CD

• Conductive disorders


  Disorders affecting the conduction of sound through the outer and middle ear
• General symptomology of conductive disorders

  • Pain
  • Discharge
  • Bleeding
  • Feeling of Fullness
  • Conductive Hearing Loss
  • Elevated SRT
  • Normal Word Recognition
  • Abnormal Tympanometry
• Pathologies of the middle ear


  • Eustachian Tube Dysfunction
  • Otitis Media
  • Mastoiditis
  • Cholesteatoma
  • Disruption of the Ossicles
  • Otosclerosis
• Eustachian Tube Dysfunction


  ET blocks, pressure cannot be equalized, oxygen and nitrogen get absorbed into the ME space, TM retracts, fluid is pulled from the cavity mucosa
• Etiology of Eustachian Tube Dysfunction

  Allergies, colds, inflammation
• Symptoms of Eustachian Tube Dysfunction

  Feel plugged, echo
• Treatment of Eustachian Tube Dysfunction

  Watch and wait, nasal spray
• No hearing loss present in Eustachian Tube Dysfunction
• Eustachian Tube Dysfunction progresses over time
• Otitis Media


  One of the most common disorders of the middle ear causing hearing loss, infection of the mucous membrane of the middle ear, more common in children due to ET development, exposure to second-hand smoke
• Otitis Media - Serous or Secretory (Non-Infectious)


  Etiology: Obstructed ET, upper respiratory disorder, allergies/cold, dental malocclusion.

  
  

  Pathology: Clear or yellow sterile fluid, mucoid discharge.

  
  

  Symptoms: Feel full or blocked, resonance of own voice, conductive hearing loss.

  
  

  Diagnosis: History, otoscopy. Treatment: Watch and wait, drain fluid, myringotomy
• Otitis Media - Purulent or Suppurative (Infectious)


  Etiology: Obstructed ET, bacteria.

  
  

  Pathology: Presence of a microorganism.

  
  

  Symptoms: Pain and redness, possible TM perforation, pus in ME, conductive hearing loss.

  
  

  Diagnosis: Otoscopy, culture. Treatment: Antibiotics, myringotomy with tubes
• Otitis Media causes conductive hearing loss
• Myringotomy


  Purpose: Remove fluid from the middle ear, restore normal ME pressure. Procedure: Incision, tube placement
• Myringotomy should restore hearing back to normal thresholds or minimal loss
• Mastoiditis


  If suppurative OM does not resolve, the infection invades the mastoid. Bacteria causes breakdown of the bone. Swelling and pain. Can result in meningitis and even death.
• Mastoidectomy


  Purpose: Stop infection in the middle ear. Procedure: Removal of mastoid air cells affected by infection.
• Cholesteatoma


  Epithelial pocket formed in the epitympanum.

  
  

  TM retracts creating a pocket.

  
  

  Epithelial cells from the outer layer of the TM shed and become trapped.

  
  

  Can be congenital or acquired (primary and secondary).
• Primary Acquired Cholesteatoma


  Etiology: ET closure, eardrum pulls back creating a pocket, epidermal plug.

  
  

  Treatment: Mastoidectomy, possible replacement of the ossicles.
• Secondary Acquired Cholesteatoma


  Etiology: TM perforation secondary to OM, epithelial cells enter the ME.

  
  

  Course:

  • Skin grows in Onion-like layers
  • Possible Bacterial Contamination
  • Bone Erosion
  • Labyrinthitis
  • Facial Paralysis
  • Brain Abscess.

  
  

  Treatment: Mastoidectomy, possible replacement of the ossicles.
• Cholesteatoma causes conductive hearing loss
• Mastoidectomy for Cholesteatoma


  Purpose: Stop infection in the middle ear.

  
  

  Procedure: Removal of ME structures and mastoid cells.
• Disruption of the Ossicles

  Etiology: Blow to the skull, breakdown of the ossicles due to cholesteatoma.

  
  

  Hearing loss: Potential for maximum CHL.

  
  

  Treatment: Tympanoplasty, ossicular chain reconstruction.
• Disruption of the ossicular chain causes conductive hearing loss
• Tympanoplasty


  Purpose: Reconstruction restoring function to the TM and ossicles.

  
  

  Procedure: Graft reconnecting the eardrum and ossicles.
• Otosclerosis


  Most common non-infectious conductive disorder.

  
  

  • Inherited disorder beginning in young adulthood.
  • Production of abnormal spongy bone growth in the footplate of the stapes.
  • Fixation of the stapes to the oval window.
• Otosclerosis Incidence


  20-30 years of age, more common in women, 50% of cases have a family history
• Otosclerosis Hearing


  Progressive, bilateral, conductive, can progress to sensorineural
• Otosclerosis causes conductive hearing loss
• Stapedectomy/Stapedotomy


  Purpose: Removal of stapes fixation, stop regrowth of sclerotic material.

  
  

  Procedure: Stapes is removed, prosthetic connected to incus and oval window.