Dr. Ghulam SaqulainM.B.B.S., D.L.O, F.C.P.S

Head of Department of E.N.TCapital Hospital

A disease within the labyrinth of the IE A cause of unilateral HL Could be extremely handicapping – interferes with

driving an automobile or the one’s job Called “ Labyrinthine storm” b/c of sudden and

dramatic appearance of symptoms

Characteristics:

Sudden attacks of vertigo, tinnitus, vomiting and unilateral HL

Symptoms may begin as sensation of fullness in one ear followed by a LF roaring tinnitus, HL and great difficulty in speech recognition

Not all symptoms will be present in each case

Symptoms characterized by remission and exacerbations

SymptomsTinnitusVertigoUnilateral

sensorineural hearing loss

Inflammatory conditions that occur when the immune system causes the body to attack its own tissues as it fails to distinguish them from bacteria, viruses or cells from other organisms

AIED specifically attack IE Results in bilateral fluctuating and progressive SNHL May occur over several months Other symptoms: tinnitus, aural fullness and vertigo Prevalence is low Some bilateral symptoms of Meniere’s disease may

be due to AIED Treatment: steroids via a wick for absorption into IE

through RW

When head injury results into HL, the audiogram is quite similar those typical of acoustic trauma

Notch at 3000 Hz to 6000 Hz range Damage to TM and ME mechanism IE structures may be torn, stretched or

deteriorated from the oxygen loss due to hemorrhage

When a fracture line runs through the cochlea, HL will be severe to profound or total

HCs may be lostOrgan of Corti may be flattened or

destroyed Otitis mediaMeningitis Sometimes HL occurs without fracture

(cochlear contusion) OW membrane rupture OW fistula with perilymph leak into ME

No contributing factors to HL except AGE

It is hearing loss due to aging

Expected in men by the early 60s and women by the late 60s

Produces alterations in many areas of the auditory system (TM, ossicular chain, cochlear windows, CANS

Characterized by difficulty in speech recognition “Phonemic Regression” = understanding people when they speak slowly than when they speak loudly

VIII Nerve tumors Other diseases of the VIII Nerve Neural disorders

Cochlear neuritisDiabetes mellitus

Brain Stem disordersInfarctsGliomasMultiple sclerosis

Temporal Lobe disorders

The external ear is composed of a flexible potentially mobile auricle and attaches external auditory canal formed of fibrous tissue and elastic cartilage.

The auricle develops from six separate hillocks on the side of the embryo’s head

Minor congenital abnormalities are not uncommon and most do not require treatment.

“An abnormal smallness of the auricle”

“the absence of an opening of the external canal”

Definition: Wax is normal formation in the external audiotory meatus. It is secretion of ceruminous glands. Initially the secretions are liquid, but due to evaporation of moisture the secretions dry forming semi solid to solid brownish or balck looking substance.

Function: The normal function of wax is to protect the tympanic membrane.◦ Preventing excessive or loud sound

waves to strike the tympanic mebrane directly

◦ Preventing the insects and foreign bodies because of its sticky nature

Clinical Features: ◦ Symptoms:

Deafness is sudden May give rise to vertigo and dizziness Pain: Due to secondary infection. Wax also

becauses adherent to skin causing ulceration◦ Signs:

Blockage of ear due to wax in the external auditory meatus resulting in deafness.

Treatment:◦ If little wax with no symptoms, no treatment required◦ If symptoms are present, the treatment is REMOVAL

OF WAX

Removal depends whether wax is hare or soft.Hard Wax: it is not advisible to remove it straight away:

because it will produce pain and ulceration. The hard wax is made soft by putting various substances and then remove the wax, the softening substances are:Olive Oil: 4-5 dropss 4 times a day for two days and then remove wax

Soda glycerine drops.Removal of wax is done by proble, bvlunt hook,

syringing by warm water, suction clearance.

Three examples of the usual characteristics of a conductive hearing loss arising from otitis media

OME AOM COM

76-95% of all kids will have one episode of OM by age 6

Prevalence is highest during the first two years of life 50% of all kids with one episode before their first

birthday will have 6 or more bouts within two years Most episodes occur in winter and spring

Risk factors◦ Cleft palate◦ Down syndrome◦ Native Americans◦ Urban poor◦ Day care◦ Secondhand smoke

“an epithelial pocket that forms on the tympanic membrane. Once the pocket forms, the normal shedding of epithelium results in growth of the tumor”

n An example of the audiogram illustrating the flat, mild, conductive hearing loss that can occur with a perforated tympanic membrane

“a bone disorder that affects the stapes and the bony labyrinth of the inner ear. The disease process is characterized by resorption of bone and new spongy formation around the stapes and oval window”

Facts:

HereditaryWomen are more

likely to develop the disorder

Usually bilateralprogressive

Here’s an example of an audiogram resulting from disarticulation of the ossicular chain