This document discusses several middle ear disorders including otitis media, mastoiditis, cholesteatoma, Bell's palsy, and otosclerosis. It describes the anatomy and development of the middle ear, how changes in mass and stiffness affect resonance, and symptoms, interventions, and audiometric results for each disorder.

1. Middle Ear Disorders
Lecture 13

2. Outline
 Anatomy – ME
 Development
 Changes due to Mass/Stiffness
 Disorders
 Otitis Media
 Mastoiditis
 Cholesteatoma
 Otosclerosis

4. Embryonic Development of ME
 1st month: formation of ossicles starts
 6 weeks: oval window formed
 3rd month: ossicles fully developed but still
cartilaginous tissue
 5-6 months: ossification of ossicles

5. Development of ME

6. Resonant Frequency of Ear

7. MASS vs STIFFNESS
 Mass –
 Changes in Mass occur with ME
 Stiffness
 Changes in Stiffness occur with ME

8. MASS vs STIFFNESS
 When you increase stiffness of ME, you
decrease the low frequencies on audio
 This results in a slight increase in the
resonant frequency of the ear

9. MASS vs STIFFNESS
 When you increase Mass of ME, you will see
a decrease the high frequencies
 This results in a slight lowering of the
resonant frequency of the ear

10. Otitis Media
 70% of children under age 3 have at least 1 episode
(Winskel, 2008)
 50% of children will have 1st infection before age
1(ASHA, 2004) and 9/10 before age 5.
 35 % of these will have recurring OM (ASHA, 2004)
 Most common cause of HL in children under age 3,
which occurs while developing language
 OM and language development
 OM and academic ability
 OM and literacy

11. Impact of OME
 NOT a relationship between OME and cognitive
function (Roberts et al, 1995)
 Presence of fluid/infection causes ____________ HL
 Fluid may take ___________________to resolve
 Hearing loss may continue to be present after
________________

12. Otitis Media
 Acute Otitis Media: fluid in the middle ear
with signs of infection (bulging eardrum, ear
pain, drainage, perforation)
 Otitis Media with effusion: fluid in the middle
ear without signs of infection (sometimes
called serous effusion)

13. OM Sequence
 Organisms access ME via Eustachian Tube
(ET)
 ET becomes swollen and blocked
 ME pressure drops (vacuum results)
 Infection spreads to mucous lining of ME
space
 Tympanic Membrane retracted

14. OM Sequence (cont.)
 Fluid accumulates in the ME space
 Bulging observed
 Fluid becomes infected
 Rupture of TM or Bleeding possible

15. From:http://www.rcsullivan.com
1. Serous Effusion (no
infection)
2. Acute OM –
Bulging TM
3. Resolving
OM

16. Untreated OM - Mastoiditis
 invasion of the fluid into mastoid bone

17. OME
 Symptoms
 Fever
 Ear Pain
 Hearing Loss
 Irritability
 Pulling on ear
 Poor sleep
 Drainage

18. Audiometric Results
 Degree of HL:
 Type:
 Tympanogram:
OAEs:
ABRs:
IWI:
Absolute latency of wave V
Absolute threshold of wave V

19. Interventions
(Pediatrician, ENT)
 Watchful Waiting
 Antibiotics
 PE Tubes
 Myringotomy
 Politzerization
 Valsalva maneuver

20. fromhttp://www.rcsullivan.com

21. Interventions
 Politzerization blowing air with a special
syringe into one nostril while blocking the
other, and at the same time swallowing.
 Force air into the ET and the ME
 “Ear-Popper”
 The Valsalva maneuver: forcibly blowing air
into the middle ear while holding the nose.
Should not be done if there is a cold and
nasal discharge.

22. Prevention of OM

23. Cholesteatoma
 Non malignant tumor in ME space
 Condition where skin has entered the ME space
 Small sac like tumor made up of proteins, fats and
tissue
 As it grows – damage the bones in the ME

24.  Most common cholesteatomas from OM

25. From: http://www.earsurgery.org/cholest
 Congenital cholesteatoma

26. Etiology/Symptoms
 Etiology: Perforations: skin enters ME
Retraction of TM
 Symptoms: HL, drainage with foul odor, ear
pressure, dizziness, facial weakness
 Left untreated - can spread to inner ear or
brain

27. Audiometric Results with Cholesteatoma
 Degree:
 Type:
 Tympanogram:
 Reflexes:
 OAE:
 ABR: IWI
 Lowest level of wave V
 Overall latencies of wave V

28. Intervention
 ENT: Mastoidectomy
needs frequent follow-up
keep ear dry
antibiotics: both oral and ear drops
CT-Scan/MR imaging: determines
extent
 Audiological: post-op results

29. Bell’s Palsy
 Incidence of 13-18 per 100,000
 Family tendency for onset
 Damage to the facial nerve
 Unilateral facial paralysis
 Etiology: from viral or bacterial infection,
tumor, swelling, injury

30. Facial Nerve – VII Cranial Nerve
 Innervates 7000 nerve
fibers
 Crosses the wall of the
middle ear space
 Carries impulses also to
tongue, saliva glands,
tear glands, stapes

31. Symptoms
 Twitching, weakness, tearing, numbness on
one side
 Changes in taste – Chorda tympani nerve-
branch of the facial nerve
 Not a disease
 Rarely causes HL alone
 Differentiate from acoustic
 neuroma

32. Intervention
 ENT: Steroids esp within week after onset
 Recovery in 4-6 weeks may take up to 4
months for full recovery
 Eye patch at night
 Keep eye from drying out
 Permanent Facial Nerve paralysis:
surgical interventions
PT- facial retraining

33. Audiometric Results with Bell’s Palsy
 Degree:
 Type:
 Tympanogram:
 Reflexes:
 OAE:
 ABR: IWI
 Lowest level of wave V
 Overall latencies of wave V

34. Otosclerosis
 Abnormal bone growth occurs in the middle
ear around the footplate of the stapes.
 prevents ossicular chain from moving
properly
 Footplate of stapes becomes “fixed” at the
oval window

35. Otosclerosis
 Progressive
 More common in adults, rare in children
 Higher prevalence in females: adolescence
through middle age (2:1)
 Genetic
 Hereditary: Accounts for 70 % of cases
 Autosomal Dominant
25% chance if one parent carrier
50% chance if both parents carriers

36. Symptoms
 Gradual HL: initial onset after puberty
Increased HL after pregnancies
 Tinnitus
 Dizziness
 Paracusis Willisi

37. Audiogram – Otosclerosis

38. Medical Interventions
 Sodium Fluoride Treatment – reduces bone
absorption and enhances calcium development of
bones
 Stapedectomy: removal of stapes and replacement
with prosthesis (Shea, 1957)
 BAHA implantable device

39. Audiometric Results with Otosclerosis
 Degree:
 Type:
 Tympanogram:
 Reflexes:
 OAE:
 ABR: IWI
 Lowest level of wave V
 Overall latencies of wave V