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Middle Ear Diseases Flashcards

1
Q

Middle ear diseases

A 
Congenital malformations 
Acute otitis media
Retraction pocket
Atelectasis
Serous otitis media
Mucous otitis media 
Ossicular chain disarticulation
Otosclerosis
Barotrauma
Cholesteatoma
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2
Q

What is a congenital malformation?

A

Physical defect present in a baby at birth, irrespective of whether the defect is caused by a genetic factor or by prenatal events that are non genetic

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3
Q

What is a malformation?

A

Development of a structure is arrested, delayed, or misdirected early in embryonic life and the effect is permanent

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4
Q

Other names for congenital malformation

A

Birth defect

Congenital anomaly

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5
Q

Types of non genetic malformations

A

Non-syndromic or syndromic acquired by prenatal events such as infection, alcohol, and drugs

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6
Q

Types of genetic congenital malformations

A

Non syndromic and syndromic such as treacher Collins syndrome and crouzon syndrome

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7
Q

What is a syndrome?

A

The combination of signs, and symptoms which together represent a particular disease or disorder. Different parts of the body are affected

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8
Q

Treacher Collins syndrome

A

Autosomal dominant hereditary craniofacial malformation (dysostosis) that affects ears, eyelids, cheek bones and mandible

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9
Q

What is the cause of Treacher Collins syndrome?

A

Mutation in the TCOF1 gene located at Chromosome 5

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10
Q

What does Treacher Collins lead to?

A

Malformed outer and middle ear:conductive hearing loss
Eyes slant downward
Notch in the lower eyelids
Underdeveloped cheek bones
Mandibular hypoplasia (underdeveloped or shortened jaw)
Cleft palate in some cases

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11
Q

Types of congenital malformations affecting hearing

A

Treacher Collins Syndrome

Crouzon syndrome

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12
Q

What is crouzon syndrome?

A

Autosomal dominant hereditary craniofacial malformation (dysostosis) that affects ears, eyes, jaw and upper lip

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13
Q

Physical manifestation of Crouzon syndrome

A

Malformed outer and middle ear: conductive
Bulging eyes and vision problems, eyes don’t point in the same direction (strabismus)
Beaked nose
Underdeveloped upper jaw and enlarged mandible
Shortened upper lip
Cleft palate (in some cases)

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14
Q

What is acute otitis media?

A

Infection of mucous-membrane lining the middle ear tympanic cavity
Primarily disease of childhood, can occur at any age
First URTI, bacteria can enter through ET from nasopharynx
Happens in fall and winter

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15
Q

How does a patient with acute otitis media present?

A 
Otalgia (earache)
Aural pressure ( sense of fullness in the ear)
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16
Q

Audiometric findings for acute otitis media

A

Conductive hearing loss

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17
Q

What are the otoscopy results for acute otitis media?

A

Redness and decreased mobility of TM

When severe, TM can be seen to bulge outward

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18
Q

Speech audiometry for acute otitis media

A

SRT and PTA - 0-6dB if each other ( good agreement)

WRS is 96-100%

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19
Q

Retraction Pocket

A

Small area of the TM to be retracted toward the tympanic cavity resulting in a retraction pocket

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20
Q

Audiometric results for retraction pockets

A

Normal or slight conductive hearing loss depending on the size of the retraction pocket

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21
Q

Speech audiometry for retraction pockets

A

SRT and PTA (0-6dB, a good agreement)

WRS 96-100%

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22
Q

Tympanometry for retraction pockets

A

Type C

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23
Q

Atelectasis

A

Large area of the TM to be retracted (sucked inside) toward the tympanic cavity.

