Lec 5 Ear Symptomatology.pdf

SYMPTOMS OF EAR DISEASES DR.NASLSHAH KAZEM  DEAFNESS EAR DISCHARGE (OTORRHOEA) PAIN IN THE EAR (EARACHE) DEAFNESS Types: -Conductive deafness. -Perceptive deafness (sensorineural hearing loss). -Mixed (conductive and perceptive deafness). -Functional (psychoge...

SYMPTOMS OF EAR DISEASES DR.NASLSHAH KAZEM  DEAFNESS EAR DISCHARGE (OTORRHOEA) PAIN IN THE EAR (EARACHE) DEAFNESS Types: -Conductive deafness. -Perceptive deafness (sensorineural hearing loss). -Mixed (conductive and perceptive deafness). -Functional (psychogenic and malingering) deafness. CONDUCTIVE DEAFNESS (CHL) due to diseases of the external or middle ear. External ear: 1. Congenital: Atresia. 2. Wax: Accumulation. 3. Foreign body: Impaction. 4. Inflammatory: Otitis externa, big furuncle and fungal mass.  Middle ear: a) Drum: Perforation. b) Trauma: - Haemotympanum (fracture base), Otitic barotraumas c) Inflammatory: acute and chronic suppurative otitis media - Non-suppurative otitis media (Middle ear effusion). -Ossicles: a) Congenital: Absence or fixation. b) Trauma: Dislocation. c) Inflammation: Necrosis or adhesions. d) Otosclerosis. -Eustachian tube: a) Inflammation: salpingitis. b) Allergy: Causing edema. c) Mechanical obstruction: by adenoids or nasopharyngeal tumours.  PERCEPTIVE (SENSORINEURAL) DEAFNESS (SNHL) Due to diseases of the inner ear, cochlear nerve or brain. Cochlear lesions: 1- Congenital: a) Genetic: Consanguinity (marriage of relatives). b) Prenatal: German measles affecting the mother during the first trimester of pregnancy and intake of ototoxic drugs. c) Natal: Birth injury or anoxia. d) Post-natal: Kernicterus (Rh incompatibility). 2- Trauma: a) Head injuries: Fracture skull base. b) Acoustic trauma: acute as blasts or chronic as in factories due to long exposure to loud noise. 3- Inflammatory: (labyrinthitis) a) Viral: Measles, mumps and influenza. b) Bacterial: Meningitis, typhoid, tuberculosis, syphilis and complications of chronic suppurative otitis media. 4- Toxic: (ototoxicity) a) Endogenous: Diabetes mellitus, uraemia and hypothyroidism. b) Exogenous: Streptomycin, neomycin, kanamycin and quinine. 5- Vascular: Spasm, hemorrhage or thrombosis of the internal auditory artery. 6- Miscellaneous: Menière’s disease, senile deafness and cochlear otosclerosis. Cochlear nerve lesions: Tumours: acoustic neuroma. Brain lesions: 1- Vascular: vertebrobasilar insufficiency. 2- Tumours. 3- Multiple sclerosis. 4- Epilepsy. DEAF-MUTISM A deaf infant becomes a dumb child because he does not hear; so he will not develop speech. -Congenital mal development. -Acquired diseases such as meningitis, measles or mumps. It is treated by - Powerful hearing aid, - Cochlear implantation, - Lip reading and auditory training.  EAR DISCHARGE (OTORRHOEA) a) Watery discharge (C.S.F.): -Fracture skull base. -Surgical trauma if the dura is injured. b) Bloody discharge: 1. Trauma: -Fracture skull base. -Injury of the external ear or drum. 2. Inflammatory: - Acute otitis media when the drum perforates. -Chronic otitis media with granulations. c) Mucoid or mucopurulent discharge: -Chronic suppurative otitis media (safe type). d) Purulent discharge: -Furunculosis. -Cholesteatoma (offensive due to bone osteitis). PAIN IN THE EAR (EARACHE) Local in the ear: 1. Inflammatory: acute otitis externa, malignant otitis externa and acute otitis media before perforation. 2. Traumatic conditions of the external and middle ear. 3. Cranial and intracranial complications of chronic otitis media. Referred pain: From diseased organs sharing the same nerve supply with the ear. - 5th cranial nerve: 1. Sinusitis. 2. After adenoidectomy. 3. Impacted wisdom tooth and dental caries. 4. Temporomandibular arthritis. 5. Salivary calculi. - 9th cranial nerve: 1. Tongue, pharyngeal ulcers and cancer. 2. Quinsy. 3. Post tonsillectomy. - 10th cranial nerve: - Tuberculosis of the larynx or cancer larynx. - 2nd and 3rd cervical nerves: 1-Cervical disc lesion (spondylosis). 2- Myositis of neck muscles. Referred pain: THANK AND GOOD LUCK