Chronic

Suppurative
Otitis Media
z
z
Chronic Suppurative Otitis Media
z
z
Chronic tubotympanic suppurative otitis
media (Mesotympanitis)
z
Chronic Atticoantral suppurative otitis
media (Epitympanitis)
Chronic
z
Atticoantral suppurative otitis
media (Epitympanitis)
z
z
Mesotympanitis&Epitympanitis
z
Cavity surgery on the middle ear
z
Inner Ear Diseases
z
Labyrinthitis
 z
CAUSES of Labyrinthitis:

 Infections.

 Syphylitic otitis media.

 Secondary to meningitis.

 Viral infections
(mumps,measles, herpes
zoster)
 Vascular causes
(thrombosis, embolism)
 Ototoxic drugs.
z
CLINICAL FEATURES of Labyrinthitis :

 Vertigo.

 Nausea.

 Vomitting.

 Tinnitus.

 Sensory neural hearing loss.

 Balance problems.

 Fever.

 Otalgia.
 z
DIAGNOSIS of Labyrinthitis :

 History Collection: Past medical history and Medications.

 Physical examination

1. Octoscopy.

2. Hearing test.

3. Romberg test.

 Audiometry.

 Imaging test: CT Scan and MRI of Head.

 Laboratory: CBC and Blood Culture.

 Neurological examination: Complete cranial nerve examination.

z
Treatment
 z
Sensorineural hearing loss

 Sudden Sensorineural Hearing Loss (SSHL) or

Sensorineural Hearing Loss (SNHL) is a type of hearing loss
in which the root cause lies in the inner ear or sensory organ
(cochlea and associated structures) or the vestibulocochlear
nerve (cranial nerve VIII). SNHL accounts for about 90% of
reported hearing loss. SNHL is generally permanent and can
be mild, moderate, severe, profound, or total.
 z
Congenital and acquired causes
There are two types of sensorineural hearing loss: congenital and acquired sensorineural hearing
loss.

Congenital sensorineural hearing loss happens during pregnancy. Some causes include

Prematurity

Maternal diabetes

Lack of oxygen during birth

Genetics

Diseases passed from the mother to child in the womb, such as rubella. Acquired sensorineural
hearing loss occurs after birth. Causes can include
 Aging, Noise, Head and acoustic trauma to the inner ear.
 Pathophysiology
z
of sensorineural hearing loss

 SNHL is most commonly caused by damage to the OHCs and the IHCs. There are
two methods by which they might become damaged. Firstly, the entire hair cell
might die. Secondly, the stereocilia might become distorted or destroyed. Damage
to the cochlea can occur in several ways, for example by viral infection, exposure to
ototoxic chemicals, and intense noise exposure. Damage to the OHCs results in
either a less effective active mechanism, or it may not function at all. OHCs
contribute to providing a high sensitivity to quiet sounds at a specific range of
frequencies (approximately 2–4 kHz). Thus, damage to the OHCs results in the
reduction of sensitivity of the basilar membrane to weak sounds. Amplification to
these sounds is therefore required, in order for the basilar membrane to respond
efficiently. IHCs are less susceptible to damage in comparison to the OHCs.
However, if they become damaged, this will result in an overall loss of sensitivity.
z
Symptoms of sensorineural hearing loss
 z
Diagnostic Methods of sensorineural
deafness
Physical exam. Your doctor will look in your ear for possible causes of your hearing loss, such as
earwax or inflammation from an infection. Your doctor will also look for any structural causes of
your hearing problems.

General screening tests. Your doctor may use the whisper test, asking you to cover one ear at a
time to see how well you hear words spoken at various volumes and how you respond to other
sounds. Its accuracy can be limited.

App-based hearing tests. Mobile apps are available that you can use by yourself on your tablet to
screen for moderate hearing loss.

Tuning fork tests. Tuning forks are two-pronged, metal instruments that produce sounds when
struck. Simple tests with tuning forks can help your doctor detect hearing loss. This evaluation
may also reveal where in your ear the damage has occurred.
Audiometer tests. During these more-thorough tests conducted by an audiologist, you wear
earphones and hear sounds and words directed to each ear. Each tone is repeated at faint levels to
find the quietest sound you can hear.
 z
Treatment of sensorineural hearing loss
 Profound or total hearing loss may be
amenable to management by cochlear
implants, which stimulate cochlear nerve
endings directly. A cochlear implant is surgical
implantation of a battery powered electronic
medical device in the innimpairment.

 The quality of sound is different than natural

hearing but may enable the recipient to better
recognize speech and environmental sounds.
Because of risk and expense, such surgery is
reserved for cases of severe and disabling
hearing impairment
 z
Pathology of Meniere’s disease
The symptoms of Ménière’s disease are caused by the buildup
of fluid in the compartments of the inner ear, called the
labyrinth. The labyrinth contains the organs of balance (the
semicircular canals and otolithic organs) and of hearing (the
cochlea). It has two sections: the bony labyrinth and the
membranous labyrinth. The membranous labyrinth is filled with
a fluid called endolymph that, in the balance organs, stimulates
receptors as the body moves. The receptors then send signals
to the brain about the body’s position and movement. In the
cochlea, fluid is compressed in response to sound vibrations,
which stimulates sensory cells that send signals to the brain.
 In Ménière’s disease, the endolymph buildup in the
labyrinth interferes with the normal balance and hearing
signals between the inner ear and the brain. This
abnormality causes vertigo and other symptoms of
Ménière’s disease.
 z
Symptoms of Meniere’s disease

