Done by:Done by:Rami R. AbusalehRami R. Abusaleh

External ear:

-auricle : Collects air vibrations .

Anatomy

Middle ear: Tympanic

membrane: composed of 3 layers: skin , fibrous tissue, and mucosa.

pars flaccida Fibrous tissue is absent in.

Inner Ear: a system of coiled tubes. cochlea (hearing), vestibular part (balance)

• The Utricle "leather bag“ & The Saccule

Fx: parts of the balancing apparatus.

Mechanism : they use small stones and a viscous fluid to stimulate hair cells to detect motion and orientation. The utricle detects linear accelerations and head-tilts in the horizontal plane.

cochlea

Parts:1)Basilar fibers 2)Organ of corti3)Perilymph and

endolymph

cochlea

Energy transformation

Awesome Music Has Enormous Effect

Requirements of hearing

-impairment of sensitivity to sounds , it

encompasses any degree of hearing impairment from mild to profound.

Hearing lossHearing loss

Normal Conductive Sensorineural Mixed Functional Central

Audiometry

Types Types

Causes: Common causes: wax, acute otitis media , otitis media

with effusion, chronic otitis media, barotraumas, otosclerosis.

Less common causes: i. traumatic ossicular translocations,ii.congenital atresia of the external canal

agenesis of the middle eariii. tumors of the middle ear( glomus body

tumor)

Conductive deafness

Outer ear causesMiddle ear causesWaxTM. perforation

Trauma stenting ET dysfunction

InfectionsInfection

Tumors (squamous cell carcinoma in EAC

Otosclerosis

Osteoma

Polyps Barotrauma

Congenital (atresia)Congenital

Dermatologic

Def : usually a hereditary disorder, causes abnormal bone to be

formed around the stapes footplate, preventing its normal movement. It becomes fixed to the fenestra ovalis that separates mid.ear from inn.ear, conductive deafness then results.

More rarely, the bone of the cochlea is affected and results in sensorineural deafness.

Otosclerosis

Clinical Features1. Usual onset in second and third decades. 1. Two-thirds give a family history.2. Two-thirds are female.

3. Deafness may be uni/bilateral.

4. Paracusis (patient is able to hear better in noisy surroundings)5. Tinnitus

6. The tympanic membranes are normal.7. Audiometry. Air conduction impaired. Bone conduction initially normal but deteriorates as the disease progresses

8. Tuning fork tests show conductive deafness .9. Cochlear impairment

(Rule of 2 : Age / F / Side / Sound / Exam /C ) TREATMENTHearing aids and Stapedectomy

Otosclerosis

Sensorineural deafness

• prolonged exposure to high noise level, industrial deafness.

• maternal rubella , cmv ,hereditary deafness, anoxia, jaundice, congenital syphilis,mumps,herpes zoster meningitis, measles ,suppurative labyrinthitis)

• ““Man Year”Man Year”(labyrinthytis hydrops).

• Erythromycin, tetracyclin, chemo, antimalarial chloroquine, loop dieuritcs, cocaine, heavy metals

Common causes

less common:1.-head injury head injury (trauma of petrous temporal bone

[mixed] ).2.2.metabolic diseasesmetabolic diseases: DM , hypothyroidism, Paget’s.3.3.PsychogenicPsychogenic4.4.CNS cancers , metastasis.CNS cancers , metastasis.5.5.Sudden idiopathic.Sudden idiopathic.6.6.Tumors: Tumors: glomus body tumor , acoustic neuroma

(most common) , brainstem tumors ,meningioma.((most tumors of inner ear are bengin))

7.7.Acute neuritis.Acute neuritis.

Sensorineural deafness

Meniere’s disease:

Clinical Features: vertigo causes vomiting (can last for hours). a feeling of fullness in the ear. deafness is sensorineural and more severe before

and during an attack tennitus is constant but more severe before an

attack. Low frequency hearing loss. Hearing loss that recovers within 12 to 24 h

Meniere’s disease:

Investigations: include a complete medical drug history, use

of hearing aids ,and nature of loss(gradual continuous or intermittent)

Examination:1. observe patient during conversation.2. ability to repeat spoken words at different intensities and

distances in each ear while the other ear is occluded by pressing on the tragus.

3. if there is profound hearing loss at one side, good ear should be masked by Barany noise box and deaf ear tested by shouting.

