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HIS 125 Otitis Media and Otosclerosis
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HIS 125 Otitis Media and Otosclerosis


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  • 1. Otitis Media & Otosclerosis  Otitis Media Eustachian tube dysfunction is the most significant factor in the development of Otitis Media. The most common complication associated with Otitis media is the conductive component of twenty to thirty-five decibels of hearing loss.
  • 2. Otitis Media & Otosclerosis  Otitis Media Eustachian tube dysfunction prevents middle ear secretions from draining and creates negative pressure in the middle ear space. This negative pressure leads to periodic aspiration of contaminated nasopharyngeal secretions, which in turn cause bacterial infection of the middle ear (otitis media).
  • 3. Otitis Media & Otosclerosis  Otitis MediaUntreated patients or the treatment failure ofotitis media may result in: permanent hearing loss permanent perforation of TM Cholesteatoma Mastoiditis Ossicular discontinuity Tympanosclerosis
  • 4. Otitis Media & Otosclerosis Otitis Media Intracranial complications from untreatedOtitis media may result in: Meningitis Encephalitis Brain abscess
  • 5. Otitis Media & Otosclerosis  Otitis MediaRecurrent Otitis media has also beenimplicated as a possible source of delayeddevelopment, cognitive disabilities, anddetrimental behavior problems in youngchildren.
  • 6. Otitis Media & Otosclerosis  Otitis Media Ninety percent of all children in the United States will have at least one bout of otitis media before age six. Nearly twenty percent of children who suffer ear infections will at some time require surgery to treat the problem. Eighteen percent of children under age five have a medical office visit related to otitis media.
  • 7. Otitis Media & Otosclerosis  Otitis MediaThe incidence of otitis media in children has beenfound to be a function of age (under five years),gender (higher incidence in males), race (morewhites).Recurrent episodes of otitis media are generallycontributed to day care outside of the home,passive exposure to smoking, and bottlepropping.
  • 8. Otitis Media & Otosclerosis  Otitis MediaThere are three general categories for otitismedia. They are:1. Otitis Media without effusion2. Otitis Media with effusion3. Otitis Media with perforationThe type of effusion for #2 or #3 may be eitherserous (watery), purulent (pus like), mucoid (mucuslike liquid).
  • 9. Otitis Media & Otosclerosis  Otitis MediaEach of the three general categories may befurther classified based upon the duration.1. Acute—zero to twenty-one days2. Subacute—twenty-two days to eight weeks3. Chronic—lasting longer than eight weeks
  • 10. Otitis Media & Otosclerosis  Otitis MediaAcute otitis media commonly presents with earpain in association with symptoms of upperrespiratory tract infections such as stuffy noseand/or cough. Fever is present in less than halfof the reported cases.NOTE: Not all cases of ear pain are caused byotitis media. Other considerations for ear painmay be mumps, toothache, foreign body in theear canal.
  • 11. Otitis Media & Otosclerosis  Otitis MediaOtoscopy may reveal a red or yellow TMTM mobility is markedly reduced or absentas measured by tympanometry.A red TM with absent mobility is consistentwith an Acute otitis media diagnosis.
  • 12. Otitis Media & Otosclerosis  Otitis MediaLet’s review Northern, page #131for a diagramregarding the comprehensive management ofotitis media with effusion, based upon theduration of the event.
  • 13. Otitis Media & Otosclerosis  Otitis MediaMost middle ear effusions clear within the first sixweeks of treatment. However, residual otitismedia may occur fifteen percent of the time.Residual otitis media will created a fifteen totwenty decibel conductive hearing loss with thepatient reporting no pain—just the hearing loss.Note: Children will not complain about the HL.They just become inattentive, or developbehavior problems.
  • 14. Otitis Media & Otosclerosis  Otitis MediaWhen otitis media evolves into persistent middleear effusion, surgical intervention becomes themanagement method of choice.This involves a myringotomy with ventilation tube,or possibly an adenoidectomy, or a combinationof the two procedures.
  • 15. Otitis Media & Otosclerosis  Otitis MediaChronic otitis media is the appropriate diagnosiswhen irreversible damage to the middle earstructures has occurred i.e. adhesive otitis,perforation of the TM, erosion of the ossicles,cholesteatoma, etc.NOTE: Corrective surgery is required to treatchronic otitis media damage.
  • 16. Otitis Media & Otosclerosis  Otitis MediaLet’s review Northern, page #134 to examinethe referral criteria for otitis media and middleear disorders.
  • 17. Otitis Media & Otosclerosis  OtosclerosisThis condition often results in the impairment ofthe mobility of the footplate of the stapes withinthe oval window thus, creating a conductivecomponent to hearing loss.It is generally a genetic condition mostlyaffecting white females (a two to one female tomale ratio)
  • 18. Otitis Media & Otosclerosis  OtosclerosisIt generally manifests itself as a bilateralconductive hearing loss in the third or fourthdecades of human life.Variable tinnitus may precede or coincide with itsdevelopment.The tympanic membranes appear normal.
  • 19. Otitis Media & Otosclerosis  OtosclerosisAudiometric findings often reveal Carhart’snotch. This is a characteristic conductive “notch”found at 2K.Let’s review Northern, page #142 for a visualdescription of this characteristic Carhart notch.
  • 20. Otitis Media & Otosclerosis  OtosclerosisStapes mobilization and stapedectomy are thesurgical procedures commonly used in thetreatment of this condition.Generally, the surgery is unilateral on the earwith the worst hearing thresholds, provided theword recognition is the same in both ears.Note: Surgery for the second ear is delayed forat least a year or more.
  • 21. Otitis Media & Otosclerosis  OtosclerosisA successful procedure will last for six to tenyears with few post-surgical complications.Let’s review Northern, pages #144 and #146for samples of pre-surgical and post-surgicalaudiograms.