medial ear

• - Causes:
• Slap, blast or otitic barotrauma.
• F.B. or during its removal, clumsy ear wash, fracture base of the skull.

• TTT:
• - Keep the ear dry
• - Antibiotics, analgesics and nasal decongestive drops.
• - The perforation usually heals in three to six weeks.
• - Myringoplasty after three months if the perforation fails to heal.

1. rupture of the drum

• - Symptoms:
• -Slight pain.
• -Mild deafness and tinnitus.
• -Minimal bleeding.

• - Signs:
• - Retracted congested drum
• - Fluid and bubbles in the middle ear.
• - The drum may be traumatically perforated.

• Def:
• Non infective inflammation of the middle ear
• caused by Eustachian tube obstruction. This occurs during diving & airplane descent.

2. Otitic Barotrauma

• - Symptoms:
• - Deafness, tinnitus, pain and auto-phony (patient hears his voice loud).

• TTT:
• - Analgesics and nasal decongestive drops.
• - Myringotomy to allow air in and drain fluid out.

• - Prophylaxis:
• - Avoid flying when having upper respiratory infection.
• - Avoid sleeping during flight descent

• - Longitudinal fracture (lateral head trauma).
• It passes in the temporal bone through the middle ear, drum and external ear. It causes conductive deafness, bleeding from the ear and cerebrospinal otorrhea. Facial nerve paralysis is less common.It is more common than the transverse fracture. Prognosis is good.

• - Transverse fracture (occipital head trauma).
• Usually affects the inner ear and the facial nerve. It causes hemotympanum, sensorineural deafness, vertigo and facial paralysis. Prognosis is poor.

3. Fracture Base of Skull

• -Def:
• Disconnection of ossicles following head injury, fracture skull base or ear surgery. The incudostapedial joint is the most commonly affected.
• - It causes conductive deafness and the drum may be intact.

4. Ossicles disconnection

• - TTT:
• Middle ear exploration and Ossiculoplasty.

• Defin:
• An acute inflammation of the mucosal lining of the middle ear cleft.

Subtopic 1

Acute Otitis Media (AOM)

• Cau organisms:
• - Bacterial as Haemophilus influenza, streptococci and staphylococci.
• - Viral as influenza.

• - Routes of infection:
• - Through the Eustachian tube: extension of infection from:
• - Acute rhinitis, acute sinusitis.
• - Adenoiditis, common cold.
• - Milk regurge during suckling in infants.
• - Through a drum perforation: During swimming

• a) Congenital cholesteatoma arises from embryonic epithelial rests in of the petrous bone. In the middle ear it leads to conductive deafness behind an intact drum.

• Def:
• Chronic inflammation of the middle ear: causing conductive deafness and discharge from a perforated drum.

Subtopic 2

• Clinical types:
• 1. Tubotympanic disease: Safe ear
• It is a mucosal affection of Eustachian tube and tympanic cavity. It is due to non-resolution or recurrent AOM.
• 2. Attico-antral (Cholesteatoma): Unsafe ear
• It is bony affection of the attic, antrum and bony walls of the mastoid air cells.

(C.S.O.M)

• Cholesteatoma
• It is a bag-like, cystic, foul smelling mass, formed of keratinizing desquamated squamous epithelium, pus, cholesterol crystals and proteolytic enzymes.
• It erodes bone by chemical (proteolytic enzymes) and bacterial action (secondary infection). The abnormal presence of the squamous epithelium in the middle ear is either congenital or acquired

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