lecture 14: disorders of the outer & middle ear - exam 3 Flashcards
congential
born w/ it
acquired
aquire it
low set pinna
congenital
caused by interruptions during fetal development
does not cause HL in isolation
can indicate malformations that do cause HL
protruding ear
congenital
not associated w/ hearing loss
can be corrected w/ setback otoplasty after age 5 (when pinna is fully formed)
lop ear
congenital
not associated w/ hearing loss
treatment:
do nothing
splint to reshape ear when child is a baby
otoplasty after age 5
microtia
congenital
external ear underdeveloped
caused by interruptions in fetal development
expressed externally
may indicate middle or inner ear deformities
Grade I malformed pinna
smaller than typical sized ear
grade II malformed pinna
stenosis
partially formed outer ear w/ small ear canal
audiogram, OAEs, & reflexes would all be normal
Tymps would have a smaller ECV
can’t use insert transducers
grade III malformed pinna
atresia
absent / closed ear canal
small peanut-shaped outer earlobe
conductive HL
no inserts
can’t test for tymps, OAEs, or reflexes because can’t get the probe in
grade IV malformed pinna
anotia
absence of ear canal & pinna
can still have a cochlea
preauricular pits & tags
do not cause HL in isolation
may be indicative of genetic syndromes associated w/ HL
indicates possible ME malformations
surgical treatment if necessary
craniofacial anomaly
abnormalities in the structure of the head & face
often part of a constellation of signs associated w/ a syndrome
conductive HL
treacher collins
craniofacial anomaly
1 in 50000
wears hearing aids on top of head – has a mic & vibrates bones
goldenhar syndrome
craniofacial anomaly
incomplete development of head & facial structures (& sometimes organs) on ONE side of the body
1 in 5600
conductive or SNHL (if organs underdeveloped, cochlea could be affected) on ONE side
down’s syndrome
craniofacial anomaly
3rd copy of chromosome 21
1 in 700 –> most common chromosomal disorder
ET dysfunction & partially formed airway –> chronic otitis media –> HL
low freq (ME infections tend to cause low freq HL) conductive
probably no OAEs, maybe ARTs
Type B tymp
cauliflower ear
aquired
caused by repeated blunt trauma to pinna
blood accumulates in pinna which disrupts blood supply
does not cause HL in isolation unless ear canal becomes stenotic & occluded w/ cerumen –> conductive HL
keloid
aquired
forms where skin is damages (surgery, cut, piercing, etc)
excessive scar tissue grows instead of skin
smooth, hard, benign
doesn’t cause HL in isolation
contact ulcer
acquired
injuries to the skin & tissue caused by prolonged pressure on the skin
very common from many HL treatments (hearing aids & CIs)
usually not a big deal but can become infected
frostbite
acuired
freezing of skin & tissue leading to tissue damage or death
remove blisters
topical antiobiotic
pain meds
amputation if tissues are dead
collapsing ear canal
acquired
common in older adults as cartilage becomes less firm
can’t use inserts
high freq HL
foreign object
acquired
audiologist might take out solid objects w/ a tool
generally no hearing loss associated, unless object is occluding
exostoses
acquired
abnormal growth of bone in ear canal
long term exposure to wind & cold water - “surfer’s ear”
relatively common
BILATERAL
not necessarily progressive but does tend to get worse w/ continued exposure
osteomas
acquired
slow growing, benign, bony tumor
relatively rare
UNILATERAL
progressive
exostoses & osteomas tymps, oaes, arts, audiogram
presentation similar to exostoses & radiology required to differentiate
doesn’t cause HL in early stages but can cause conductive if becomes severe –> surgical removal
tymps = low ECV
OAEs & arts = can’t measure cuz can’t fit probe
otitis externa
acquired
inflammation of the outer ear & ear canal
red w/ white flaky
due to high humidity, exposure to water/moisture, allergic reactions to earplugs
hard to test audiogram etc bcs it’s very painful
but, OAEs & arts would probably be normal
otomycosis
acquired
fungal infection - subtype of otitis externa
relatively common in elderly hearing aid users
refer to ENT & treat w/ anti fungal topical
furunculosis
acquired
infection of hair follicle
accumulation of pus
red, swollen, painful
not associated w/ HL but can affect ability to test
impacted cerumen
acquired
can’t use inserts
tymps = low ECV
no Oaes or arts
TM perforation causes
sudden pressure change (like diving or jumping out of a plane0
blow to the ear (car accident, sports injury)
ear infection left untreated
perforation by a swab or other object
TM perforation audiogram things
may cause no HL or low freq conductive
tymps = high ECV
type B
pressure equalization tube
TM perforation on purpose
ME fluid drainage & pressure equalization
because of ET dysfunction – used as an alternate ET
typically extrude on their own
PE tube audiogram stuff
present the same as a perforation
only way to tell is by otoscopy
tympanosclerosis
TM tissue calcification after chronic otitis media &/or tubes
very common
no HL
tymps = As or normal
negative middle ear pressure
retracted TM
often associated w/ ET dysfunction
infection creates swelling at opening of tube in nasopharynx
chronic negative ME pressure may lead to effusion (fluid buildup then infection)
- ME pressure audiogram stuff
conductive low freq HL
tymps = type C, negative ME pressure
peak all the way to the left
otitis media
infection of mucous membrane lining of ME
very common in children cuz ET is flat so it can’t drain properly
pain, fever, opaque & bulging TM
leads to TM perf if left untreated –> often feels better, releases pressure
acute or chronic
w/ fluid = otitis media w/ effusion
otitis media audiogram stuff
low freq conductive
tymps = type C or B depending on stage
OAEs & arts not likely
otitis media aftermath
common but serious
results in transient (temporary) HL
untreated –> speech & language delays, poor academic performance
necrosis (tissue death)
mastoiditis (bone infection)
cholesteatoma
meningitis (infection of meninges in the brain)
mastoiditis
infection in temporal bone that begins to erode skull
can extend laterally & protrude out of head
can extend medially causing meningitis or brain abscess
mastoidectomy
otitis media treatment
1st one = wait & see
don’t want to do antibiotics if not bacterial
antibiotics
myringotomy = incision in TM to relieve pressure & drain fluid
PE tube or tympanoplasty
ossicular chain discontinuity
break anywhere along chain that causes decrease in stiffness
caused by trauma
usually treated w/ prosthesis
PORP = partial ossicular replacement prosthesis
TORP = total ossicular replacement prosthesis
OAEs & arts hard to predict
otosclerosis
progressive
most common ME Pathology after otitis media
bone growth around staples –> fixes it to oval window –> can longer push into cochlea (do it’s job)
often affects women during pregnancy
surgical treatment
carhart’s notch
audiogram sign of otosclerosis
conductive HL
BC thresholds show notch at 2 kHz
tymps = very variable, depends on progression of disease
A or severe As
schwartz’s sign
sign of otosclerosis
increased vascularity observed on promontory through TM
more blood = causes bone to grow
otosclerosis sugery
effective but imperfect
avg improvement in thresholds = 10 dB
prosthesis not as good as impedance matching as ossicles
has risks
