The Ear

Normal Tympanic Membrane

Physiology of Hearing
Auditory Pathway
Ear Examination
 Aural speculum

Uses:
• Examination of EAM & TM.
• Surgical operations of the ear.
Aural speculum
Angulated Suction Tube

Uses: Suction of discharge or blood from

ear or nose
Rinne test
Weber test
Tuning Fork tests
 Tuning Forks

Uses:
1. Rinne’s test
2.Weber’s test
3.Schwabach’s test
Tuning Forks
Siegle’s pneumatic otoscope
Siegle’s pneumatic otoscope

Uses:
1. To test the
mobility of the
TM
2. Fistula test
Microscopic Examination
Endoscopes
Hearing tests in children
Distraction test
Between 2 months to 3 years
Hearing tests in children

Cooperation test Pure Tone Audiometry

 Ear washing syringe

Uses:
2. Ear wash for wax or F.B.
3. Caloric test
Caloric test
Positional tests
 Myringotomy Knife

Uses:
Incise the TM during myringotomy operation for:
• OME after failure of medical treatment.
• ASOM if complicated or with impending rupture of
TM.
 Bat Ears

Treatment: Plastic surgery

Bat Ears
Microtia & Congenital Meatal
Atresia
Microtia & Congenital Meatal
Atresia
Investigations:
• CT scan temporal
bone.
• Audiological
evaluation.
Treatment:
• Plastic surgery
Congenital Meatal Atresia

Treatment:
Meatoplasty
 Accessory Auricle

Treatment: Excision
 Infected Preauricular fistula

Investigations: Culture & sensitivity of discharge

Treatment:
• Systemic Antibiotics
• Analgesics & antipyretics
• Incision if pus collects
• Latter on excision
 Preauricular fistula

Treatment: Microscopic excision if symptomatic

Auricular Perichondritis

Investigation: Culture & sensitivity (C&S) of discharge.

Treatment:
– Systemic Antibiotics
– Rest, Analgesics & antipyretics
– Wide Incision if pus collects
Auricular Perichondritis
 Cauliflower Ear

Treatment: Plastic surgery

Herpes Zoster Oticus
“Ramsay hunt syndrome”

Treatment
2. Acyclovir systemically &
locally.
3. Analgesics for pain.
 Haematoma Auris

Investigation:
Bleeding profile:
1. PT & PTT
2. BT & CT
Haematoma Auris
Treatment:
– Aspiration if blood
still fluid.
– Excision if blood is
clotted.
– Tight bandage.
– Systemic Antibiotics.
Foreign bodies (F.B.) in the
external auditory canal
Treatment:
If living insect:
– Kill it first by
instillation of oil in
EAM.
– Extraction by hook
or ear wash.
Foreign bodies (F.B.) in the
external auditory canal

Treatment:
Extraction by hook or ear wash (if not vegetable)
 Right LMNL Facial Nerve Paralysis

Investigations:
1.Topognostic tests: 2.Prognostic tests:
• CT scan temporal bone. • Electroneurography “ENOG”
• Stapedial reflex • Electromyography “EMG”
• Shirmer’s test
• Electrogustometry
• Salivary Flow test
Left LMNL Facial Nerve Paralysis

Treatment:
• Care of the eye
• Corticosteroids
• Facial nerve exploration if indicated
Schirmer’s Test
Postauricular Mastoid abscess
Investigations:
• CT scan temporal bone
or plain X-ray mastoid
view
• Audiometry : CHL
• C&S for discharge
Treatment:
• Systemic Antibiotics
• Rest, Analgesics &
antipyretics
• Cortical mastoidectomy
& myringotomy
Postauricular Mastoid abscess
 Ear wax

Treatment:
• Soft: Ear wash
• Hard: Glycerin bicarbonate ear drops then ear wash
Ear wax
 Otomycosis

Investigation: swab for Fungal culture

Treatment:
• Removal of fungus by: Suction or Dry mopping
• Antifungal ear drops
• Avoid wetting the ear
Otomycosis
Diffuse Otitis Externa
 Exostosis

