11- NON - w crackling noise 3.

Eustachian tubal
SUPPURATIVE (+ve) catheterization
DISEASES OF THE EAR - pass Eustachian
ACUTE CATARRHAL 2. Politzerization catheter along nose
OTITIS MEDIA - Connect Politzer bag to floor until post
Etiology olivary nozzle nasopharyngeal wall
Eustachian tube - insert nozzle into - rotate catheter tip at
obstruction affected nostril 90’ medially
- Adenoid hypertrophy + - pinch other side to - withdraw catheter till
infection close to close tip is against posterior
- Simple edema of ET - ptt swallow water + end of nasal septum
mucosa compress Politzer bag - rotate catheter 180 w
to expel air fr nasal beak passing down
Symptoms cavity and laterally
- Deafness - if successful – hear - it’lie in nasopharyngeal
- Popping in affected crackling noise end of ET
area - if fail – go to 3. - Attach Politzer bag and
- Nasal & pharyngeal blow air through
URTI symptoms catheter
- No pain - Surgeon listen through
- No pyrexia/malaise otoscope at other end
of external meatus
Otoscopy - May hear
1. Nasal obstruction bubble/crackle/ blow
2. Mucopurulent - Introduce decongestive
nasal discharge drugs (Hydrocortizone)
3. Congested
pharynx CHRONIC CATARRHAL
4. TM: OTITIS MEDIA
- retracted Etiology
- normal color/pink 1. Chronic tubal
- pronounced blood obstruction
vessel - repeated infections
- congenital stenosis
Audiometry - anatomical
- Conductive deafness abnormality
- Severity: slight – to –
moderate Chronic salpingitis
Symptoms
Treatment - Block/stuffiness in ear
- Nasal /oral - X clear ear by Valsalva
decongestants maneuver
- Inflation of ET - Conductive deafness
- Adenoidectomy
- Expectant after URTI Examination
resolve Otoscopy
- Drumhead retraction
ET Inflation (Partial / localized) 
1. Valsava’s method drape over
- pinch nose to close ET incudostapedial joint /
- ptt force expiration w appear adhere
mouth shut promontory of middle
- air enter middle eary ear
cavity
- Membrane tensa Symptoms
retraction Peak occurrence = 4 – 7 Etiology
o shortened handle of y.o - female > male
malleus - insidious painless - familial
o more horizontal deafness - 18 – 30 y.o or earlier
position HOM - otalgia - related to puberty and
- Lateral process of - feeling unwell pregnancy
malleus prominent - recurrent acute otitis
- Cone of light absent media Pathology
- secretions fr middle - normal bone is
Catheterization ear absorbed & replaced
- Sound of tube unlike by vascular spongy
soft blowing murmur in Diagnosis osteoid tissue
normal 1. Otosocpy: - process advance along
- fluid level in middle blood vessel
Treatment ear - new bone > thicker &
- Periodal - Change TM < vascular
catheterization & o Change lucency - most common site:
inflation o dilated bld vessel fr promontory in region
- Grommet insertion malleus handle of anterior margin of
- Hearing aid o Yellow – red oval window
- Treat predisposing membrane - stapes is ankylosed in
factor of infection at o Blue tinge if present position
pharyngeal end of tube blood
SECRETORY OTITIS o Retracted/bulge Symptoms
MEDIA membrane - increasing deafness
Pseudonyms - tinnitus in head than
- Non suppurative otitis 2. Tuning fork test ear
media - conductive deafness - Paracusis Willisii
- Seromucinous otitis - Giddiness to
media 3. Pure tone paroxysmal vertigo
- Exudative otitis media audiometry:
- Glue ear - 30 – 40dB conduction Examination
loss - N / flamingo pink blush
Histology through membrane
- Mucosa: Hyperplasia of 4. Tympanometry: - patent ET
ciliated cuboidal - -ve middle ear
epithelium pressure changes Types Of Sclerosis
- Fluid: -  compliance 1. Tympanal
Polymorphonuclear - -ve Rinne’s test
WBC + macrophages + Treatment - Weber’s test twd
cell debris + - Local /oral nasal affected ear
Glycoprotein + decongestant - audiomettry:
nucleoprotein + - Mucolytic agents conductive deafness +
plasmas cell - Myringotomy N inner ear fn.
+adenoidectomy w or
Etiology w/o grommet tube 2. Cochlear
- Allergy insertion - spongification at
- Virus OSTEOSCLEROSIS cochlea capsule
- ET malfunction 2 layer bone surround - no paracusis
- ET obstruction membranous labyrinth: - normal tuning fork test
(adenoids) 1. Labyrinth capsule - sensorineural deafness
proper
2. Lamellar bone 3. Mixed
 - Vomiting - -ve fistula test
Treatment - Tinnitus (may return
- Hearing aid after attack) 2. Tuning fork test:
- Stapedectomy / - Deafness (may return - Sensorineural deafness
Stapedoplasty after attack)
- Dizziness 3. Audiometry
Complication - Feeling of tension in - sensorineural deafness
