middle ear advanced Flashcards
define serous otitis media
transudation of fluid due to prolonged eustachian tube dysfunction with resultant negative middle ear pressure
when does serous otitis media occur in adults
after a URI, barotrauma, or chronic allergic rhinitis
must not miss dx for persisten unilateral serous otitis media
nasopharyngeal carcinoma
appearance of tympanic membrane in serous otitis media
dull, hypomobile, sometimes air bubbles
does serous otitis media cause sensorineuro or conductive hearing loss?
conductive
treatment of serous otitis media
oral steroids vs oral abx
if failed response- ventilation tubes
define tympanosclerosis
calcification of the TM and middle ear structures from inflammation
define myringosclerosis
calcification of the TM only
does tympanosclerosis or myringosclerosis cause hearing loss?
tympanosclerosis
what is a retraction pocket?
chronic inflammation and negative pressure causes invagination of the pars tensa or pars flaccida.
produces atrophy and atelectasis
what does chronic retraction and inflammation result in?
adhesive otitis- predisposes to formation of cholesteatoma or fixation and erosion of the ossicles
define cholesteatoma
greasy or pearly white mass in a retraction pocket or perforation- causes destruction of temporal bone
Hallmark is painless otorrhea
symptoms of cholesteatoma
persistent, recurrent, foul smelling otorrhea
treatment of TM perforation due to AOM
ototopical abx for 10-14 days. refer for hearing evaluation. if it doesn’t heal on it’s own, surgery can correct.
etiology of chronic suppurative otitis media
persistent otorrhea with tympanostomy tubes or TM perforation. has ongoing purulent ear drainage. may be associated with cholesteatoma
chronic infection with mucosal edema, ulceration, granulation tissue, and polyp formation
bacteria associated with chronic suppurative otitis media
P aeruginosa, S aureus, Proteus, Klebsiella pneumoniae, and diphtheroids
if chronic suppurative otitis media fails culture directed treatment, what is the ddx?
foreign body, neoplasm, langerhan’s cell histiocytosis, tuberculosis, granulomatosis, fungal infection, or petrositis
treatment of chronic suppurative otitis media
culture drainage and treat with appropriate abx
pathogenesis of mastoiditis
infection from middle ear spreads to the mastoid portion of temporal bone into air-filled spaces
most common affected age group for mastoiditis
60% younger than 2
symptoms of mastoiditis
postauricular pain, fever, outwardly displaced pinna
mastoid is indurated and red, swollen, and fluctuant
mastoid is tender
AOM almost always present
imaging for mastoiditis
CT- initially looks like AOM
progression of disease shows coalescence of mastoid air cells
pathogens of mastoiditis
S pneumo, H influenzae, and S pyogenes
ddx of mastoiditis
lymphadenitis, parotitis, trauma, tumor, histiocytosis, OE, furuncle
major complication of mastoiditis
meningitis or brain abscess
treatment of mastoiditis
IV abx- depends on culture, must cross blood-brain barrier
if no improvement in 24-48 hours requires sugery- tympanostomy tube and culture vs I and D vs cortical mastoidectomy
prognosis for mastoiditis
good. typically full recovery
essentials of diagnosis of acute otitis media
moderate to severe bulging of the TM
or
mild bulging of TM and less than 48 hours of otalgia
or
middle ear effusion by pneumatic otoscopy or tympanometry
ddx for acute otitis media
otitis media with effusion, bullous myringitis, mastoiditis, or middle ear mass
pathophysiology of acute otitis media
eustachion tube dysfuntion causing negative pressure and effusion
bacterial colonization- S pneumo, H influenzae, M catarrhalis
viral URI
smoke exposure- prolongs inflammatory response, impedes drainage of middle ear
immunocompromised- IgA deficiency causes reccurent AOM
bottle feeding- reduced AOM
season- surge in respiratory viruses in winter
day care- exposure to URIs
genetic- cause is unknown
age- 1-3 greatest risk
symptoms of AOM
otalgia, aural pressure, decreased hearing, and fever
treatment of AOM
abx- amoxicillin and nasal decongestants
can use cefaclor or augmentin for resistant cases
chronic otitis media essentials of dx
chronic otorrhea, TM perforation with conductive hearing loss
most common bacteria causing chronic otitis media
P aeruginosa, Proteus, S aureus, and mixed anaerobes
define cholesteatoma
variety of chronic otitis media, most commonly due to eustachian tube dysfunction
inward migration of tympanic membrane creating a squamous epithelium-lined sac- fills with desquamated keratin and becomes infected.
Can erode bone, destroy ossicular chain, erode inner ear, effect the facial nerve and spread intercranially
define otosclerosis
lesions of footplate of the stapes impede passage of sound, causing conductive hearing loss
lesions can impede on the cochlea causing sensory hearing loss
middle ear neoplasia
rare
presents with pulsatile tinnitus and hearing loss
nerves involved with middle ear neoplasia
VII, IX, X, XI, and XII
treatment of middle ear neoplasia
surgery, radiotherapy or both
ototoxic medication
aminoglycosides, loop diuretics, antineoplastic agents
