Congenital

1
Congenital Traumatic conditions ?? ???? ??????
2
Congenital

• Aplasia
• Complete absence of the middle ear?CD ? Hearing
  Aid
• Ossicular
• Absence
• Deformity
• Fixation ? CD? Ossiculoplasty i.e surgical
  reconstruction of the ossicular chain
• Wall deheiscence
• Floor exposure of the jagular bulb?
• injuru of the jagular bilb during ear
• operations
• Facial canal injury of the facial Nerve
• during ear operations

3

• 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

0
0
Negative
positive
Negative
positive
Negtive
positive
4
Otitic barotrauma occurs 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

• 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
• Valsalva manoeuvre
• Vasoconstrictor nasal drops
• TTT
• Retracted Drum? Vasoconstrictor nasal drops
• Valsalva manoeuvre
• - 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.g myringoplasty, 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 41
• 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

• 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

Antibiotics Avoid ear wash Avoid entry of water
into the ear Avoid ear drops Avoid forcible nose
blowing
Reconstruction of the ossicles
After 3 month Repair of tympanic membrane
perforation by a graft
11
Transverse fractures differs from longitudinal
fracture How?
Transverse Longitudinal
20 80 Incience
Perpendicular to the longtudinal axis of the temporal bone Parallel to the longtudinal axis of the temporal bone Fracture line
Affects the inner ear The drum external canal are intact Affects the external canal, drum and middle ear Pathology
O abnormality Laceration of the skin of external canal Rupture drum Bloody otorrhea Csf otorrhea Otoscopic exam
SNHL CD Type of deafness
present absent Vertigo
common uncommon VII nerve paralysis