ENT SURGERY MODULE -7.pptx

Common problem of ear ..
variety of conditions may affect your hearing or balance:
Ear infections are the most common illness in infants and young children.
Tinnitus, a roaring in your ears, can be the result of loud noises, medicines or a variety
of other causes.
Meniere's disease may be the result of fluid problems in your inner ear; its symptoms
include tinnitus and dizziness.
Ear barotrauma is an injury to your ear because of changes in barometric (air) or water
pressure.

1. OTITIS MEDIA…
Overview
An ear infection (sometimes called acute otitis media) is an infection of the middle ear, the air-filled space
behind the eardrum that contains the tiny vibrating bones of the ear. Children are more likely than adults to
get ear infections.
In an ear infection, narrow tubes that run from the middle ear to high in the back of the throat (eustachian
tubes) can become swollen and blocked. This can lead to mucus build-up in the middle ear. This mucus
can become infected and cause ear infection symptoms.
Because ear infections often clear up on their own, treatment may begin with managing pain and
monitoring the problem. Sometimes, antibiotics are used to clear the infection. Some people are prone to
having multiple ear infections. This can cause hearing problems and other serious complications.

Symptoms..
● Symptoms
● The onset of signs and symptoms of ear infection is usually rapid.
● Children
● Signs and symptoms common in children include:
● Ear pain, especially when lying down
● Tugging or pulling at an ear
● Trouble sleeping
● Crying more than usual
● Fussiness
● Trouble hearing or responding to sounds
● Loss of balance
● Fever of 100 F (38 C) or higher
● Drainage of fluid from the ear
● Headache
● Loss of appetite
● Adults
● Common signs and symptoms in adults include:
● Ear pain
● Drainage of fluid from the ear
● Trouble hearing

Causes
An ear infection is caused by a bacterium or virus in the middle ear. This infection often
results from another illness — cold, flu or allergy — that causes congestion and
swelling of the nasal passages, throat and eustachian tubes.
Middle ear
The middle ear has three small bones — the hammer, or malleus; the anvil, or incus;
and the stirrup, or stapes. The eardrum keeps the bones away from the outer ear. A
narrow path called the eustachian tube joins the middle ear to the back of the nose and
upper part of the throat. The cochlea, a snail-shaped structure, is part of your inner
ear.

Role of eustachian tubes
The eustachian tubes are a pair of narrow tubes that run from each middle ear to high in the back of the
throat, behind the nasal passages. The throat end of the tubes open and close to:
Regulate air pressure in the middle ear
Refresh air in the ear
Drain normal secretions from the middle ear
Swollen eustachian tubes can become blocked, causing fluids to build up in the middle ear. This fluid can
become infected and cause the symptoms of an ear infection.
In children, the eustachian tubes are narrower and more horizontal, which makes them more difficult to
drain and more likely to get clogged.
Role of adenoids
Adenoids are two small pads of tissues high in the back of the nose believed to play a role in immune
system activity.
Because adenoids are near the opening of the eustachian tubes, swelling of the adenoids may block
the tubes. This can lead to middle ear infection. Swelling and irritation of adenoids is more likely to
play a role in ear infections in children because children have relatively larger adenoids compared to
adults.

Related conditions
Conditions of the middle ear that may be related to an ear infection or result in similar middle ear problems
include:
Otitis media with effusion,
or swelling and fluid buildup (effusion) in the middle ear without bacterial or viral infection. This may occur
because the fluid buildup persists after an ear infection has gotten better. It may also occur because of some
dysfunction or noninfectious blockage of the eustachian tubes.
Chronic otitis media with effusion,
occurs when fluid remains in the middle ear and continues to return without bacterial or viral infection. This makes
children susceptible to new ear infections and may affect hearing.
Chronic suppurative otitis media,
an ear infection that doesn't go away with the usual treatments. This can lead to a hole in the eardrum.

Risk factors
Risk factors for ear infections include:
Age. Children between the ages of 6 months and 2 years are more susceptible to ear infections because of the size
and shape of their eustachian tubes and because their immune systems are still developing.
Group child care. Children cared for in group settings are more likely to get colds and ear infections than are childre
who stay home. The children in group settings are exposed to more infections, such as the common cold.
Infant feeding. Babies who drink from a bottle, especially while lying down, tend to have more ear infections than do
babies who are breast-fed.
Seasonal factors. Ear infections are most common during the fall and winter. People with seasonal allergies may h
a greater risk of ear infections when pollen counts are high.
Poor air quality. Exposure to tobacco smoke or high levels of air pollution can increase the risk of ear infections.

