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OT18 Otolaryngology
Diseases of the Middle Ear
Toronto Notes 2019
Complications
Table 8. Complications of Cholesteatoma
Local
Ossicular erosion: CHL
Inner ear erosion: SNHL, dizziness, and/or labyrinthitis Temporal bone infection: mastoiditis, petrositis
Facial paralysis
Investigations
• audiogramandCTscan
Treatment
Intracranial
Meningitis
Sigmoid sinus thrombosis
Intracranial abscess (subdural, epidural, cerebellar)
Classic Triad
• Otorrhea
• Tenderness to pressure over the mastoid • Retroauricular swelling with protruding ear
Complications of AOM are rare due to rapid and effective treatment of AOM with antibiotics
Otosclerosis is the 2nd most common cause of CHL in 15-50 yr old (after cerumen impaction)
• thereisnoconservativetherapyforcholesteatoma
• surgical:mastoidectomy±tympanoplasty±ossicularreconstruction
Mastoiditis
Definition
• infection(usuallysubperiosteal)ofmastoidaircells,mostcommonlyseenapproximatelytwowkafter onset of untreated or inadequately treated acute suppurative otitis media
• morecommoninchildrenthanadults
Etiology
• acutemastoiditiscausedbythesameorganismsasAOM:S.pneumoniae,H.influenzae,M.catarrhalis, S. pyogenes, S. aureus, P. aeruginosa
Clinical Features
• otorrhea
• tendernesstopressureoverthemastoid
• retroauricularswellingwithprotrudingear
• fever,hearingloss,±TMperforation(late)
• CT radiologic findings: opacification of mastoid air cells by fluid and interruption of normal
trabeculations of cells (coalescence)
Treatment
• IVantibioticswithmyringotomyandventilationtubes–usuallyallthatisrequiredacutely • corticalmastoidectomy
■ debridement of infected tissue allowing aeration and drainage • indicationsforsurgery
■ failure of medical treatment after 48 h
■ symptoms of intracranial complications
■ aural discharge persisting for 4 wk and resistant to antibiotics
Otosclerosis
Definition
• fusionofstapesfootplatetoovalwindowsothatitcannotvibrate
Etiology
• autosomaldominant,variablepenetranceapproximately40% • F>M,progressesduringpregnancy(hormoneresponsive)
Clinical Features
• progressiveCHLfirstnoticedinteensand20s(mayprogresstoSNHLifcochleainvolved)
• ±pulsatiletinnitus
• TMnormal±pinkblush(Schwartz’ssign)associatedwiththeneovascularizationofotoscleroticbone • characteristicdipat2000Hz(Carhart’snotch)onaudiogram(seeFigure16C,OT10)
Treatment
• monitorwithserialaudiogramsifcopingwithloss
• hearingaid(airconduction,boneconduction,BAHA)
• ACandBCinsteadofairconduction,boneconduction
• stapedectomyorstapedotomy(withlaserordrill)withprosthesisisdefinitivetreatment