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