3) Diseases of the Middle Ear
1. Non-inflammatory diseases
This involves injury to the tympanic membrane or injury to the middle ear in the form of fractures/dislocations of the ossicles or direct trauma to the facial nerve
a. Traumatic rupture of the tympanic membrane
Etiology
- Can be indirect
- caused indirectly by pressure changes and are more common.
- Typical examples include slaps to the ear or sports related injuries like diving
- Can be direct
- typically caused by sharp branches, self-cleaning manipulations (cotton swab) or welder’s slag burns, in which molten droplets may penetrate the ear canal and drum and enter the middle ear
Symptoms Due to perferation
- Pain of brief duration
- Followed by a clogged sensation and slight bleeding from the ear canal
- The patient may feel air escaping in response to a Valsalva manoeuvre (breathing out strongly through your mouth while holding your nose tightly closed) or nose blowing
- Presence of vestibular symptoms (vertigo, nausea) or facial nerve palsy signifies trauma that is not confined to the tympanic membrane
Diagnosis:
- Perforation detectable Otoscopy - perforation appears as a slitlike/triangular opening with jagged margins in the inferior quadrant of the membrane
- Hearing test → an injury confined to the tympanic membrane, they would show only mild conductive hearing loss (weber test lateralised to affected ear and Rinne test weakly negative or even positive) Worse ear
Treatment:
- Tympanic membrane has a strong capacity for self-healing
- Can be covered with plastic film/cigarette paper to aid the process (protect from water shampoo, soap etc.)
- any curled edges of the perforation should be straightened out
Part of 3rd essay
2. Inflammatory diseases