babak saedi. md assistant professor of tehran university
TRANSCRIPT
Babak Saedi . MDAssistant professor of Tehran university
Ear anatomy & physical examination External ear Middle ear Internal ear
http://www.earaces.com/anatomy.htm#Cross%20Section%20Of%20Ear
Normal TM
Malleus (short process and handle
Cone of light Incus Pars tensa The unbelievable
UMBO
Right TM
Middle Ear
The inner ear communicates with the acoustic environment outside of the body by means of a funnel (pinna), a short tube (the EAC), a thin membrane TM and three small bones.
The purpose of the middle ear and ossicular chain is to overcome the impedance mismatch of going from an air filled outer ear to a fluid filled inner ear.
Middle Ear
http://www.iurc.montp.inserm.fr/cric/audition/english/ear/fear.htm
Ossicles
Impedance Mismatch
The purpose of the middle ear and ossicular chain is to overcome the impedance mismatch of going from an air filled outer ear to a fluid filled inner ear.
Like yelling to someone underwater. About a 30 dB loss.
Inner Ear
There are three sections of the inner ear: semicircular canals (superior, lateral, posterior), vestibule (mid-section) and the cochlea (snail shaped).
The vestibule and semicircular canals serve to function in balance not hearing.
The cochlea functions in hearing, by changing fluid energy into neural energy.
Basic Structures
http://oto.wustl.edu/cochlea/intro1.htm
http://www.neurophys.wisc.edu/h%26b/auditory/anatomy/a09.html
Cerumen in canal
May advise parents to soften first
May remove yourself in office
At the VA: May remove a lot of ear wax in the ER
Differential Diagnosis
external otitis or furunculosis of external auditory meatus: post auricular tenderness.
bullous myringitis: the earache may be intense but deafness only slight, the membrane may be obscured by a large hemorrhagic bleb or blebs.
Otitis Media
Red, Bulging Hyperemia Dullness of light
reflex Opaque
ASOM
Acute suppurative otitis media is one of the most common infections of childhood. It may accompany any upper respiratory tract infection such as the common cold, measles, scarlet fever, or influenza. When virulent bacteria invade the middle ear, an acute suppuration occurs.
Bacteriology
The hemolytic streptococcus, staphylococcus , the pneumococcus and hemophilos are most commonly responsible for the infection.
Serous OM
Bulging, amber drum
Decreased mobility
Tympanic Membrane Perforation
CSOM OR COM
Neglected or recurrent infection of the middle ear may eventually produce a chronic change in the mucosa of the ear or destruction of the periosteum covering the ossicles, The infection then tends to become chronic. Chronic infection of the middle ear is much more common in persons who had ear disease in early children. Disease of the ear in infancy and early children may arrest the normal pneumatization of the mastoid. It is possible that the same process alters the mucosa of the middle ear, so that it is more susceptible to recurrent infection than is the normal ear.
Cholestatoma
Epithelium work as a tumor Complications :meningitis,
labyrantitis , facial paralysis and brain abscess
tympanomastoidectomy
Tumor
Benign : osteoma , chondroma ,glumous
Malignant : SCC , BCC ,ACC and metastasis
Ear: Squamous cell carcinoma
Hearing loss
Conductive Sensory neural Mixed Diagnosis :PTA , TYMPANOMETRY ,
SDS , & SRT TRETMENT
Conductive
COM Otosclerosis Trauma Congenital
Sensory neural
Congenital Trauma Infection Presbucosis Drugs Tumor Menier occupational
Congenital
Rubella Syphilis Toxoplasmosis Kernicterus Drugs Anoxia
EthmoidMaxillaPalatineLacrimalPterygoid plate of
SphenoidNasal Inferior Turbinate
Bony Structure
Arterial Supply
External Carotid Maxillary A. SphenopalatineInternal Carotid Ophthalmic A. Ant. Ethmoid Post. Ethmoid Supraorbital Supratrochlear
Facial Analysis
Analysis of nose is very important
Sinus
Maxillary Frontal Ethmoid Sphenoid
Ethmoid BullaUncinate Process
Hiatus Semilunaris
Function of Nose & Paranasal Sinuses
Humidifying and warming inspired air Regulation of intranasal pressure Increasing surface area for olfaction Lightening the skull Resonance Absorbing shock Contribute to facial growth
Nasal & sinus disease
Infection Rhinitis Epitasis Tumor Trauma
Viral Rhinosinusitis
Most upper respiratory infections are viral
Short lived, last less than 10 days
Sinus mucosa as well as nasal mucosa is involved
Most will clear without antibiotics
Treatment: decongestants, nasal lavage, rest, fluids
Classification of Bacterial Sinusitis
Acute bacterial sinusitis- infection lasting 4 weeks, symptoms resolve completely (children 30 days)
Subacute bacterial sinusitis- infection lasting between 4 to 12 weeks, yet resolves completely (children 30-90 days)
Chronic sinusitis- symptoms lasting more than 12 weeks (children >90 )
Bacteria Involved in Acute Bacterial Sinusitis
Streptococcus pneumoniae 30%
Haemophilus influenza 20%
Moraxella catarrhalis 10%
Antibiotics for Acute Bacterial Sinusitis
Amoxicillin 500 mg tid for 10-14 days First line choice in most areas Local differences in antibiotic resistance occur
Where beta-lactamase resistance is an issue Amoxicillin/clavulanate Cefuroxime Cefexim Cefprozil
CT Scan Maxillary and Ethmoid Sinuses
Sinusitis
Sinus endoscopy
Allergic Rhinitis
Nasal Polyp
Septal deviation
Foreign body
Malignant tumor