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Umbo of malleus -

Figure 11-32 Congenital cholesteatoma.

Normal tympanic membrane

Anterior external auditory canal

Figure 11-33 Chronic tympanic membrane perforation.

Figure 11-33 Chronic tympanic membrane perforation.

Air bubble

Incus

Umbo

Light reflex

Figure 11-34 Photograph (A) and labeled schematic (B) illustrating serous otitis media of the right ear. Note the air bubble in the middle ear behind the tympanic membrane.

Incus

Umbo

Light reflex

Figure 11-34 Photograph (A) and labeled schematic (B) illustrating serous otitis media of the right ear. Note the air bubble in the middle ear behind the tympanic membrane.

producing a vacuum that draws in or retracts the tympanic membrane. The sensation of ''plugged ears'' occurs. If the pressure is not relieved, this vacuum draws serous, nonpurulent fluid from the blood vessels into the middle ear. The tympanic membrane appears yellowish-orange as a result of the amber-colored fluid, and the landmarks are clearly seen as the membrane is retracted against these structures. Partial obstruction of the eustachian tube produces air bubbles or an air-fluid level in the middle ear. Figure 11-34 shows the tympanic membrane of a patient with serous otitis media.

Recurrent middle ear infections and tympanic membrane rupture may lead to chronic otitis media. Chronic infections may produce a foul-smelling discharge, which is the main symptom of chronic otitis media;pain is usually not present. Erosion of the ossicles with formation of scar tissue may occur, causing a conductive hearing loss.

Figure 11-35 shows the right tympanic membrane in an adult patient with chronic eustachian tube dysfunction. An early pars flaccida retraction pocket is seen. These retraction pockets result from chronic negative pressure within the middle ear and may progress to form an acquired cholesteatoma. A pressure-equalizing tube, called a tympanostomy tube, or T-tube, has been placed to eliminate the negative middle ear pressure. Figure 11-36 shows the right tympanic membrane in another patient with long-standing eustachian tube dysfunction whose middle ear is ventilated with a long-term T-tube. Resolving mild otitis externa is seen, with canal skin erythema and desquamation of the epithelium.

Table 11-4 summarizes the comparative features of conductive and sensorineural hearing loss. Table 11-5 enumerates the common causes of deafness. Table 11-6 differentiates acute otitis externa from acute otitis media.

Tympanic Membrane Air Fluid Level

Figure 11-35 Chronic eustachian tube dysfunction.

T-tube

Figure 11-36 Tympanic membrane ventilated with tympanostomy tube (T-tube).

T-tube

Figure 11-35 Chronic eustachian tube dysfunction.

Figure 11-36 Tympanic membrane ventilated with tympanostomy tube (T-tube).

Table 11-4 Comparative Features of Conductive and Sensorineural Hearing Loss

Feature

Pathologic process

Loudness of speech External canal Tympanic membrane Rinne test result Weber test result

Conductive Hearing Loss

External canal Middle ear

Softer than normal May be abnormal Usually abnormal Negative

Sensorineural Hearing Loss

Cochlea Cochlear nerve Brain stem

Louder than normal

Normal

Normal

Positive

Heard on better side (only in severe unilateral loss)

Table 11-5

Common Causes of Deafness

Patient

Conductive Deafness

Sensorineural Deafness

Child

Congenital

Congenital

Acute otitis media

Mumps labyrinthitis

Chronic otitis media

Maternal rubella during first trimester

Cerumen

Birth trauma

Trauma

Congenital syphilis

Adult

Serous otitis media

Delayed-onset congenital

Chronic otitis media

Meniere's disease

Otitis externa

Ototoxic drugs

Cerumen

Viral labyrinthitis

Eustachian tube blockage

Acoustic neuroma

Viral myringitis

Presbycusis (age-related deafness)

Cholesteatoma

Otosclerosis

Table 11-6 Differentiation of Acute Otitis Externa from Acute Otitis Media

Signs and Symptoms Acute Otitis Externa* Acute Otitis Media{

Pressure on tragus Lymphadenopathy External canal Season

Tympanic membrane

Fever Hearing

Painful

Frequent

Edematous

Summer

Normal

Slight loss or normal

Painless Absent Normal Winter

Fluid behind eardrum, possible perforation

Decreased

*See Figure 11-26. {See Figure 11-29.

Useful Vocabulary

Listed here are the specific roots that are important to understand the terminology related to diseases of the ear and nose.

Root

Pertaining to

Example

Definition

audio-

to hear

audiometer

Device to measure hearing

aur-

ear

auricle

Portion of the external ear not contained within the head

-cusis

hearing

presbycusis

Progressive decrease in hearing with age

-lalia

speech

echolalia

Meaningless repetition by a patient of words addressed to him or her

myringo-

tympanic membrane

myringotomy

Surgical incision of the tympanic membrane

ot(o)-

ear

otitis

Inflammation of the ear

phon-

sound; the sound of a voice

phonasthenia

Weakness of the voice

rhino-

nose

rhinoplasty

Plastic surgery of the nose

tympan(o)-

middle ear

tympanotomy

Surgical puncture of the tympanic membrane

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