- Hearing loss head - present recruitment
- Fistula btw inner ear & - Nystagmus - normal impedance
middle ear via new - Sensorineural deafness - no tone decay
opening of footplate of w sound distortion
stapes  fluctuation - Negative examination
hering / intermittent btw attack 4. Pure tone
vertigo audiogram
Modified - speech in keeping
Prognosis - Constant sense if
- Slow progress imbalance 5. Vestibular test:
- No brain dss present - Increase of hearing - Btw attack: normal
- Not dangerous to life loss - On attack: canal
- Dont result to absolute - Slight nausea paresis / hypofunction
deafness - Fullness/pressure in
- Pregnancy, illness & ear 6. X – ray mastoid:
accidents - Suboccipital - normal internal
headaches auditory meatus
MENIER’S DISEASE Severe attack
- Deafness - Sweating
- Tinnitus - Bradycardia
- Vertigo - Diarrhea
- Loss of balance
- Nausea Advanced
- Vomiting - constant imbalance
- without nausea
Pathology - anxiety state
- Dilatation of - migraine
endolymphatic
compartment of inner Lermoyez Syndrome
ear - loss balance over
days/week
Etiology - increase deafness &
- Local ischaemia head that terminate
- Suergery: Faulty with vertigo paroxysm
absorption of - improvement in
endolymph by hearing and other
endolymphatic sac symptoms later
- Allergy
- Focal infection Differential Diagnosis
- Biochemical - Acoustic neuroma
disturbance - Labyrinthitis
- Vitamin deficiency - Intracranial dss
- Endocrine disturbances - Syphilis
- Viral infections
Diagnosis
Clinical Features 1. Otoscopy
- Vertigo sudden - Normal intact TM
Treatment 2. Neural / FRACTURES OF THE
Medical retrocochlear deafness TEMPORAL BONE
1. Antihistamine - auditory nn lesion - Longitudinal fracture:
labyrinthine sedatives labyrinthine
2. Tranquilizer Clinics concussion 
3. Vasodilators - Slight / severe sensorineural deafness
4. Betahistine deafness
hydrochloride - Reduce speech Course OF Longitudinal
5. Fluid and salt discrimination 1. Squamous
restriction temporal bone
6. Diuretics Audiometric test 2. Roof of EAM w TM
To know type, use rupture
Surgical audiometric test: 3. Roof of middle ear
1. Endolymphatic sac - presence recruitment 4. Petrous of
decompression  cochlea temporal bone
- to reduce vertigo - absent recruitment  5. Anterior to
- reduce tinnitus auditory nn labyrinthine capsule
- improve hearing 6. Carotid canal
PENETRATING 7. Foramen lacerum /
2. Vestibular INJURIES OF spinosum
neurectomy TEMPORAL BONE
- relieve vertigo Etiology Course Of Transverse
- diminish hearing - Bullets/ missles 1. Cross petrous
- intracranial procedure - Sharp things: bone at right angle to
needles/hairgrips long axis
3. Destruction of 2. Pass vestibule of
labyrinth Pathology inne ear
- consider in persisten - Go to EAM  perforate
vertiginous patient TM  penetrate inner Symptoms
ear. - Severe sensorineural
4. Selective deafness
destruction of labyrinth Symptoms - Very severe rotary
+ US - Deafness vertigo
- to preserve hearing - Vertigo - Damage facial nn
- US to affected lateral - Nausea NOISE INDUCED
semicircular canal - Vomiting DEAFNESS
- Facial paralysis Etiology
Prognosis 1. Workers
- Uncontrolled tx bad for BLAST INJURY occupations
ear Etiology 2. Traumatic
- Frequent remission - Explosion exposure
- 40% maybe bilateral - Head injuries 3. Entertainment
recreation
SENSORINEURAL Symptoms
DEAFNESS - Sensorineural deafness Effect
- Cochlea & Auditory - Spontaneous 1. Temporary loss of
nerve cause improvement at 48 hr hearing maximal at 4 –
till 6 months 6kHz (TTS)
Type Of Sensorineural - Tinnitus - deafness
Deafness - tinnitus
1. Sensor deafness Examination
- cochlea lesion - Rupture/intact TM 2. Permanent
hearing loss
- irreversible damage 3. Alteration
hair cells of organ of conduction along
Corti defective basilar
membrane
3. Max hearing loss Symptoms
at 3,4, 6kHz - Bilateral deafness
- deafness increase - Slow progression
- smooth high tone loss - Deafness clear at 3rd
decade
Treatment - Difficulty in
- Hearing aid understanding speech
- Prevetion (Cant hear consonant
sound properly)
DEAFNESS DUE TO - Difficult to hear in
VIRUSES background noise
1. Mumps: - Lack concentration
- Permanent unilateral - Slowing down of
sensorineural deafness mental processes
at 4th/5th day of dss
- vertigo Treatment
2. Measles - Hearing aid
3. Chicken pox
4. Zoster OTOTOXICITY
5. Rubella Etiology
6. Poliomyelitis - Quinine
7. Influenza type A & - Salicylates
B
- myringitis bullosa Treatment
hemorrhagica - Stop drugs