4. otoscopic examination5. tuning fork tests.

Diagnosis

Investigations:

1. Audiogram2. tympanogram

upon need1. speech audiometry2. -vestibular tests3. -lab tests4. -radiology

Diagnosis

Signs & symptoms :Conductive:Sensorineural:

Talks in a soft voice. Hears speech well in noisy

places. tolerates high intensities of

noise. No tinnitus. good discrimination.

Talks in a loud voice. can not hear speech well

in noisy places. hears low frequencies

and cannot tolerate high intensities.

tinnitus poor discrimination score. Recruitment phenomena:

slight increase in intensity perceived as a large increase in loudness of voice.

TestConductive:Sensorineural: Weber Test Sound localizes

to affected ear (ear with conductive loss)

Sound localizes to normal ear

Rinne Test Negative Rinne; Bone Conduction > Air Conduction (Bone/Air Gap)

Positive Rinne; Air conduction > Bone conduction (both air and bone conduction are decreased equally, but the difference between them is unchanged).

The Barany Box is a clockwork noise generator that is used in audiological testing with tuning forks and speech testing.

-Congenital: : counseling , hearing aids , speech therapy , surgery

in cases of cleft palate and atresia.

-Idiopathic otosclerosis: hearing aids, surgery.

-Sudden hearing loss: idiopathic ( viral or vascular ) corticosteroids in high risk patient .

Treatment

Hearing aid is an electroacoustic body worn apparatus which typically fits in or behind the wearer's ear, and is designed to amplify and modulate sound for the wearer.

BTE aids consist of a case, a tube and an earmold. The case is small and made of plastic. It fits behind the pinna (ear). The case

contains the amplification system .

In the ear aids (ITE)These devices fit in the outer ear (called the concha); they are sometimes visible when standing face to face with someone. ITE hearing aids are

custom made to fit each individual's ear .

In high risk patients:

FH of childhood hearing loss. prenatal infection. anatomic malformation. birth weight less than 1500gm. hyperbilirubinemia >20 mg/100 ml bacterial meningitis,esp H.influenza. severe hypoxia during labor

Hearing screening

VIDEOVIDEOTinnitus

Quality of tinnitus varies according to origin:High pitch ( inner ear )Crackling ( middle ear )Pulsating( vascular).

Tinnitus

Types:ObjectiveSubjective Rare Causes:

1. palatal myoclonus, middle ear myoclonus.

2. vascular ( aneurysm, glomus tumor, AV shunt , atheroma of cranial vessels).

3. infestation of external ear by worms

4. TMJ abnormality. .5. acute middle ear infection

very common Causes:1. acute trauma2. Meniere’s disease3. ototoxicity , otosclerosis4. acoustic neuroma5. systemic disease: CVS

disease,blood diseases ( anemia ), neurological ( MS, neuropathy), drugs, fever, alcohol abuse.

6. middle ear effusion and chronic otitis

7. psychogenic( hallucinations )

8. labyrinthitis, perilymph fistula

9. idiopathic ( majority )

Dx:*Proper hx taking:-localization , pitch , duration,audiological : deafness ,noise

exposure,Otological : discharge & drug hx

*Examination: ENT , neck ,TMJ, auscultation*investigations: -audiometry,

tympanometry ,vestibulometry. -Tinnitus test (pure tone matching) -blood test ( T3, T4 , lipid profile,…) -radiograms( x-ray , CT, MRA )

Tinnitus

Treatment: 1. Underlying cause 2. Drugs : muscle relaxants, Antidepressants,

tranquilizers, anticonvulsants.3. surgery: labyrinthectomy , Acoustic neuroma resection

if tinnitus is intolerable.4. Hearing aids.( if the patient is deaf)5. Tinnitus maskers ( white noise instrument ), by

producing quite noise .6. Tinnitus retraining therapy ( TRT ): a method of

treating tinnitus based around a neurophysiological model of the condition, it embraces various techniques, including explanation , counselling, relaxation techniques, and sound therapy.

Tinnitus

Masking. In this graphic, masking sounds are applied at C6, the tinnitus frequency. The result is that the sensation of tinnitus is reduced. In the auditory cortex, this corresponds to decreased spontaneous firing rates.

Another Reason to be Grateful. Thank God, You Can Hear