Case presentation

&
Middle ear disorders

By
Hagar Ahmed
Resident of AVM at zagazig university hospitals
master's degree in audiovestibular medicine
Personal history:

Female patient , 47 years old , married and

has 3 offspring, the youngest is 10 years
old, housewife, lives in egypt, With no
special habit of medical importance.

Complaint :
Diminution of hearing in both ears of six
years duration.
HISTORY OF PRESENT ILLNESS:
 The condition started 6 years ago with
bilateral gradual progressive diminution
of hearing , associated with bilateral
machinery tinnitus , which is intermittent
& increased at night .

 NO history of ear discharge ,earache ,

headache or vertigo.

 No history of using hearing aids.

PAST HISTORY :
 No past history of diabetes or hypertension
or chronic disease of medical importance.
• No past history of ototoxic drugs intake .
• No previous ENT operations.
• No previous noise exposure, physical trauma
or fever.
Family history:
• +ve consanguinity  2nd degree of maternal
cousin
• -ve as regard similar conditions .
EAR EXAMINATION:
 Inspection & palpation :
• NAD
 Otoscopic examination :
• Bilateral intact mobile tympanic membrane.

 Tuning fork tests:

• By using tuning fork of 512Hz,
Rinne test Weber test
RT  BC >AC No lateralization
LT  BC >AC
Audiological evaluation
TYMPANOMETRY
 PURE TONE AUDIOMETRY

[ [ ]
[ ] ]
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Speech audiometry
Ear SRT Discrimination intensity Masking
SRT DIS
Right 50 92% 90 - 70
Left 50 92% 90 - 70
 DIAGNOSIS
 Bilateral moderately severe conductive hearing
loss, both with excellent speech discrimination.

 Bilateral type(A) Tympanogram with absent

acoustic reflexes  reflecting bilateral normal
middle ear pressure.
DIFFERENTIAL
DIAGNOSIS
Hearing Loss

Conductive Sensorineural Mixed

Transmission Transduction Both

Outer &\or middle ear Inner ear Both

MIDDLE EAR DISORDER
Congenital
 Fixation , deformity or absence of the ossicles
Traumatic
 Traumatic rupture of the drum
 Ossicular Disconnection
 Fracture Base Of Skull
 Otitic Barotrauma
Inflammatory
 Acute otitis media

 Chronic suppurative otitis media :

1- Tubo – Tympanic type .
2- Attico – Antral type .

 Chronic Non-Suppurative otitis media :

1- Secretory otitis media .
2- Adhesive otitis media .
Neoplastic
 Glomus tumor

Otosclerosis
 Stapedial otosclerosis
 Cochlear otosclerosis
 Gradual replacement of the normal bone by new
spongy bone of increased thickness & vascularity
Schwartz’ sign : a
 The commonest site is immediately anterior to the flamingo red shadow
may be
seen behind an intact
oval window. (Stapedial type) tympanic membrane.
 The cochlea may be involved. (cochlear type)
 Type (A) Middle
tympanogr aged
am

Gradual
Absent Female progressive
AR. hearing
patient loss +
Tinnitus

+ve Intact
CHL family TM
history
PROVISIONAL
DIAGNOSIS
 Congenital: ossicular
chain fixation.
Bilateral  Traumatic: Ossicular
clinical discontinuity
 Inflammatory: otitis
otosclerosis media.
 Glomus tumor
 otosclerosis
RECOMMENDATIONS:

 CT temporal bone.

 Hearing aids fitting.

 ENT referral for exploration tympanotomy.

 Avoid ototoxic drugs and noise.

 Avoid CCPs or hormonal therapy.

 Regular follow up .
Thank you