PRESBYACUSIS AMINOGLYCOSIDES
Hearing loss due to 1. Streptomycin in
aging TB tx  loss vestibular
fn
1. High tone hearing 2. Dihydrostreptomy
loss (atrophy of organ cin  cochlear damage
of Corti)
- Neural presbyacusis = 3. Ototoxic +
loss neural elements Nephrotoxic
- Inconsistent - Neomycin
audiometric pattern - Gentamicin
loss - Kanamycin
- Speech discrimination - Tobramycin
loss
- Pure tone loss 4. Diuretic Drugs
(reversible)
2. Degeneration of - ethacrynic acid
stria vascularis - furosamide
- flat type audiometric
loss 5. Cytotoxic drugs
- good speech - nitrogen mustards
discrimination
6. Antihelmintics
- oil of chenopodium
Other Causes Of 5. ______________
Sensorineural stimulators
Deafness - Extract aloe
1. Perilymph fistula - Fibs
2. Surgical trauma - Humisol
3. Suppuirative
labyrinthitis 6. Specific antidotes
4. Syphilis - Unithiol
5. Acoustic - Natgrii thiosulfast
neurinoma
7. Electrophoresis of
SUDDEN IDIOPATHIC Vit B1/ KI in ear
DEAFNESS 8. Oxygenotherapy
Ptt suddenly aware of (toxic deafness)
moment of onset of 9. Hearing aid
deafness
- Wake up morning –
deaf
- Tinnitus
- Hearing distortion
- Resonance effect
- Quick recover within
hrs, days weeks (if >
3weeks – maybe not)

Diagnosis
- Exclude acustic
neuroma & Meniere’s
dss
- Audiometric: low tone
loss
- Loss hearing

TREATMENT OF
SENSORINEURAL
DEAFNESS
1. ___________
removal
2. ________________
- Trental
- Cavinton

3. Inhibitors of
cholinesterase
- Galantamine
- Proserine

4. Vitamiins
- B1, B2
- Nicotinic acid
- Cocarboxylase
- Ascorbinic acid