Meniere’s disease symptoms tend to come on as “episodes” or “attacks.” These

symptoms include:

vertigo, with attacks lasting anywhere from a few minutes to 24 hours

loss of hearing in the affected ear

tinnitus, or the sensation of ringing, in the affected ear

aural fullness, or the feeling that the ear is full or plugged

loss of balance

headaches
 nausea, vomiting, and sweating caused by severe vertigo
 z
Diagnosis of Meniere’s disease

Diagnosis is based upon your medical history and the presence of

Two or more episodes of vertigo lasting at least 20 minutes each

Tinnitus

Temporary hearing loss

A feeling of fullness in the ear

 Some doctors will perform a hearing test to establish the extent of hearing
loss caused by Ménière’s disease. To rule out other diseases, a doctor
also might request magnetic resonance imaging (MRI) or computed
tomography (CT) scans of the brain
 z
Balance tests for diagnosis of patients

The balance test most commonly used to test for Meniere’s disease is
electronystagmography (ENG).

In this test, you’ll have electrodes placed around your eyes to detect eye
movement. This is done because the balance response in the inner ear
causes eye movements.
 During this test, both hot and cold water will be pushed into your ear. The
water causes your balance function to work. Your involuntary eye
movements will be tracked. Any abnormalities can indicate a problem
with the inner ear.
z
Other diagnostic tests

 Audiometric exam: This will find a hearing loss in the affected ear. It
might include a test to gauge your ability to tell the difference
between words like “fit” and “sit.” That’s called speech discrimination.

 Electrocochleography: This measures fluid pressure in your inner

ear.

 Additional imaging tests: An MRI or CT scan might be ordered to rule

out the possibility that something other than Ménière’s has caused
your symptoms.
 z
Treatment of Meniere’s disease

 There is no cure for Ménière’s disease but medications, diet, physical therapy
and counseling, and some surgical approaches can be used to manage it.

 Medications

 During MD episodes, medications to reduce nausea are used, as are drugs

to reduce the anxiety caused by vertigo.

 Diuretics such as the thiazide-like diuretic chlortalidone, are widely used to

manage Ménière’s on the theory that it reduces fluid buildup in the ear. Based
on evidence from multiple but small clinical trials, diuretics appear to be
useful for reducing the frequency of episodes of dizziness but do not seem to
prevent hearing loss.
 z
Diet and surgical methods

 People with MD are often advised to reduce their salt intake. Reducing salt intake,
however, has not been well studied.Based on the assumption that MD is similar in
nature to a migraine, some advise eliminating “migraine triggers” like caffeine.
However, the evidence for this is weak. There is no high quality evidence that
changing diet by restricting salt, caffeine or alcohol improves symptoms.

 The inner ear itself can be surgically removed via labyrinthectomy, although
hearing is always completely lost in the affected ear with this operation. The
surgeon can also cut the nerve to the balance portion of the inner ear in a
vestibular neurectomy. The hearing is often mostly preserved; however, the
surgery involves cutting open into the lining of the brain, and a hospital stay of a
few days for monitoring would be required.
z
z
 Otosclerosis Introduction
z

 Otosclerosis also called “hardening of the

ear” result from the formation of an
abnormal spongy bone , like bone growth
along the stapes in the middle ear.

 With the new bone growth , the stapes

become immobile which prevents
transmission as sound vibration into the
ear, leading to conductive hearing loss.

 Otosclerosis usually affect both ears.

Classification
There are mainly two types of classification

1. Histological
otosclerosis
2. Clinical
otosclerosis
 Histological otosclerosis

This type of otosclerosis does

not produce any symptoms
during life. It is revealed only at
postmortem
z
2.Clinical otosclerosis
There are three sub types

1. Stapedial otosclerosis
2. Cochlear otosclerosis
3. Mixed otosclerosis
 1.stapedial otosclerosis
 The otosclerosis focus may produce ankylosis
of the membraneous labyrinth

 2.Cochlear otosclerosis
 The otoscleroticprocess encroaches upon the
membraneous labyrinth producing
sensoryneural deafness.
 3.Mixed otosclerosis
 Otosclerosis causes both fixation of the stapes as
well as in involvement of the labyrinth so that
there are mixed hearing loss.
 causes
z

1. Genetic factors
2. Viral infection
3. Measles
4. Other ear conditions
 Manifestations
z

1. Hearing loss
2. Dizziness
3. Tinnitus
4. Roaring
5. Vertigo
6. headache &
earache
z
Diagnostic evaluation
 History
 Physial examination
 Tuning fork test
 Audiometry test

 Tympanocentesis – fluid for middle ear send for

culture
 CT scan – collection of fluidin ear & mastoid
region ,
abscess formation
 MRI – evaluation of tumor & soft tissue
 AUDIOGRAPHY – to assess hearing loss
 Treatment
z

 Otosclerosis may slowly get worse. The condition

may not require treatment until you having
severe hearing problems.

 Medications such as fluoride, calcium, or vitamin

D may help to slow the hearing loss, but the
benefits have not yet been proved.

 No known medical treatment exists for this form

of deafness, but amplification with a hearing
aid may be helpful.
 Administer analgesics such as –
 IBUPROFEN
 OXYCODONE
 ACETAMENOPHEN (PCM)
 Hearing aid may be used to treat the hearing loss
General measures :
 Avoidance of noise full environment
 Side lying position
 Continuous applications of medications
 High protein diet
z
Surgerical management
stapedectomy.
The removal of portion of the
sclerotic stepes footplate of
stapes or complete removal of the
stapes and the implant with
prosthesis to maintain suitable
conduction.
z
Stapedotomy

 Modern surgery called stapedotomy is

performed by drilling a small hole in the stapes
footplate with micro drill or laser, and the
insertion of a piston like prosthesis.
z