Ear Disorders
Ear Disorders
Introduction
·
The ear is a complex sensory organ responsible
for both hearing and balance. It consists of three main parts:
- External
ear – collects sound waves.
- Middle
ear – transmits vibrations through ossicles
(malleus, incus, stapes).
- Inner
ear – contains cochlea (for hearing) and vestibular
apparatus (for balance).
Definition
Otitis media is an inflammation or infection of the
middle ear (behind the tympanic membrane), common in children due to
shorter and horizontal eustachian tubes.
Types:
- Acute
Otitis Media (AOM)
- Otitis
Media with Effusion (OME)
- Chronic
Suppurative Otitis Media (CSOM)
Causes
- Bacterial:
Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis
- Viral:
Respiratory syncytial virus, adenovirus
- Predisposing:
Upper respiratory infections, allergy, cleft palate, adenoid hypertrophy,
eustachian tube dysfunction
Pathophysiology
- URI
→ eustachian tube obstruction → negative middle ear pressure → fluid
accumulation → bacterial colonization → pus and inflammation.
Symptoms
- Ear
pain (otalgia)
- Fever,
irritability (esp. children)
- Hearing
loss, ear fullness
- Otorrhea
(if tympanic membrane ruptures)
Diagnosis
- Otoscopy:
bulging/red tympanic membrane
- Tympanometry:
reduced mobility
- Audiometry
(for chronic cases)
Treatment
- Analgesics,
antipyretics
- Antibiotics
(e.g., amoxicillin) for bacterial cases
- Myringotomy
(drainage) or grommet insertion (for recurrent OME)
- Adenoidectomy/tonsillectomy
(in recurrent CSOM)
Prevention
- Breastfeeding
- Pneumococcal
and influenza vaccination
- Avoid
bottle feeding in supine position
Definition
Mastoiditis is an infection and inflammation of the
mastoid air cells in the temporal bone, usually a complication of untreated
or poorly treated otitis media.
Causes
- Extension
of middle ear infection (S. pneumoniae, H. influenzae, Streptococcus
pyogenes, Staphylococcus aureus)
Pathophysiology
- Pus
spreads from middle ear → mastoid air cells → bone destruction → abscess
formation → risk of intracranial complications (meningitis, brain abscess,
sigmoid sinus thrombosis).
Symptoms
- Severe
ear pain and discharge
- Swelling,
redness, and tenderness behind the ear
- Fever,
irritability
- Protrusion
of the auricle outward and downward
Diagnosis
- Clinical
examination (postauricular swelling)
- CT
scan of temporal bone – opacification of mastoid cells
- Ear
swab culture
Treatment
- IV
antibiotics (broad spectrum, e.g., ceftriaxone)
- Myringotomy
to drain pus
- Mastoidectomy
(surgical drainage) in severe or refractory cases
Prevention
- Prompt
treatment of otitis media
- Adequate
antibiotic course
Definition
Otosclerosis is a progressive disease of the bony
labyrinth characterized by abnormal bone remodeling in the otic capsule,
particularly around the stapes footplate, causing conductive hearing loss.
Causes
- Genetic
predisposition (autosomal dominant with variable penetrance)
- Hormonal
factors (worsens during pregnancy)
- Viral
infections (measles virus implicated)
Pathophysiology
- Normal
bone is replaced by spongy, vascular bone around oval window → fixation of
stapes → impaired sound conduction → conductive deafness.
Symptoms
- Progressive,
painless conductive hearing loss (usually bilateral)
- Tinnitus
- Paracusis
Willisii (better hearing in noisy environment)
- Normal
tympanic membrane on otoscopy
Diagnosis
- Audiometry:
Conductive hearing loss (Carhart’s notch at 2000 Hz)
- Tympanometry:
As (reduced compliance) curve
- CT
scan (for surgical planning)
Treatment
- Hearing
aids (for mild cases)
- Surgical:
Stapedectomy / Stapedotomy with prosthesis placement
- Fluoride
therapy (to slow progression, rarely used now)
Definition
Meniere’s disease is an inner ear disorder
caused by endolymphatic hydrops (excess endolymph in the membranous
labyrinth), leading to episodic vertigo, hearing loss, and tinnitus.
Causes
- Idiopathic
(primary Meniere’s)
- Secondary:
Trauma, syphilis, allergy, autoimmune inner ear disease
Pathophysiology
- Excess
endolymph → distention of Reissner’s membrane → rupture → mixing of
endolymph (K+-rich) and perilymph (Na+-rich) → hair cell dysfunction →
fluctuating hearing loss and vertigo.
Symptoms
(“Classic Triad”)
- Recurrent
episodic vertigo (spinning, lasts 20 min – hours)
- Sensorineural
hearing loss (fluctuating, initially
low-frequency)
- Tinnitus
(“roaring” sound) and ear fullness
Diagnosis
- Clinical
criteria (≥2 episodes of vertigo + hearing loss + tinnitus/aural fullness)
- Audiometry:
fluctuating SNHL (low frequency)
- MRI
(to rule out vestibular schwannoma)
Treatment
- Acute
attack: Vestibular suppressants (diazepam,
meclizine), antiemetics
- Maintenance:
Salt restriction, diuretics (hydrochlorothiazide), betahistine
- Refractory
cases: Endolymphatic sac decompression, vestibular
nerve section, labyrinthectomy
Prevention
- Low-salt
diet, caffeine/alcohol avoidance
- Stress
management
Deafness
Definition
Deafness is a partial or complete loss of hearing
ability.
Types:
- Conductive
Hearing Loss (CHL): Problem in external/middle ear
(e.g., wax, otitis media, otosclerosis)
- Sensorineural
Hearing Loss (SNHL): Damage to cochlea or auditory
nerve (e.g., noise-induced, Meniere’s, presbycusis)
- Mixed
Hearing Loss: Combination of CHL and SNHL
- Central
Hearing Loss: Due to brainstem/cortical lesions
Causes
- Congenital:
Genetic, intrauterine infections (rubella, CMV), birth trauma
- Acquired:
Infections (meningitis, otitis media), trauma, drugs (aminoglycosides,
cisplatin), aging (presbycusis), noise exposure
Symptoms
- Inability
to hear sounds or conversations
- Tinnitus
- Delayed
speech development in children (if congenital)
Diagnosis
- Tuning
fork tests (Rinne, Weber)
- Pure
tone audiometry
- Tympanometry
- Brainstem
Evoked Response Audiometry (BERA) for infants
Treatment
- Conductive:
Wax removal, surgery for otosclerosis, tympanoplasty
- Sensorineural:
Hearing aids, cochlear implants (for severe cases)
- Prevention:
Avoid ototoxic drugs, reduce noise exposure, vaccinations, early treatment
of infections
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