OTOSCLEROSIS
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Otosclerosis is a disease that results in the abnormal growth of spongy bone around the footplate of the stapes. As one ages, bone tissue renews itself by replacing old tissue with new. In the case of otosclerosis, abnormal remodeling of bone tissue impairs the transmission of sound from the middle ear to the inner ear and as these spongy growths become more fixed, the stapes and its typical vibratory response is altered, causing conductive hearing loss (Otosclerosis). Symptoms of otosclerosis include dizziness, tinnitus (ringing), balance problems and hearing loss. Sensorineural hearing loss may also accompany otosclerosis, as the spongy growth surrounding the stapes may infiltrate the cochlea, and cause issues within the inner ear. Audiograms of patients with otosclerosis often present a Carhart's notch, which is a depression of the bone conduction hearing threshold at a frequency of 2000 Hz, as seen on the audiogram (Musiek). In order to diagnose, clinicians may use hearing tests, CT scans, or tympanograms, which measure the function and movement of the middle ear and the tympanic membrane (eardrum). Otosclerosis and the subsequent hearing loss can be treated using a hearing device, or even surgery, referred to as a stapendectomy. During this procedure, a prosthetic device is placed in the middle ear in order to bypass the abnormal bone growth, allowing sound waves to travel normally and restore hearing (Otosclerosis). Hearing loss can worsen and become permanent if not adequately treated with a hearing device or surgery. |
TYMPANOSCLEROSIS
Tympanosclerosis is a condition in which the tissue of the middle ear and the eardrum become calcified, and is typically caused by reoccurring inflammation in the middle ear. It often manifests following a case of otitis media, which is is an inflammation or infection of the middle ear. Symptoms of tympanosclerosis include white patches visible on the eardrum during a tympanogram, as well as conductive hearing loss due to the obstruction of the calcified tissue (Knott). It's fairly easy to diagnose, as the white appearance of the eardrum is fairly unique to the condition. Although it may have characteristics similar to that of a chlosteotoma—a tissue condition of the middle ear—its patches are visible behind the eardrum rather than on it (Knott). Treatment of tympanosclerosis is only necessary if hearing loss is present, and an audiogram will provide the clinician with an understanding of the severity of the hearing loss and the potential devices that can aid in repairing it. Due to reoccurring inflammation in the middle ear associated with tympanosclerois, the patient's audiogram will likely present a conductive hearing loss. As seen to the right, the patient was tested in the right ear and has normal bone conduction results with impaired air-conduction results, resulting in conductive hearing loss. |
TYMPANIC MEMBRANE PERFORATION
Tympanic membrane perforation is characterized by a tear in the tympanic membrane (eardrum), resulting in the connection of the external ear canal to the outer ear. It often manifests itself following a case of otitis media, which is an inflammation of the middle ear, and can also be caused by an infection, noise or head trauma, or a sudden change in pressure that results in a ruptured eardrum. Although perforation can occur at any age, it's more prevalent in younger populations and especially men. Common symptoms include a sudden onset of pain, tinnitus (ringing), dizziness, and discharge (Dolhi). Conductive hearing loss—as seen on the audiogram—is a common result of a perforated eardrum due to impaired sound transmission in the middle ear, and research shows that the greater the size of the perforation, the more severe the hearing loss will be. Clinicians can diagnose tympanic perforation using a tympanogram, and in some cases in otoscopy. A fogged otoscope is a telltale sign of a tear in the eardrum, as the warm humidified air from the upper part of the throat (nasopharynx) is bypassing the middle ear an into the external auditory canal, causing condensation to form on the otoscope. Prognosis for a tympanic membrane perforation is overall positive, as it typically resolves itself spontaneously within six to eight weeks. Ear drops have been shown to accelerate the healing process, and the ear canal should be kept as dry as possible to prevent further infection. If the perforation does not heal on its own and symptoms worsen, a procedure called a tympanoplasty may be used to repair the tear (Park). |
OTITIS MEDIA
Otitis media is characterized as inflammation or an infection of the middle ear, resulting from a cold, sore throat, respiratory infection, or malformation of the Eustachian tube. As children have a much shorter, more horizontal Eustachian tube, otitis media is much more common in their case because bacteria finds its way back to the middle ear much easier. About three out of every four children experience this before the age of three, and it especially presents itself during the winter and early spring (Ear). Symptoms of otitis media include ear pain, difficulty sleeping, impaired balance, hearing loss, and fluid draining from the ears, however, otitis media can present itself as asymptomatic as well. Otitis media is characterized by the presence of a retracted tympanic membrane (eardrum), which is often discolored and transparent, so air bubbles and fluid are visIble behind it. To diagnose, a clinician will first do a physical examination and get an understanding of the patient's case history. They may also preform an otoscopy, by looking in the ear with a lighted tool, or using tympanometry, which tests for any abnormal pressure changes in the middle ear. If the patient is suffering from hearing loss—typically conductive due to the obstruction of fluid in the middle ear—an audiogram will be preformed, as seen to the right, in order for a clinician to recommend hearing aid devices to improve it. Other treatments include antibiotic drops and medication to control the patient's fever, however, the prognosis for otitis media is excellent if adequately cared for. If the infection is not treated, the patient may expose them to a host of other issues, such as, permanent hearing loss, infections in other parts of the head, and problems with speech and language development (Ear). |