Complications
Most ear infections don't cause long-term complications. Ear infections that happen again and again can lead to
serious complications:
Impaired hearing. Mild hearing loss that comes and goes is fairly common with an ear infection, but it usually
gets better after the infection clears. Ear infections that happen again and again, or fluid in the middle ear, may
lead to more-significant hearing loss. If there is some permanent damage to the eardrum or other middle ear
structures, permanent hearing loss may occur.
Speech or developmental delays. If hearing is temporarily or permanently impaired in infants and toddlers, they
may experience delays in speech, social and developmental skills.
Spread of infection. Untreated infections or infections that don't respond well to treatment can spread to nearby
tissues. Infection of the mastoid, the bony protrusion behind the ear, is called mastoiditis. This infection can result
in damage to the bone and the formation of pus-filled cysts. Rarely, serious middle ear infections spread to other
tissues in the skull, including the brain or the membranes surrounding the brain (meningitis).
Tearing of the eardrum. Most eardrum tears heal within 72 hours. In some cases, surgical repair is needed.

Prevention
The following tips may reduce the risk of developing ear infections:
Prevent common colds and other illnesses. Teach your children to wash their hands frequently and thoroughly
and to not share eating and drinking utensils. Teach your children to cough or sneeze into their elbow. If possible,
limit the time your child spends in group child care. A child care setting with fewer children may help. Try to keep
your child home from child care or school when ill.
Avoid secondhand smoke. Make sure that no one smokes in your home. Away from home, stay in smoke-free
environments.
Breast-feed your baby. If possible, breast-feed your baby for at least six months. Breast milk contains antibodies
that may offer protection from ear infections.
If you bottle-feed, hold your baby in an upright position. Avoid propping a bottle in your baby's mouth while he or
she is lying down. Don't put bottles in the crib with your baby.
Talk to your doctor about vaccinations. Ask your doctor about what vaccinations are appropriate for your child.
Seasonal flu shots, pneumococcal and other bacterial vaccines may help prevent ear infections.

Treatment
Antibiotics
Your child may need antibiotics if bacteria are causing the ear infection. Healthcare providers
may wait up to three days before prescribing antibiotics to see if a mild infection clears on its
own. If an infection is severe, your child may need to start antibiotics immediately.
Often, ear infections heal without treatment. Your provider may monitor your child’s condition to
see if it improves before prescribing treatments. Your child may need antibiotics or surgery for
infections that don’t go away. In the meantime, pain medicines can help with symptoms like ear
pain.

OTOSCLEROSIS
Otosclerosis (oh-tuh-skli-ROH-sis) is a condition that causes hearing loss. The term “oto” means “of the ear”
and “sclerosis” means “abnormal hardening of body tissue.”
Otosclerosis happens when irregular bone remodeling/growth occurs in your middle ear or, more rarely, your
inner ear. Bone remodeling is a lifelong process in which existing bone tissue repeatedly restores itself. In
otosclerosis, irregular bone remodeling interferes with sound’s ability to travel through your ear.
People with otosclerosis can develop mild to severe hearing impairment. The condition rarely results in total
deafness. It typically affects both ears, but one ear is usually worse than the other.
Symptoms

Cause
Deep inside your ear, there are three tiny bones (ossicles) that vibrate to amplify the sound waves that pass
through them. These sound waves travel to the cochlea in your inner ear, where they convert into signals
before moving on to your brain. Otosclerosis most often develops when the stapes bone (a small, triangular
bone in your middle ear) fuses with the surrounding bone tissue. As a result, sound can’t travel effectively.
Risk factor
Family history. You’re more likely to develop otosclerosis if a parent, sibling or grandparent
has it.
Gender. People AFAB are more prone to developing otosclerosis.
Race. Overall, white people have a higher chance of getting otosclerosis.
Pregnancy. People who are already prone to otosclerosis may develop the condition while
they’re pregnant.

Diagnosis
If your primary care physician thinks you might have otosclerosis, they’ll refer you to an
otolaryngologist (ear, nose and throat specialist). First, they’ll rule out other health conditions that
share similar symptoms. Next, they’ll run hearing tests to determine the extent of hearing loss.
These tests may include a/an:
Audiogram, which measures your hearing across a range of frequencies.
Tympanogram, which tells your provider how well your eardrum works.

