Disorders of Outer and Middle Ear

Question 1

Auricle Disorders

Answer 1

Doesn’t affect hearing, mostly localization
Hematomas can close ear canal if swollen enough
Ex: cancer, animal attacks

Question 2

Atresia

Answer 2

SIGNIFICANTLY impacts hearing
Cartilage, bony portion or whole canal fail to develop
1 or both ears, isolation or other w/ other disorders
*Suspect tympanic membrane & ME cavity involvement
Ex: Treacher Collins

Question 3

Treacher Collins Syndrome

Answer 3

Involves facial bones - face/lower jaw, auricle & atresia of EAC

• Inner ear INTACT, if loud enough should get 100% on WRT
• Can’t do Immittance or OAEs

Question 4

Stenosis

Answer 4

Narrowing of EAC

Doesn’t cause HL but can lead to blockage (wax/debris)

Question 5

Collapsing Canals

Answer 5

Supraaural headphones during test can cause canals to collapse causing conductive HL
More common in kids/elderly
Use insert headphones!

Question 6

Foreign Bodies

Answer 6

Don’t typically cause hearing loss

Question 7

External Otitis

Answer 7

Infection in the skin of the EAC
“Swimmers ear”
Pain, inflammation, mild conductive loss common
If gets to bone: Osteomyelitis - can be very severe

Question 8

Osteoma

Answer 8

Bony tumour/growth in EAC

Conductive loss if it blocks canal

Question 9

Exostoses

Answer 9

Bony projections from canal
Often in cold-water swimmers
Only problematic if occlude EAC

Question 10

Cerumen

Answer 10

Wax only problem if completely occludes canal

Question 11

TM Perforations

Answer 11

Rupture from ME pressure buildup, trauma, explosions, thunder clap
*Side and place of perf = variations in amt of hearing loss/configuration

Question 12

Surgical Repair of TM Perforation

Answer 12

Myringoplasty

• Use fascia to cover TM
• If can get eardrum seal, Equivalent Ear Canal Volume (immitance) will be abnormally large b/c middle ear space included in measurement

Question 13

Tympanosclerosis

Answer 13

Thicking of TM
Results from previous infections
If scar tissue has large mass, may contribute to HL

Question 14

Otitis Media

Answer 14

Ear infection in mucous membrane lining of ME
>70% of children before age 2
Focus on pain management

Question 15

External & Internal Factors in OM

Answer 15

External: cigarette smoke, fumes
Internal: eustachian tubes, barotrauma, anatomical deformities, immune system, age, race (aboriginal), SES, gender (male)

Question 16

Early OM

Answer 16

Type C tymp
Small effect on hearing
Retracted TM

Question 17

Serous OM

Answer 17

Fluid in ear but no infection
Type C or B
Slight effect on hearing

Question 18

Acute OM

Answer 18

Type B
Definite conductive loss
Red, inflammed TM (bulges out)
No reflexes - if stiff system (no compliance)

Question 19

Mastoiditis

Answer 19

Common in BAHA patients
Pus can invade mastoid breaking down walls & separating air cells
Can lead to meningitis and death
Surgical Tx: Mastoidectomy

Question 20

Mastoidectomy

Answer 20

Treatment for mastoiditis
Bigger scraping out of the canal
Abnormally large equivalent volume
May not be able to seal
Conductive loss (maybe mixed)

Question 21

Cholesteatoma

Answer 21

Pseudocancer (not malignant)
Abnormal growth of skin in ME, forms onion-like rings of tissue
May cause: ororrhea (foul smelling drainage), otalgia (ear pain)
Treatment: surgery

Question 22

Otosclerosis

Answer 22

Bony growth (usually around stapes)
Hereditary in (70% of cases)
Conductive HL
White women (often during preg, menopause)
May have tinnitus
Paracusis Willisii (lombard reflex)

Question 23

Audiometric Info for Otosclerosis

Answer 23

1st symptom: low air-bone gap
Carhart Notch @ 2000 Hz (worse BC than expected)
Mass will first affect high Hz
Stiffness will effect low Hz 1st
Type As tymp (shallow)
No OAEs (sound can't come back out)
No reflexes (too stiff)
Treatment: clear growth, put stapes prosthetic, BAHA if hearing aid/surgery doesn't work