ME PATH

Question 1

Nasopharyngeal carcinoma

Answer 1

Tumor in vault of nasopharynx
Can block ET- no air into ME- mastoid ear cells secrete fluid- effusion

Unilateral middle ear effusion - unilateral CHL

Surgical removal & radiotherapy

Question 2

Patulous ET

Answer 2

Cartilage is stiffer and so ET more open
- TM building in and out
- aural fullness
- autophony (abnormal hearing of own voice/breathing)

Question 3

Glomus tumours

Answer 3

• Slow growing
• tinnitus due to tumour touching ossicles/TM, blood flow to it, sound directly thru cochlea
• pulsatile tinnitus
• more common in women (middle age)
• red mass behind TM

CHL

Watchful waiting for small ones in elderly
Surgery & radiotherapy

Question 4

Granular Myringitis:

Answer 4

• chronic
  -granulations on TM
  -Chronic, painless otorrhoea
  -common w TM trauma (foreign body)

Normal or CHL

Topical agents : antibiotic drops
Surgical excision and reconstruction if non surgical fails

Question 5

Bullous Myringitis:

Answer 5

-acute
-fluid filled blisters on TM
-acute inflammation w pain
-viral /bacterial causes
-common w otitis media

CHL

-pain management
-anti inflammatory agents

Question 6

Barotrauma

Answer 6

Tissue injury due to pressure differences (that ET can’t preserve anymore) in ear
-blood vessels engorgement & inflammation
- potential TM rupture

-Alternobaric vertigo from unequal pressure

-Major damage cause CHL/ balance issue

-Equalisation techniques (gum)
-decongestants
Surgical intervention if needed

Question 7

Acute otitis media (AOM)

Answer 7

• Redness of TM
  -can have ME effusion/ perforation of TM then otorrhoea come out
  -painful

Can have CHL if fluid come out or when TM perforated

• 90% healed in 3m (untreated)
• antibiotics when no improvement after 2 days/ perforated TM/ cochlear implant kid

Question 8

Otitis media with effusion (OME)

Answer 8

• amber color fluid in middle ear (can follow AOM but not necessary)
• can be due to ETD (TM retracted)
  No pain
• serous (low viscosity)
  -mucoid (high viscosity)

If air bubbles- ET start to function again

CHL

OME after AOM
- 90% good in 3m
(untreated)

-no antibiotic treatment!!!
At least 4m w HL:
Grommets- to ventilate ME, not trying to drain!!

Question 9

Atelectasis
(retraction pockets)

Absence of air, TM thin due to damage to ME fibrous layer that collapse

Answer 9

Grade1: attic retraction &process of malleus more prominent

Grade 2: TM thin & adheres to incudostapedial joint

Grade 3: TM touch promontory, MEE, tympanosclerosis, head of malleus in attic

Grade 4: TM cover promontory & touch stapes, erosion of long process of incus

Grade 1-3 : CHL Normal Grade 4

Grade 1-3: ventilation tube to prevent further retraction of TM

Grade 4: grommets/ ventilation won’t work!

May reconstruct TM using tympanoplasty if needed or any damage

Question 10

Adhesive otitis media

Answer 10

Atelectasis when TM stuck to ossicles (ETD)

CHL if ossicular erosion

Surgery if large infected retraction pockets with polyps & frequent discharge & HL

Question 11

Chronic TM perforation

Answer 11

Not healed after 3m

scarring/
tympanosclerosis

can have CHL

Myringoplasty: (also for retraction pockets)
repair/graft TM

Overlay technique (anterior洞, graft placed outer lateral surface)/ Underlay technique (posterior洞,graft placed medial under TM)

Question 12

Tympanosclerosis

Answer 12

White plaques in TM (or ossicles/ ME) - usually follow inflammation/ trauma/surgery

CHL if ossicles involved

Question 13

Myringosclerosis

Answer 13

Calcification on TM ONLY
No impact on TM mobility

Normal

Question 14

Chronic Suppurative Otitis
media (CSOM)

Answer 14

Chronic perforation of TM下方 with otorrhoea & mastoiditis (inflammation of mastoid air cells)
Can have erosion of ossicles

CHL

1.remove active disease
2.restore air-filled ME
3.prevent complication
4.restore hearing function

Tympanoplasty:
-Eradicate infection and ME pathology
-Reconstruct sound-conducting mechanism
-May include a graft for TM (myringoplasty)
-Incision behind ear compared to Myringoplasty where it’s directly to TM

Question 15

congenital cholesteatoma (2%)

(big ball of skin in ME)

Answer 15

• white mass behind intact TM
• no retraction

NORMAL

Question 16

accuired chlesteatoma (98%)

(big ball of skin in ME)

Answer 16

• poor ET function negative pressure retract pars flaccida上
• sucks keratin into ME and accumulate

CHL or SNHL (depends on where erosion and attic retraction)

Mastoidectomy

:canal wall down
- radical: TM & most ME structure removed- big ABG-maximal CHL
- modified radical: TM & ME structures saved- better hearing

(for chronic infection- intact canal wall: mastoid air cells drill out removing infection/ cholesteatoma)