Prevention
Hearing aids
Hearing aids amplify the sounds around you to help you hear better. An audiologist can customize the
settings on your hearing aid according to your specific needs.
While hearing aids can improve your hearing, they can’t keep otosclerosis from getting worse. Ask your
healthcare provider whether hearing aids are right for your situation.
Stapedectomy
“Stapedectomy” (stay-puh-DEK-tuh-mee) is the medical term for otosclerosis surgery. During this procedure, an
otolaryngologist places a prosthesis (replacement hearing bone) in your middle ear. This prosthesis bypasses the
stapes bone, allowing sound waves to travel to your inner ear. As a result, your hearing improves.
If otosclerosis affects both of your ears, your surgeon will operate on one ear at a time so each has time to heal.
Once the first surgery is complete, you’ll probably have to wait at least six months to schedule your next procedure.
Cochlear implants
Cochlear implants can improve hearing in people with cochlear otosclerosis. (Your cochlea is a spiral, fluid-filled
structure in your inner ear that helps with hearing.) A cochlear implant bypasses your inner ear structures and
creates a new pathway on which sounds can travel to your brain

Functional aphonia
If you have aphonia or loss of voice, it means you can’t make yourself heard because your voice
sounds hoarse, or you can‘t speak above a whisper. Sometimes you can’t speak at all. Other times
you may not want to speak because you think your voice sounds strange or different. Aphonia is a
voice disorder that can affect anyone but is often seen in people who constantly raise their voice to
be heard. Healthcare providers treat aphonia with voice therapy exercises.
What are the symptoms of aphonia?
The most common — and most obvious — symptom is not being able to speak up or be heard when
you speak. Suddenly losing your voice is another aphonia symptom.
. Those sound waves travel through your throat, nose and mouth. These are called resonating cavities.
Cause.
. Your respiratory system drives airflow that powers your voice. If you’re not breathing properly, you
may have trouble using your voice.
. Your larynx (voice box) houses your vocal cords, which are also called vocal folds. Your larynx has a
set of muscles called the phonatory muscles. These muscles move your vocal cords together. When
air from your lungs flows past your vocal folds, they begin to vibrate, creating sound waves. (Think .
how a breeze can make a wind chime ring.)

What is psychogenic aphonia?
Psychogenic aphonia, or psychogenic conversion aphonia, is when you suddenly lose your voice due to
emotional or psychological stress. People who have psychogenic aphonia can speak but only in strained
whispers.
Diagnosis and test
Rigid laryngoscopy. Your provider will slide a rigid tube or endoscopy into your mouth
and then hold your tongue still so they can view your larynx.
Flexible laryngoscopy. This test is done with a flexible tube that your provider passes
through your nose to the back of your throat. You may be asked to talk, sing or cough
so your provider can view your larynx in action.
How is aphonia treated?
Healthcare providers typically treat aphonia with voice therapy. Your provider may recommend you
work with a speech therapist. Your therapist will tailor treatment to your specific situation. Treatment
may include breathing exercises and voice exercises.

FUNCTIONAL DEAFNESS
Hearing loss happens when something affects your hearing system. If you have hearing loss, you may have
trouble understanding, following or participating in conversations. It may be hard for you to hear telephone
conversations, to take part in online meetings or follow dialogue when you’re watching television.
TYPES OF DEAFNESS
Conductive hearing loss: In this hearing loss, something keeps sound from passing through
your outer ear (ear canal) or your middle ear.
Sensorineural hearing loss: This hearing loss happens when something damages your inner
ear over time. Rarely, sensorineural hearing loss happens very quickly. This is sudden
sensorineural hearing loss (SSHL), or sudden deafness. SSHL may happen all at once or over a
few days.
Mixed: This happens when you have issues in your middle or outer ear (conductive hearing loss)
and your inner ear (sensorineural hearing loss).

