Middle Ear Disorders and Congenital Anomalies

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Questions and Answers

What are common signs of chronic suppurative otitis media (C.S.O.M.)?

Increased hearing

Facial nerve paralysis

Granulations (correct)

Foul smelling mass

Which type of cholesteatoma is formed primarily through invagination of the pars flaccida?

Secondary acquired cholesteatoma

Congenital cholesteatoma

Primary acquired cholesteatoma (correct)

Cystic cholesteatoma

Which treatment is typically used after attempts to dry the ear in tubotympanic type C.S.O.M.?

Tympanoplasty (correct)

Mastoidectomy

Cochlear implant

Stapedectomy

What is a key characteristic of cholesteatoma?

Formation of keratinizing desquamated squamous epithelium Signup and view all the answers

What typical symptom is associated with chronic suppurative otitis media?

Deafness Signup and view all the answers

Which investigation is used to assess the mastoids in cases of C.S.O.M.?

X-ray and CT scan Signup and view all the answers

In congenital cholesteatoma, where does it typically arise from?

Embryonic epithelial rests Signup and view all the answers

What is the role of culture and sensitivity tests in the context of C.S.O.M.?

To identify the causative organisms of discharge Signup and view all the answers

What predisposes to facial paralysis during acute otitis media?

Dehiscence of the bony facial canal Signup and view all the answers

Which of the following is NOT a causative organism of acute otitis media?

Mycobacterium tuberculosis Signup and view all the answers

What symptoms are likely present before the perforation of the drum in acute otitis media?

Fever, throbbing pain, and deafness Signup and view all the answers

What is a potential consequence of dehiscence of the floor of the tympanic cavity during tympanoplasty?

Injury to the jugular bulb Signup and view all the answers

What is one of the treatments for acute otitis media before potential perforation of the drum?

Myringotomy Signup and view all the answers

Which of the following treatments is NOT typically used for acute otitis media?

Antivirals Signup and view all the answers

Which statement is TRUE regarding complications of acute otitis media?

Mastoiditis and facial paralysis are cranial complications Signup and view all the answers

What could cause minimal bleeding in cases of traumatic rupture of the drum?

Indirect trauma such as slap or blast Signup and view all the answers

What is indicated by Schwartz's sign in the context of otosclerosis?

Flamingo red color of the tympanic membrane Signup and view all the answers

Which test result indicates conductive deafness in stapedial otosclerosis?

Negative Rinne’s test Signup and view all the answers

What is the proposed theory explaining the effects of stapes fixation on hearing?

It disrupts normal ossicular resonance at 2000Hz Signup and view all the answers

Which treatment option is commonly used for severe mixed deafness in otosclerosis if surgery is refused?

Hearing aid fitting Signup and view all the answers

What does an absent stapedial reflex indicate on impedance audiometry?

Otosclerosis with stapes fixation Signup and view all the answers

What is the primary treatment method for Tubotympanic type otitis media after initial conservative measures?

Tympanoplasty Signup and view all the answers

Which surgical procedure is appropriate for extensive Atticoantral cholesteatoma?

Radical mastoidectomy Signup and view all the answers

What is a common cause of Secretory Otitis Media (SOM) in children?

Eustachian tube dysfunction Signup and view all the answers

During the otoscopic examination in Secretory Otitis Media, what is typically observed?

Intact yet retracted eardrum Signup and view all the answers

Which test would most likely show an air-bone gap in a patient with Secretory Otitis Media?

Pure tone audiometry Signup and view all the answers

What is a characteristic finding of Otosclerosis?

New spongy bone formation Signup and view all the answers

At what age does deafness from Otosclerosis typically begin?

Between 20 and 30 years Signup and view all the answers

Which symptom is NOT typically associated with Secretory Otitis Media?

Severe ear pain Signup and view all the answers

What is a common reason for increased susceptibility to otitis media in infants?

Shorter Eustachian tubes Signup and view all the answers

Which of the following is NOT a treatment for residual deafness due to secretory otitis media?

Tonsillectomy Signup and view all the answers

What can cause residual discharge following a chronic ear infection?

Inadequate drainage Signup and view all the answers

What is one of the signs of acute otitis media in infants?

Congested eardrum Signup and view all the answers

Which type of chronic suppurative otitis media is characterized by a foul odor discharge?

Attico-antral (Cholesteatoma) Signup and view all the answers

How does treatment differ between tubotympanic disease and attico-antral infections?

Tubotympanic is treated with medications only, attico-antral often requires surgery Signup and view all the answers

In the case of chronic suppurative otitis media, what type of deafness is expected in the safe ear?

