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Hearing Disorders > Middle Ear Diseases > Flashcards

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
Q

Speech audiometry for atelectasis

A

SRT and PTA are at 0-6 dB of each other (a good agreement)

WRS is 96-100%

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26
Q

Tympanogram of atelectasis

A

Type B

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27
Q

Otitis media with effusion

A

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
Q

Types of otitis media with effusion

A

Serous otitis media, mucous otitis media

29
Q

Serous otitis media

A

ET dysfunction➡️chronic neg pressure within tympanic cavity➡️fluid accumulation within the middle ear ➡️fluid - thin, watery, sterile, golden yellow

30
Q

Otoscope examination of serous otitis media

A

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
Q

Mucous Otitis Media

A

Accumulation of thick, opalescent, mucoid effusion like glue in middle ear

32
Q

Otoscopic findings for mucous otitis media

A

Tympanic membrane is dull, lacking brilliance, no cone of light

33
Q

Pure tone audiometric results for otitis media with effusion

A

Conductive hearing loss

Degree directly related to the amount of fluid in the middle ear

34
Q

Speech audiometry for otitis media with effusion

A

SRT and PTA 0-6 dB

WRS 96-100%

35
Q

Tympanogram for otitis media with effusion

A

Type B

36
Q

ECV

A

Normal

37
Q

Tympanostomy tube (pressure equalizing tube)

A

Primary function is to provide ventilation of the middle ear tympanic cavity by allowing the free passage of air through the tympanic membrane

38
Q

Tympanogram for tympanostomy tube

A

Type B

39
Q

ECV for tympanostomy tube

A

Large

40
Q

Ossicular chain disarticulation

A

Discontinuity of ossicular chain
Occurs most often in incudostapedial joint
Can occur with head trauma or erosion by choleateatoma

41
Q

Audiometric findings for ossicular chain disarticulation

A

Moderate to moderately severe conductive hearing loss

42
Q

Speech audiometry for ossicular chain disarticulation

A

SRT and WRS are at 0-6 dB each other

WRS 96-100%

43
Q

Tympanogram for ossicular chain disarticulation

A

Ad

44
Q

Ear canal volume for ossicular chain disarticulation

A

Normal

45
Q

Otosclerosis

A

Formation of new bone that usually grows over the footplate of the stapes becoming partially or completely fixed

46
Q

Conductive hearing loss and otosclerosis

A

When new bone grows over footplate of the stapes, limits the movement of the ossicular chain

47
Q

Mixed hearing loss and otosclerosis

A

When new bone grows over the the stapes and inside the cochlea

48
Q

Sensorineural hearing loss and otosclerosis

A

When the new bone only grows inside the cochlea

49
Q

What is the cause of otosclerosis?

A

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
Q

Sex disparity in otosclerosis

A

2:1 female:male ratio

Bilateral in up to 85% of cases

51
Q

Age of onset for otosclerosis

A

20-50 years

52
Q

How does pregnancy affect otosclerosis

A

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
Q

Racial disparity in otosclerosis

A

Most common in caucasians, about half as common in the oriental population, very rare among blacks and American Indians

54
Q

Audiometry findings for early stage otosclerosis

A

Bilateral conductive mild low frequency hearing loss

55
Q

Audiometric findings for late stage otosclerosis

A

Conductive hearing loss increases. There is frequently a Carhart notch 20 dB at 2000 Hz
Mixed hearing loss

56
Q

Speech audiometry for otosclerosis

A

SRT and PTA are at 0-6dB

WRS 96-100%

57
Q

Tympanometry for otosclerosis

A

Type As

58
Q

Ear canal volume for otosclerosis

A

Normal

59
Q

Barotrauma

A

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
Q

Cholesteatoma

A

Pseudotumour

Composed of keratin (protein) mixed with squamous epithelium (skin cells) and cholesterol located in the middle ear

61
Q

Otoscopy for cholesteatoma

A 
White mass 
Chronic pyorrhoea ( foul smelling discharges)
62
Q

How does a cholesteatoma develop

A

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
Q

Cholesteatoma is extremely dangerous

A

Highly erosive and cause destruction of bone and other tissues

Can lead to labryntitis, facial palsy, mastoiditis, meningitis

64
Q

Mastoiditis

A

Inflammation or infection of the mucosa lining of Aditus, antrum and mastoid air cell system

65
Q

Labyrinthitis

A

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
Q

Facial palsy

A

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
Q

Meningitis

A

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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