Middle Ear Disorders

Question 1

Acute non suppurative otitis media

Answer 1

-thin, non infective fluid in the middle ear. Leads to a sudden hearing impairment due to ossicles having to operate in fluid not air.
- ET dysfunction results in conductive hearing loss
- negative pressure in middle ear causes mucous to be secreted for ME cleft.
- golden/ yellow watery fluid. Sudden unilateral hearing loss. Blocked up sensation, retracted tm with fluid levels.
- treatment: 95% self resolve or can drain fluid.

Question 2

Chronic non suppurative otitis media (glue ear)

Answer 2

• common in children due to et dysfunction. Their ET is shorter and more horizontal so affects drainage.
• thick sticky non infective mucous
• bilateral, conductive loss up to 40dBHL
• Tm looks grey/yellow in colour with dilated blood vessels
• resolves in 1-2 months
• treatments: myringotomy and grommets/ hearing aids if recurrent and consistent loss

Question 3

ASOM

Answer 3

Happens rapidly, infection arrives via nasopharynx, blood supply or via EAM due to perforation.
4 stages:
- arrival
- redness
- suppuration
- resolution
Treatments: antibiotics, nasal decongestants, myringotomy , or meatus can be cleaned by Dry mopping

Question 4

CSOM

Answer 4

• untreated ASOM
• irreversible changes to the structure and function of the middle ear
• possible destruction of ossicles
• May damage cochlea via the round window
• considered safe or unsafe dependant on progress
• conductive hearing loss
• recurring discharge

Question 5

Cholestestoma

Answer 5

Due to blocked ER and weak part of the TM.
- retraction pocket from in ME cavity due to unequal pressure and weak part of tm
- skin and discharge build up in pocket and it becomes infected
- forms a septic sack filling ME and eroding ossicles
- if left untreated can infect mastoid bone and cause meningitis.
- septic sac can work as part of ossicles so may not cause as much of a loss
Treatment:
Cleaned by suction, surgically removed, ossicularplasty to reconstruct the ossicles

Question 6

Otosclerosis

Answer 6

This is hereditary condition from a defective gene. Normally presents itself later in life and is 2x as common in woman.
- it is calcification of the stapes - abnormal bony growth in the middle ear. They are initially soft and fibrous but will then harden. They are fixated to the stapes footplate which stops the stapes from working causing a conductive hearing loss. Normally a drop in 2k in BC threshold called carhaarts notch.
Treatment: stapes mobilisation: breaking bony growth
- stapedectomy: is the removal of the stapes which is then replaced with a prosthetic stapes.
- hearing aids can be used to aid the loss

Question 7

Tympanosclerosis

Answer 7

Chalky white patches on TM. This is a result from Otisis media. Particularly from Grommet insertion. Usually no loss but depends on the size.

Question 8

Glomus tumours

Answer 8

Most common benign tumour of middle ear - comes with pulsating tinnitus.
Symptoms: facial palsey, hearing loss and pulsating red mass behind the TM. Removal through surgery.