Sunteți pe pagina 1din 48

Davao Medical School Foundation

Chris Robinson D. Laganao, MD, DPBO-HNS


Review of the Middle Ear Anatomy

Noninfectious Disorders of the Middle Ear

Infectious Disorders of the Middle Ear


MIDDLE EAR

 Longitudinal vs. transverse


Signs & Symptoms
 Bleeding from EAC
 Otorrhea/ rhinorrhea
 Hemotympanum
 Protruding bone in EAC
 Hearing loss
 Facial paralysis
MIDDLE EAR

Diagnosis Treatment
 Multisystem evaluation  Stabilize life threatening injuries
 Imaging (CT/MRI)  Observation
 Audiologic evaluation  Antibiotic coverage
 ENoG (facial paralysis)  Systemic steroids
 Surgery to address TM perforation,
conductive hearing loss, facial
paralysis, persistent CSF leak
MIDDLE EAR

Etiology Treatment
 Cotton applicators,  Prevention of secondary
sticks, pins infection
 Blast injury
 Topical antibiotic drops
 Barotrauma
 Dry ear precautions
Diagnosis
 Observation
 Otoscopic exam
 spontaneous healing in 78 to
 Audiologic evaluation 94%
 Imaging if necessary  Surgery: Tympanoplasty,
Ossicular chain reconstruction
MIDDLE EAR

 Middle ear inflammation, <3 weeks


duration, abrupt onset of symptoms
 Prevalence in PH = 9.6%
 Associated with URTI
 Viral = most common etiology (45-70%)
 Bacterial pathogens:
 Streptococcus pneumoniae 13-33%
 Hemophilus influenzae 9-38%
 Moraxella catarrhalis 2-20%
MIDDLE EAR

 Acute and recent onset


 Any one of the ffg otoscopic findings:
 Retracted tympanic membrane
 Erythema of TM
 Bulging of TM
 Limited or absent mobility of TM
 Air-fluid level or bubbles behind TM
 TM perforation with otorrhea
 Any one of the following:
 Fever
 Otalgia
MIDDLE EAR

Stages of AOM
1. Erythema
2. Exudation
3. Suppuration
4. Coalescence and
mastoiditis
5. Complication or
Resolution
MIDDLE EAR

1. Erythema
 Redness of TM due to middle ear
inflammation caused by direct extension of
pathogen from URTI
 Otalgia

2. Exudation
 Red/erythematous, bulging TM
 Eustachian tube dysfunction
 Myringotomy if too painful, not relieved by
analgesics and decongestants
MIDDLE EAR

3. Suppuration
 TM perforation
 Ear discharge, mucoid/serous
 Not painful
 Tx: Toilet, Wicking, Otic drops

4. Coalescence and Mastoiditis


 Recurrence of pain and fever
 Mastoid tenderness
 Postero-superior wall sagging
MIDDLE EAR

5. Resolution or Complication
 Resolution  URTI resolves, TM perforation
heals; can occur at any stage

 Complication  TM does not heal, persistent


ear dischage
MIDDLE EAR

Treatment
 Pain control
 Oral antibiotics
 Amoxicillin 40-50mkday
 Erythromycin/Azithromycin

 Antibiotic otic drops with steroid


 Tympanostomy or myringotomy
 Aural toilet
MIDDLE EAR

 Middle ear effusion w/o evidence


of inflammation
 Eustachian tube dysfunction
 Cleft palate
 Nasopharyngeal obstruction
Treatment
 Treat nasopharyngeal obstruction
 Tympanostomy tube insertion
 Adenoidectomy
MIDDLE EAR

 Persistent infection and/or


inflammation of middle ear for >3
months
 Tympanic membrane perforation with
intermittent or continuous otorrhea
MIDDLE EAR

Diagnosis
 Otoscopic exam
 Audiologic evaluation
 Imaging (high resolution CT)

Treatment
 Create a safe, dry ear
 Topical antibiotics
 Surgery: Tympanoplasty or
Tympanomastoidectomy
MIDDLE EAR

 Matrix of keratinizing stratified


squamous epithelium formed within
the middle ear or mastoid
 Cystic lesion with surrounding
inflammatory reaction and bony
erosion
 Congenital = intact TM
 Acquired = perforated TM
MIDDLE EAR

Diagnosis
 PE: whitish, foul-smelling debris
 Audiometric evaluation
 Imaging (HRCT)

Treatment
 Surgery: complete removal of debris and
matrix, prevention of recurrence, hearing
rehabilitation
MIDDLE EAR

 MDR-TB strains, immunocompromised


patients
 Hematogenous, direct inoculation, or direct
extension from nasopharynx or ET
Signs & Symptoms
 Painless otorrhea
 Multiple TM perforations
 Polypoid granulation tissue in ME
 Failed medical/surgical treatment for COM
MIDDLE EAR

 Foreign body reaction to cholesterol crystals,


hemosiderin from ruptured erythrocytes
 Due to obstructed drainage and insufficient
aeration
 History of recurrent OM or OME
 TM appears bluish
 Treatment: ventilation tube insertion,
tympanoplasty with mastoidectomy
MIDDLE EAR

Extracranial Extracranial
Intracranial
Extratemporal Intratemporal
• Subperiosteal • Facial nerve injury • Meningitis
abscess • Labyrinthine fistula • Brain abscess
• Bezold abscess • Petrous apicitis • Lateral sinus
• Citelli abscess thrombosis
• Epidural abscess
• Otitic
hydrocephalus
complications of otitis media
complications of otitis media
complications of otitis media
complications of otitis media
complications of otitis media
complications of otitis media
complications of otitis media
complications of otitis media
complications of otitis media
complications of otitis media
complications of otitis media
complications of otitis media
complications of otitis media
complications of otitis media
complications of otitis media
complications of otitis media
complications of otitis media
 Eradication of disease
 Prevention on further deterioration of hearing
 Prevention of disabling and fatal complications
 Restoration of hearing
 ENT – Head and Neck surgeon
 Operating room and table
 Otologic instruments
 Operating microscope
 Surgical drill system
 Suction-irrigation system
Indications:
 Acute otitis media, not responding to medical treatment
 Acute otitis media with complications
 Otitis media with effusion
Indications
 Chronic otitis media with
effusion longer than 3 months
 Recurrent acute otitis media
 Indications
 Acute mastoiditis with impending or existing
complications, without resolution after medical treatment
 Chronic suppurative otitis media nonresponsive to
medical treatment
 Indications:
 Chronic suppurative otitis media with cholesteatoma, with
impending or existing complications
 Chronic mastoiditis with destruction of surrounding bony
structures
 Indications
 Dry TM perforation and/or ossicular chain discontinuity
or fixation
 Chronic suppurative otitis media, done in combination
with mastoidectomy
 https://www.researchgate.net/profile/Timothy_Cox/publication/51817708/figure/fig1

 http://microtiaearsurgery.com/microsite/wp-content/tn3/3/AM_RLAT3.png

 http://img.medscapestatic.com/pi/meds/ckb/62/19262tn.jpg

 http://img.medscapestatic.com/fullsize/migrated/488/345/cou488345.fig2.jpg

 https://encrypted-tbn0.gstatic.com/images?q

 https://www.researchgate.net/profile/Jonathan_Kay/publication/236227174/figure/fig1/AS:
299544374988807
 WHO Primary Ear and Hearing Care Training Resource. Switzerland, 2006.

S-ar putea să vă placă și