Large area of TM may cover or adhere to the ossicular chain and the promontory

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24
Q

Audiometry of atelectasis

A

Mild or moderate conductive hearing loss depending on the degree of retraction

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25
Speech audiometry for atelectasis
SRT and PTA are at 0-6 dB of each other (a good agreement) | WRS is 96-100%
26
Tympanogram of atelectasis
Type B
27
Otitis media with effusion
Accumulation of effusion within the middle ear behind an intact tympanic membrane , and is one of the most common cause of hearing loss in children
28
Types of otitis media with effusion
Serous otitis media, mucous otitis media
29
Serous otitis media
ET dysfunction➡️chronic neg pressure within tympanic cavity➡️fluid accumulation within the middle ear ➡️fluid - thin, watery, sterile, golden yellow
30
Otoscope examination of serous otitis media
Presence of air/fluid level called meniscus, visible through the TM as amount of fluid increases, air/ fluid level disappears May reveal presence of bubbles, visible through TM
31
Mucous Otitis Media
Accumulation of thick, opalescent, mucoid effusion like glue in middle ear
32
Otoscopic findings for mucous otitis media
Tympanic membrane is dull, lacking brilliance, no cone of light
33
Pure tone audiometric results for otitis media with effusion
Conductive hearing loss | Degree directly related to the amount of fluid in the middle ear
34
Speech audiometry for otitis media with effusion
SRT and PTA 0-6 dB | WRS 96-100%
35
Tympanogram for otitis media with effusion
Type B
36
ECV
Normal
37
Tympanostomy tube (pressure equalizing tube)
Primary function is to provide ventilation of the middle ear tympanic cavity by allowing the free passage of air through the tympanic membrane
38
Tympanogram for tympanostomy tube
Type B
39
ECV for tympanostomy tube
Large
40
Ossicular chain disarticulation
Discontinuity of ossicular chain Occurs most often in incudostapedial joint Can occur with head trauma or erosion by choleateatoma
41
Audiometric findings for ossicular chain disarticulation
Moderate to moderately severe conductive hearing loss
42
Speech audiometry for ossicular chain disarticulation
SRT and WRS are at 0-6 dB each other | WRS 96-100%
43
Tympanogram for ossicular chain disarticulation
Ad
44
Ear canal volume for ossicular chain disarticulation
Normal
45
Otosclerosis
Formation of new bone that usually grows over the footplate of the stapes becoming partially or completely fixed
46
Conductive hearing loss and otosclerosis
When new bone grows over footplate of the stapes, limits the movement of the ossicular chain
47
Mixed hearing loss and otosclerosis
When new bone grows over the the stapes and inside the cochlea
48
Sensorineural hearing loss and otosclerosis
When the new bone only grows inside the cochlea
49
What is the cause of otosclerosis?
Inherited in an autosomal dominant pattern with variable in penetrance 50% chance of getting the gene if one parent has it but not everyone with the gene develops the symptoms
50
Sex disparity in otosclerosis
2:1 female:male ratio Bilateral in up to 85% of cases
51
Age of onset for otosclerosis
20-50 years
52
How does pregnancy affect otosclerosis
An initial awareness of hearing loss or an accelerated progression of an existing hearing loss or an accelerated progression of an existing hearing loss due to hormonal changes
53
Racial disparity in otosclerosis
Most common in caucasians, about half as common in the oriental population, very rare among blacks and American Indians
54
Audiometry findings for early stage otosclerosis
Bilateral conductive mild low frequency hearing loss
55
Audiometric findings for late stage otosclerosis
Conductive hearing loss increases. There is frequently a Carhart notch 20 dB at 2000 Hz Mixed hearing loss
56
Speech audiometry for otosclerosis
SRT and PTA are at 0-6dB | WRS 96-100%
57
Tympanometry for otosclerosis
Type As
58
Ear canal volume for otosclerosis
Normal
59
Barotrauma
Poorly functioning Eustachian tube (allergies, cold, sinusitis, enlarged adenoids) + sudden changes in air pressure (when flying or diving) Leads to barotrauma - hearing loss, ear pain, fluid, bleeding
60
Cholesteatoma
Pseudotumour | Composed of keratin (protein) mixed with squamous epithelium (skin cells) and cholesterol located in the middle ear
61
Otoscopy for cholesteatoma
``` White mass Chronic pyorrhoea ( foul smelling discharges) ```
62
How does a cholesteatoma develop
Tympanic membrane retraction pocket may produce a primary cholesteatoma Tympanic membrane perforation may produce a primary cholesteatoma (skin may enter the tympanic cavity through a perforation in the past flaccida May be congenital
63
Cholesteatoma is extremely dangerous
Highly erosive and cause destruction of bone and other tissues Can lead to labryntitis, facial palsy, mastoiditis, meningitis
64
Mastoiditis
Inflammation or infection of the mucosa lining of Aditus, antrum and mastoid air cell system
65
Labyrinthitis
An inflammatory or infectious disease of the inner ear (labyrinth) Clinically this condition produce disturbances of balance and hearing: Vertigo ( a sensation of turning in space or a feeling the room is spinning) imbalance, nausea or vomiting, sensorineural hearing loss, tinnitus
66
Facial palsy
Paralysis (loss of muscle function ) or weakness on one side of the face, making it difficult to smile or close the eye in the affected side
67
Meningitis
An infection of the coverings (meninges) of the brain Meninges are the three layers of membranes that protect the brain and spinal cord Headache, fever, stiff neck, sensitivity to light, nausea, vomiting, drowsiness, confusion, coma

Hearing Disorders (5 decks)

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