Treatment: Microscopic Excision

Exostosis
Bullous Myringitis
Aural Polyp
Investigations:
• CT scan temporal
bone or plain X-ray
mastoid view
• Audiometry: CHL
• Culture &
Sensitivity “C&S”
for discharge
Aural Polyp
Treatment:
2. Polypectomy
3. Tympanoplasty with
mastoidectomy
Otitis Media
Acute Suppurative Otitis Media

Investigations:
• Audiometry: CHL
• C&S for discharge
after perforation or
during myringotomy
Acute Suppurative Otitis Media

Treatment:
• Systemic Antibiotics
• Rest, Analgesics &
antipyretics
• Myringotomy if
there is complication
Acute Suppurative
Otitis Media
Acute Suppurative
Otitis Media
 Traumatic perforation of
Tympanic Membrane

Investigations:
• Audiometry Conductive Hearing Loss “CHL”
• CT temporal bone if there is fear of fracture base
 Traumatic perforation of
Tympanic Membrane

Treatment:
• Nothing per ear (avoid wetting the ear)
• Myringoplasty if there is no spontaneous healing after 6 months
Traumatic perforation of
Tympanic Membrane
Otitis Media with Effusion
Investigations:
• Audiometry (CHL)
• Tympanometry
(type B)
• Plain X-ray adenoid
view
Otitis Media with Effusion
Treatment:
• Nasal decongestants,
corticosteroids,
Mucolytics, antibiotics
• Myringotomy & grommet
tube insertion after
failure of medical
treatment
• Treatment of the cause
e.g. adenoidectomy
Otitis Media with Effusion
Otitis Media with Effusion
Valsalva’s method
 Grommet Tube in place

Use: Otitis Media with Effusion “OME”

Grommet Tube in place
Grommet Tube
Adhesive Otitis Media

Investigations:
• Audiometry
(CHL),
• Tympanometry
(type B )
• CT & Plain X-ray
nasopharynx
Adhesive Otitis Media
Treatment:
• Myringotomy &
T-tube insertion for
some early cases
• Hearing aid
• Better Prophylactic
by proper treatment
of ASOM & OME
Dehiscent Jugular bulb
Glomus Tumour
Angiogram for Glomus Tumour

Pre-embolization Post-embolization
 T-tube in place

Uses:
2. Adhesive otitis media, atelectatic ear “some early cases”
3. Chronic Eustachian tube dysfunction e.g. cleft palate
T-tube
Haemotympanum
Investigations:
• Audiometry: CHL
• CT temporal bone
for fear of fracture
base of skull
Treatment:
Conservative
Chronic suppurative 0.M.
Tubo-tympanic Type
(Dry central perforation)
Investigations:
• CT scan temporal
bone or plain X-ray
mastoid view
• Audiometry: CHL
• C&S for discharge
(if any)
Chronic suppurative 0.M.
Tubo-tympanic Type
(Dry central perforation)

Treatment:
Tympanoplasty operation
Chronic suppurative 0.M.
Tubo-tympanic Type
(Dry central perforation)
 Chronic suppurative 0.M.
Tubo-tympanic Type
(Wet central perforation)
Treatment:
• Systemic Antibiotics
“according to C&S”
• Nasal decongestants
“local& systemic”
• Antibiotic ear drops.
Then Tympanoplasty
operation
 Chronic suppurative 0.M.
Tubo-tympanic Type
(Wet central perforation)
 Cholesteatoma
(Attic Retraction)
Investigations:
• CT scan temporal
bone or plain X-ray
mastoid view
• Audiometry: CHL
• C&S for discharge
 Cholesteatoma

Treatment: Tympanoplasty with mastoidectomy

Cholesteatoma
 Cortical Mastoidectomy

A posterior approach & a drill are used The mastoid antrum is identified
to uncover the mastoid antrum
Complete Cortical
Mastoidectomy
Radical Mastoidectomy
Otosclerosis
Stapedectomy Operation
Piston for stapedectomy operation
Uses:
1. Otosclerosis
2. Congenital fixation
of foot plate!!!!
Fractures of Temporal Bone