild : decongestant nasal drop , chewing gum , valsalva manuveur
Moderate : myringotomy with drainage
Severe : Myringoplasty within 3: 6 months
Talk about fracture base of skull ( temporal bone )
(6)
1- types
Longitudinal
Incidence : more common ( 80%) less dangerous
Aetiology : trauma at the side of head ~> fracture line passing along the longitudinal axis of petrous bone through EAC ( laceration ) , drum ( rupture ) , ossicles ( dislocation ) then to foramen laceram
Clinical picture (5)
• otorrhea
• facial n paralysis : rare ( 20)
- delayed and partial due to compression of n by edema or hematoma
• CHL ( due to ruptured drm and dislocation of ossicles)
• ostoscope : ruptured drum and lacerations in EAC
• bleeding due ruptered drum and lacerations
Transverse
Incidence: less common ( 20%) more dangerous
Aetiology : trauma at the back of head ~> fracture line passing peripendicupar to longitudinal axis of petrous bone through ( foramen magnum firstly ) internal auditory canal that has facial n ( paralysis) and inner ear ( injury )
Clinical picture : (5)
• loss of consciousness
• otorhinorrhea
• facial paralysis: common ( 50%)
- complete and immediate due to cut of the n
• SNHL and vertigo
• otoscope : drum is reddish or bluish due to hemotympanum ( bleeding in middle ear with intact drum “
Investigations
CT : detact bone fracture
MRI : to exclude brain injury
Treatment ( HSSS 🤫)
Hospitlization under complete aseptic condition
Systemic antibiotics : cross BBB
Steroid : prevent brain edema
Surgery
Of brain injury by neurosurgeon
Of facial n injury
Of dislocated ossicles by ossiculoplasty
Of ruptured drum by myringoplasty
Talk about the glomus tumour ?
(10)
1- chemodectoma
2- paraganlioma
3- arises from paraganglionc tisse related to certain nerves in temporal bone
4- bengin
5- locally aggressive
6- very vascularising
7- types
Glomus jugulare : more common
Arises from auricular branch of vagus ( arnolds) at the bulb
Glomus tympanicum : less common
Arises from tympanic plexus of glossopharyngeal n ( jacobson) at the promontry
8- clincial picture
•Symptoms (2)
-Deafness
- pulsatile tinnitus
•Signs (2)
Sun rising appearance which blanchs on seigalization ( BROWN SIGN)
Extension
7 ~> facial palsy
9~> chocking
10~> hoarseness of voice
11~> drop of shoulders
12~> tongue paralysis
++ icp ( with its manifestations)
- severe , persist headache does go with drug
- projectile vomiting
- blurred vision
- papilledema
9- inv (4)
- CT : ( jugular foramen)
- MRI : soft tissue ( tumour )
- angiography : to detect the abnormal vascularity , feeding vessel ( ascending pharyngeal in this case ) for embolization
- no biopsy as it bleeds
10- treatment
Surgical exision with pre operative embolization to decrease bleeding
Talk about squamous cell carcinoma ?
(7)
1- rare
2- age : more in old ( above 60)
3- sex : males more
4- predisposing factors
- long standing CSOM ( most common to be on top of CSOM )
- irradition , smoking ( de novo )
5- clinical picture
• manifestations of the primary tumour
Symptoms :
Deafness , tinnitus and discharge ( CSOM) with change of characters
- pain
- bleeding
- facial palsy
- increase in hearing loss
( all above are due to invasion )
Signs : irregular mass that bleeds on touch , spread to other structures
• manifestations of local spread
Parotid swelling with TMJ fixation
• manifestations of lymphatic spread
Upper deep cervical lymph node enlargement
• manifestations of blood spread
Lung : dyspnea, hemostasis , chest pain
Liver : jaundice , abdominal pain , asitis
Bone : pathological fracture ( with no trauma or minimal ) , bonache
Brain : + ICP
6- investigations
CT : detect bone erosion
MRI : soft tissue ( tumour )
Biopsy
Metastatic work up
7- treatment ( 3R)
- radical mastoidectomy
- radical neck disecction if lymph node involved
- radiotherapy
Causes of bluish tympanic membrane?
HCG
212
1- hemotympanim ( as otitic barotrauma or fracture)
2-high jugular bulb
3- carotid aneurysm
4- glomus tumour
5- glue ear
Causes of aural polyps
• inflammatory
CSOM : ( more in unsafe ) : originates from ME mucosa
Chronic otits externa ( more by scratching ) : orignates from EAC
EOSINOPHILIC granuloma : ( rare ) ( more in children ) : destructive inflammatory lesion
• neoplastic
Glomus : vascular polyps
Sqamous : malignant polyps
Talk about otosclesrosis
(8)
1- hereditary localized disease in otic capsule ( bony labyrinth )characterized by replacement of compact bone by spongy bone ( otospongiosis ) of increased cellularity, vascularity , thickness
2- cause : unkown but may be hereditary
3- types :
-Stapedial : more common
Arises around the footplate of stapes ~> fixation ( ankylosis) ~> chl
-cochlear : less common
Arises from cochlea ~> SNHL AND VERITGO
- mixed : mixed HL +- vertigo
4- incidence : ( mariam fakhr)
- bilateral ( unilateral in 15%)
- females > males
- more in middle aged
5- clinical picture
Symptoms:
Deafness : bilateral , associated by paracusis willicii phenomena ( hearing better in noisy places ) ( -ve recruitment)
Tinnitus
Vertigo( rare ) : in cochlear , mixed types
Signs :
Otoscope : drum is normal but rarely shows flamingo red in colour in active ( schwartz sign )
Tuning fork : CHL IN STAPEDIAL
SNHL IN COCHLEAR
MIXED IN MIXED
6- investigations:
- PTA
- tympanometry : AS ( normal but stunt ) stiff due to fixation of stapes
- acoustic ( stapedial ) reflex : no response
7- dd
- osteogenic imprefecta : chl ,blue sclera , multiple fracture ( بيحصل كسر حقيقي ساعتها وبعد كده فيبروزس)
- diseases have chl with intact drum
• som
• adhesive
• congenital stapedial fixation
• tympanosclerosis
8- treatment
-No treatment
If air bone gap( on PTA) is less than 20 dB
- medical : sodium floride if surgery is contraindicated as
• active ( shwartz sign )
• SNHL IN cochlear , mixed
• refusal - surgery :
Stadedectomy is the treatment of choice - partial removal of stapes
- making hole in footplate
- application of teflon piston or fat with wire
- hearing aid : in severe SNHL
Operations in general
- otomy : insicion but mostly followed by close
- ostomy : insicion without closing
- ectomy : exision
- plasty
- pexy : correcting the location
