ME Disorders

Question 1

Otitis Media w Effusion

Answer 1

Infectious inflammation of the ME that results in fluid (effusion) in the cavity.
- Incidence of childhood otitis media with effusion: most common visit for children. ET are more horizontal and do not drain as properly until older.
- Prevalence declines at 6 years old. (Can occur in adults but more rare)
- Race is a prevalent factor that can be related to differences in E.T and there is higher incidence rates in eskimos, natives, hispanics, and australian aborigines.

Etiology:
Bacterial - streptococcus pneumoniae, Haemophilus influenzae

Viral - RSV, Rhinovirus, Parainfluenza, Influenza Virus

Question 2

Otitis Media

Question 3

Cholesteatoma

Answer 3

Cholesteatomas are the occurrence of squamous epithelium (skin) in areas of the temporal bone where it does not belong
- external ear canal, ME cavity, or extend through
mastoid bone into the brain cavity
- Cholesteatoma manifest highly aggressive, progressively enlarging, tumor-like characteristics.

Known as a Pseudotumor because….
They are highly erosive and may cause destruction of bone and other tissue.

Congenital cholesteatoma: present in children
5 years present
anterior - superior quadrant
Etiology is controversial

Acquired cholesteatoma: more common than congenital
Chronic or untreated OM w/ effusion
TM retraction
Previous ear surgery
Slow growing

Iatrogenic Cholesteatoma: Delayed complication of middle ear surgery, due to seeding of squamous epithelium in tympanic cavity

Question 4

Otosclerosis

Answer 4

Otosclerosis: focal disease, unique to temporal bone.
- Insidious (slow-growing) and progressive
- Affects otic capsule from where inner ear develops
- Ankylosis (fixation) of the stapes footplate to the oval window due to abnormal bony growth.
- IPSI of affected side, CONTRA of both sides

Differential Dx: Meniere’s Disease

Obliterative Otosclerosis: occurring of the round window

Cochlear Otosclerosis: bony growth spreads to cochlea, the result is a progressive irreversible SNHL worse in the higher frequencies

Histologic Otosclerosis: lesions do not encroach on stapes footplate
They remain small and asymptomatic

Question 5

Ossicular Disarticulation

Answer 5

“The Ice Cream Cone” Sign - Incudomalleolar disarticulation - Ossicles can be disconnected and completely detached.
Trauma to head/neck/face, Osteoporosis in cases
Untreated ME infection

Audio Finding’s:
Perf ™
Bleeding in canal
Jerger Type Ad
Abnormal Reflexes
Conductive/Mixed HL

Treatment:
Surgical Repair
Amplification

Question 6

Temporal bone trauma

Question 7

Paraganglioma (glomus tumor)

Answer 7

Paraganglioma: benign soft tissue tumor of M.E (typically unilateral and lobulated), next to nerve fibers. (paraganglion cells) (glomus tumor)

• typically happen 5th decade of life
  Common in females
• NF1 related
• Association w/wo Pheochromocytoma is a tumor of the adrenal glands

Symptoms include: sweating, rapid HR, headache, life threatening BP

Question 8

Glomus Tympanicum

Answer 8

Glomus tympanicum - arising along the course of Jakobson nerve primarily in the tympanic cavity.
- Smaller and can grow
- Unilateral pulsatile tinnitus
-TM may appear red due to increased vasculature of the ME cavity. Lateral growth through TM can mimic bleeding polyp.

Audio - (sawtooth tymp)

Surgery - removal of tumor

Question 9

Glomus Jugulare

Answer 9

Glomus Jugulare - arise from the dome of the internal jugular vein bulb and involves jugular foramen and related structures

Conductive Hearing Loss depends on size of tumor and effect on ossicles.
Jerger Type As Tymp if tumor is big
Jerger Type B if tumor is pressing on ™ and making ™ immobile
Sawtooth jagged tymp!
GLOMUS TUMORS CAN BE INHERITED VIA SPORADIC OR AD. 100% Penetrance.
Treatment - surgery or radiation