Medical Diagnostics, Otitis Media, & OtosclerosisOzarks Technical Community CollegeHIS 125

Medical Diagnostics • Lab/Blood work• Imaging• CT Scan

• Best at visualizing bony structures• Ossicles• Bony labyrinth• Temporal bone

• MRI• Best at visualizing soft tissues• Auditory nerve• Brainstem/brain

Otitis Media

• Definition: inflammation of the middle ear• Cause: usually bacterial; often accompanies/follows a cold,

sore throat, or upper respiratory infection• Treatment: antibiotics, tubes if OM is chronic and not

successfully responsive to medical treatment

• More common in children (especially those <2 yo) due to smaller and more horizontal eustachian tubes and weaker immune systems• 90% of children in US will have at least one case of OM before

age 6

Common Symptoms in Children

• Tugging or pulling at the ear(s) • Fussiness and crying • Trouble sleeping • Fever (especially in infants and younger children) • Fluid draining from the ear • Clumsiness or problems with balance • Trouble hearing or responding to quiet sounds

• *Increased risk in children who are bottle-fed, use a pacifier, exposed to smoke, attend group daycare

Source: nidcd.nih.gov

Common Symptoms in Adults• Pain• Pressure• Popping/crackling• Drainage• Hearing loss• Tinnitus• “I feel like I have water stuck in my ear”• “My ear feels like it needs to be popped”

Otitis Media• Classified by type and duration of symptoms:• Type

• 1. OM without effusion (fluid)• 2. OM with effusion• 3. OM with perforation of tympanic membrane

• Duration• 1. Acute (0-21 days)• 2. Subacute (22 days-8 weeks)• 3. Chronic (>8 weeks)

Types of Effusion• 1. Serous• Watery, sterile

• 2. Purulent• Pus-like, infected

• 3. Mucoid• Thick mucus

Serous OM

http://wps.prenhall.com/chet_martin_audiology_11/194/49689/12720513.cw/index.html

Purulent OM• Note the pus-like fluid in the upper half of the middle ear

(Image courtesy of Hawke Library)

Mucoid OM• This left tympanic membrane appears

to be normal; however, on careful inspection you’ll see that the middle ear is filled with a gray fluid.

• Mucoid fluid that was drained from a middle ear

• Images courtesy of Hawke Library

Audiometric Findings in OM• Otoscopy• May see obvious signs of inflammation, redness• May see fluid and/or retraction of the TM

• Tympanometry• Most commonly you will find significant negative pressure (Type

C) or an immobile TM/flat tymp (Type B)• Audiometry• Slight-to-mild conductive hearing loss

If left untreated…• Permanent HL• Perforated TM• Mastoiditis• Cholesteatoma• Ossicular discontinuity• Tympanosclerosis

(scarring of TM)• Meningitis• Encephalitis• Brain abscess

Tympanosclerosis(Image courtesy of Hawke Library)

Otosclerosis• Occurs when excessive bone grows around the stapes

footplate and fixates the stapes to the oval window• Results in a conductive component to hearing loss• Often hereditary, more common in women• Usually bilateral• Occurs most commonly in 30s or 40s (may occur after

childbirth)

Common Symptoms of Otosclerosis• Hearing loss• Tinnitus

Audiometric Findings in Otosclerosis• Otoscopy• Usually WNL (within

normal limits)• May see Schwartze’s

sign=reddish and/or bluish coloration on TM

• Tympanometry• Most commonly you will

find either normal middle ear function (Type A) or hypocompliance (Type AS)

• Audiometry• Conductive and/or mixed

hearing loss, often with Carhart’s notch at 2 kHz

Schwartze’s sign (L ear); image courtesty of Hawke Library

Audiogram - Otosclerosis

• Carhart’s notch present at 2kHz

• Note: This patient had normal tympanograms and absent acoustic reflexes

Treatment for Otosclerosis• Do nothing • Surgery• Stapedectomy (removal of stapes and prosthesis

placement)• Amplification• Usually very easy to fit with a hearing aid(s)

Image from: drmkotb.com