Conductive and not severe Signup and view all the answers

What is a typical symptom of acute otitis media in infants?

Persistent high fever Signup and view all the answers

Study Notes

Congenital Anomalies

Dehiscence of the bony facial canal can lead to facial paralysis during acute otitis media, cholesteatoma, or ear surgical trauma.
Ossicular fixation or absence results in conductive deafness.
Dehiscence of the tympanic cavity floor may result in jugular bulb injury during tympanoplasty, causing severe hemorrhage.

Trauma of the Middle Ear

Traumatic rupture of the tympanic membrane may result from indirect trauma (like slap or barotrauma), foreign body removal, or skull base fracture.
Symptoms include slight pain, mild deafness, tinnitus, and minimal bleeding.

Inflammations of the Middle Ear

Types include acute otitis media, chronic suppurative otitis media (C.S.O.M), cholesteatoma, non-suppurative otitis media, and otosclerosis.

Acute Otitis Media

Characterized by inflammation of the middle ear mucoperiosteum, often caused by bacterial (Haemophilus influenza, streptococci, staphylococci) or viral (influenza) infections.
Common infection routes include the Eustachian tube and drum perforation (e.g., during swimming).
Symptoms before perforation include fever, throbbing pain, and conductive deafness; after perforation, signs include discharge and relief of pain.

Acute Otitis Media Treatment

Management involves antibiotics, analgesics, nasal decongestants, and myringotomy for drainage.
Potential complications include mastoiditis and facial paralysis.

Sequelae of Acute Otitis Media

Healing: leads to normal hearing and no discharge.
Non-resolution may result from inadequate treatment, leading to secretory otitis media or residual perforation.

Acute Otitis Media in Infants

More prevalent in infants due to lower resistance, shorter and more horizontal Eustachian tubes.
Symptoms include fever, vomiting, and irritability.
Treatment may include myringotomy under general anesthesia if conservative measures fail.

Chronic Suppurative Otitis Media (C.S.O.M)

Characterized by chronic infection causing conductive deafness and discharge from a perforated tympanic membrane.
Two main types: Tubotympanic disease (safe ear) and Attico-antral disease (cholesteatoma) (unsafe ear).

C.S.O.M Signs and Symptoms

Safe ear: conductive deafness, mucopurulent discharge, central perforation; uncommon cholesteatoma.
Unsafe ear: severe conductive deafness, purulent discharge, marginal/peripheral perforation; common cholesteatoma.

C.S.O.M Investigations and Treatment

Imaging (X-ray, CT), culture tests, and audiological assessments are crucial.
Safe type managed with tympanoplasty after conservative treatment; unsafe type may require more invasive surgical intervention.

Cholesteatoma

Bag-like cystic structure, containing keratinizing squamous epithelium and associated with destructive properties on bone.
Can be congenital or acquired, with clinical manifestations like conductive deafness and foul-smelling discharge.

Acquired Cholesteatoma Causes

Can arise from attic retraction due to Eustachian tube obstruction or from skin invasion through perforations.

Secretory Otitis Media (SOM)

Characterized by fluid accumulation in the middle ear without infection; commonly seen in children and often leads to conductive deafness.
Causes include Eustachian tube dysfunction and unresolved acute otitis media.

SOM Clinical Picture and Diagnosis

Symptoms include deafness, tinnitus, a sense of fullness; physical examination reveals retracted tympanic membrane with fluid levels.
Diagnosis confirmed through tuning fork tests, pure tone audiometry, and impedances.

SOM Treatment

Medical management includes nasal drops, anti-allergics, and steroids.
Surgical options involve myringotomy and ventilation tube insertion, targeting underlying causes if present.

Otosclerosis

A heredo-familial condition leading to conductive deafness due to footplate fixation of the stapes.
Typically presents in individuals aged 20-30, with a higher prevalence in females during pregnancy.

Otosclerosis Clinical Signs

Symptoms include progression of deafness and tinnitus, particularly during pregnancy; paracusis (better hearing in noise) may occur.
Investigations show conductive deafness, possibly with mixed hearing loss in advanced cases.

Otosclerosis Treatment

Stapedectomy with prosthesis is a common surgical intervention; hearing aids may be used for severe cases or if surgery is declined.

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Description

Test your knowledge on the various disorders of the middle ear, including congenital anomalies and inflammations. This quiz covers conditions such as acute otitis media, tympanic membrane trauma, and more. Gain insights into symptoms, causes, and effects related to these ear conditions.