SYMPTOMS
1.You often ask people to repeat themselves.
2. You have trouble following a conversation, especially when you’re talking on the telephone or in a noisy
environment like a restaurant.
3. You think people are mumbling.
4.You can’t hear certain high-pitched sounds, like birds singing.
5. You need to turn up the volume on your television, computer or tablet.
6.You have tinnitus (ringing in your ears).
7.Your ear hurts (earache).
8.You feel as if there’s pressure or fluid inside your ear.
CAUSES
1. Earwax that’s built up in your ear.
2. Fluid in your middle ear from colds or allergies.
3. Middle ear infection (otitis media).
4. Swimmers’ ear (otitis externa).
5. Eustachian tube issues that traps fluid in your middle ear.
6. Ruptured eardrum.
7. Ear tumors.
8. Something stuck in your ear. For example, your child, faced with a side dish of peas, may decide to put

DIAGNOSIS AND TEST
Pure-tone testing: This common hearing test finds the quietest volume you can hear at each pitch. You’ll
wear headphones or earplugs to hear the sounds and speech. You’ll also wear a device on your head for
bone conduction testing. The combination of testing with headphones/earplugs and bone conduction testing
helps your audiologist determine which type of hearing loss you have.
Otoacoustic emissions test (OAE): Audiologists use this test to check your inner ear function.
Tympanometry: This test checks how well your eardrum moves. Audiologists may do tympanometry tests
to see if you have a ruptured eardrum, fluid in your middle ear or wax in your ear canal
STAGES
Normal.
Slight.
Mild.
Moderate.
Moderately severe.
Severe.
Profound.

Treatment
Conductive hearing loss
Medications, like antibiotics, to treat ear infections.
Surgeries, including tympanoplasty, to repair a ruptured eardrum, tympanostomy to insert ear tubes or surgery to
remove tumors.
Procedures to remove earwax or other objects in your ear canal.
Sensorineural hearing loss
Medications, like corticosteroids, to reduce swelling in your cochlea hair cells. (You can damage your cochlea
hair cells if you’re exposed to loud noise.)
Management like hearing aids and cochlear implants.
Mixed hearing loss
Treatments vary based on the specific issues affecting your outer, middle and inner ear.

FACIAL PALSY
Facial paralysis happens when your facial nerve (cranial nerve #7) becomes damaged. This results in
weakness, droopiness and a loss of facial movement on one side (unilateral) or both sides (bilateral) of
your face.
Facial nerve damage can occur for several reasons, including infection, trauma or stroke. It can also occur
without a known cause, which is referred to as Bell’s palsy. Face paralysis may complete or partial and
can be temporary or permanent.
CAUSE
1.Your facial nerve, which transmits signals from your brain to your facial muscles, becomes damaged
or swollen.
2.The area of your brain that carries signals to your facial muscles becomes damaged.
Facial paralysis causes may include:
3.Stroke.
4.Bell’s palsy.
5.Middle ear infection.

classification of facial palsy

Nonsurgical treatments may include
Corticosteroids to reduce inflammation and swelling in your facial nerve.
Antivirals to fight possible infection.
Botox injections to treat synkinesis — a secondary condition that results in involuntary muscle movements. (This
is common with Bell’s palsy.)
Physical therapy to improve facial symmetry, increase muscle strength and regain facial coordination.
Speech therapy to help you regain your speech and swallow function.
Occupational therapy to help you improve functions like facial expressions and interpersonal
communication.
Surgical treatments may include
Eyelid surgery.In order to help your eye close, various procedures may be performed to support your eye and make
blinking more efficient.
Reanimation surgery. There are various types of reanimation surgery. For some procedures, a surgeon takes
muscles and/or nerves from other areas of your body (some nearby and some from remote sites) and uses them to
restore facial movement. Facial reanimation may involve nerve transfers, tendon transfers or muscle transplants,
depending on the specific goals of treatment.
Surgery to remove a tumor. If facial paralysis is the result of a tumor, a surgeon may perform surgery to remove
it and take pressure off your facial nerve.
Cosmetic surgery. There are several cosmetic surgery procedures that can restore balance and symmetry to
your face. These procedures may include brow lifts, facelifts, facial slings and eyelid surgery.

TYPES OF FACIAL PALSY
- BELL’S PALSY
Bell's palsy is a condition that causes sudden weakness in the muscles on one side of the face. In most
cases, the weakness is temporary and significantly improves over weeks. The weakness makes half of
the face appear to droop. Smiles are one-sided, and the eye on the affected side resists closing.
Bell's palsy is also known as acute peripheral facial palsy of unknown cause. It can occur at any age.
The exact cause is unknown. Experts think it's caused by swelling and inflammation of the nerve that
controls the muscles on one side of the face. It could be caused by a reaction that occurs after a viral
infection.
Symptoms usually start to improve within a few weeks, with complete recovery in about six months. A
small number of people continue to have some Bell's palsy symptoms for life. Rarely, Bell's palsy
occurs more than once.
- Central facial palsy.
Due to damage above the facial nucleus.

ENT SURGERY MODULE -7.pptx

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