Congenital & Traumatic conditions أد مسعد السيسي

1. Congenital & Traumatic conditions أد مسعد السيسي

2. Congenital Aplasia: Complete absence of the middle earCD  Hearing Aid Ossicular: • Absence • Deformity • Fixation  CD Ossiculoplastyi.e surgical reconstruction of the ossicular chain Wall deheiscence : Floor : exposure of the jagular bulb injuru of the jagularbilb during ear operations Facial canal: injury of the facial Nerve during ear operations

3. 0 0 Definition: Trauma due to rapid increase of atmospheric pressure Non infective inflammation due to relatively negative Intratympanic pressure Physiology: At rest : the middle ear pressure is equal to the atmospheric pressure Why? Because the ET is opening during swallowing and yawning During airplane ascent: The atmospheric pressure is decreased middle ear pressure becomes relatively higher than the atmospheric pressure Air outflow from the middle ear through the ET the pressure in the ME becomes equal to the atmospheric pressure During Air plane descent( And diving) The atmospheric pressure increases pressure in the middle ear becomes relatively lower than the atmospheric pressure Air inflow to the middle ear ( during swallowing) pressure in the middle ear becomes relatively lower than the atmospheric pressure Negative positive Negative positive Negtive positive

4. Otiticbarotraumaoccurs when the ET fails to open during descent in a non pressurized plane or during diving ET obstruction may be due to: Sleep during descent ET obstruction In mild cases : retracted Drum In moderate cases: effusion ( or hemotympanum) In severe cases: drum rupture +VE -VE

5. واحد نازل من الطيارة عنده الم بالاذن وتقل في السمع Symptoms: • History of flying or diving • Earache • Hearing loss Signs: • Otoscopic: -Retracted drum -Sgns of middle ear effusion - Reupture drum • Tunning fork: conductive deafness Investigations: PTA: Conducive deafness ( Air Bone gap) Tympanometry: Type C : in retracted drum Type B: in middle ear effusion Air Bone Gap Type C Type B

6. Prophylaxis: • Avoid flying or diving with nasal obstruction • Avoid sleep during descent • Try to open the ET by: Frequent swallowing & chewing gum Valsalvamanoeuvre Vasoconstrictor nasal drops TTT • Retracted Drum Vasoconstrictor nasal drops Valsalvamanoeuvre - ME Effusion Myringotomy • Rupture Drum conservative treatment for 3 months ( see truamatic drum perforation) • Myringoplasty if healing fails after 3 months

7. Ossicular disruption Etiology: • Head trauma : with or without temporal bone fracture • Ear operations; e.gmyringoplasty, stapedectomy Symptoms: - History of trauma -Hearing loss, tinnitus Signs • Drum is intact or ruptured • Tunnng fork test: conductive deafness Investigations: • PTACD • Tympanometry( if the drum is intact)  Type Ad • TTT: osiculoplasty

8. Longitudinal temporal bone fracture Etiology: - Severe trauma to the head e.g fall from a height or motor car accident Incidence: -more common than transvrse temporal bone fracture 4:1 Pathology • The fracture line is parrallel to he longtudinal axis of temporal bone it passes in the roof of external canal and middle ear and then passes anterior to the VII nerve canal

9. CP: History of trauma Otoscopic: • Laceration of the skin of the external canal • Rupture drum • Bloody otorrhea • CSF otorrhea Tuning fork tests: CD Facial nerve Paralysis is not common with this type of fracture but with transverse type • Investigations: -CT scan -PTA

10. Antibiotics Avoid ear wash Avoid entry of water into the ear Avoid ear drops Avoid forcible nose blowing Treatment: Conservative: Similar to rupture drum CSF otorrhea • Prophylactic antibiotics • Bed rest with head elevated • Avoid straining • Cover the ear with sterile dressing Surgical: If conservative measures fail - Myringoplasty • Ossiculoplasty • Repair of CSF leak • Facial nerve paralysis Reconstruction of the ossicles After 3 month Repair of tympanic membrane perforation by a graft

11. Transverse fractures differs from longitudinal fracture How?