10 02 2014 Tympanometry clinical test that evaluates the integrity of the middle ear system Tells us about the mobility of the middle ear system also manubrium and malleus embedded in middle fibrous layer of tm sets ossiscular chain into movement Can tell us pressure in middle ear The middle ear system will be freest to move when air pressure in eac matches that of the inner air space prime to mobility o Usually atmospheric pressure if everything is good and Put a tip in the EAC which closes off the canal airtight seal do a healthy pressure sweep Peak mobility is when pressure in middle ear spaces matches that of what we set the ear canal to be Can get an estimate of how large the ear canal itself is earcanal volume normative date exsists to support this Output of a Tympanogram will vary based on health of middle ear and underlying pathologies Yellow tympanogrm Eustachian tube disfunction Any hearing loss you can see is conductive because its not testing inner ear so how could you make assumptions based on something you arent testing Red Tympanogram no measureible TM mobility one reason is because fluid in ear meringosclerosis perforation in the TM or impacted cermumen Can tell the diff between the 3 because volume of the ear canal is diff depending on the apthology 10 02 2014 Vocabulary Prefixes o Myringo tympanic membrane o Tymp entire middle ear o Mastoid mastoid air cell system Suffiexes o otomy cut o plasty reconstruction o ectomy removal o centesis aspiration of fluid suctioning Myringotomy tympanic membrane cut Myringoplasty tm reconstruction Tympanoplasty reconstruction of the middle ear Mastoidectomy removal of mastoid air cell system Tympanocentisis suctioning of fluid from the middle ear space Ottitis Media Middle ear infection infection or inflammation Ottits media is extremely common in young children o Almost all kids have had one 96 by 6 years old Occurs most often in children 0 2 years old Can occur in adults but not nearly as prevent as in children Who Gets Ottits Media More common in males More common in Caucasians Common in Native Americans due to Eustachian tube and skull anatomy Most common in winter and early spring Reasons of Common Occurrence of OM Esustahchan tube development in children o In infants and young children this tube is shorter and more horizontal therefore its much easier for bacteria to migrate from the nose and throat up into the middle ear space As the child grows this tube becomes more vertical more adult like Development of immunities o Children haven t yet developed immunities to viruses that adults have o Swollen adenoids lead to blockage of the ET Risk Factors for OT Second hand smoke day care centers endemic upper respiratory infections genetic predisposition General OT categories OM without effusion fluyid in the middle ear space OM with effusion OME o Effusions refers to a fluid produced in the middle ear space behind an itact TM OM with perforation Sub Categories based on duration Acute 0 21 days Sub acute 22 days 8 weeks Chronic Lasting longer than 8 weeks Recurrent three or more incidences of OM within 6 months Sub categories of OME based on type of fluid Serous thin watery sterile fluid Purulent pus like infected fluid yellow or green in color likely to have an odor Mucoid thick mucus like fluid Pathophysiology of OME Starts with blocked Eustachian tube because of either poor ET function congetial issue or Anatomic Obstruction like swollen adenoids or general swelling then build up of negative pressure in Middle Ear space then mucous membrane secrete fluid Signs and Symptoms of OM Note OM E can be asymptomatic Subjective o Aural pressure feelings of fullness pain popping sounds in the ear depends on the kind of OM and the duration o TM refracted possibly see bubblrs of fluid line behind intact TM depends on the kind of OM and the duration Otoscopic exam Audiometirc exam o Child has mile or moderate conductive hearing loss typically in the low frewunecies o Tympanometry Acute Ottits Media AOM is symptomatic o Symtpoms sudden onset pain possibly fever o TM is inflamed bulging cant see usual landmarks Otoscpic Inspection Etiology o Bacterial infection o Viral Infection Usually streptococcus pneumonia or influenza Invades ear through back of throat aspirated in the eustachain tube Treatment of OM 50 resolve spontaneously Pharmaccologically antibitoics o Amoxicillin Penicillin Surgery o Myringotomy and tympanocentisis o Myringotomy and pressure equaliation tub e PE Tube o Myringotomy and adenoidectomy and or tonsillectomy PE pressure equalization Tubes PE tubes ar eplaced in the TM ro qualize the pressure in the ME when the ET is unable to do so o Aka Typansotomy tubes ear tubes ventilation tubes gromments One of the most common surgeries in US o 1 3 million opersations 1988 o 1 3 of all children have had them o over 3 children 2 years old Chronic Otitis Media Etiology o Bacterial or viral infection of long duration greater than 8 weeks that often results in permanent damge to middle ear structures Type of damage to the middle ear o Performatio of the TM o Adhesions on the TM ossicles nad ligaments o Cholesteatoma beign tumor o Destructions of ossicles s erosion firxation o Tympanosclerioiss hardening scarring of ME can refer to fixation of ossicular chain o Myringosclerosis hardenig of the TM Symptoms o Moderate or moderately severe conductive hearing loss o Intermittenet fluid draining from ME Treatmnet o Tympanoplasty Recontuction of the middle ear Surgery of varying degrees depending on the damage Primary goal is to mobilize the ossicular chain o Myringoplasty Reconstiction of the tympanic membrane Used if there are adhesions of the tympanic membrane or a perforation of the TM o Suregy can usually improve hearing thresholds but cant really make things perfect Recurrent Otitis Media o Defintion three or more separate incidences of ottis media within 6 months o Incidence occurs in 15 20 of young children 0 2 years o Treatment will vary but may perform myringotomy with PE tubes or use low dosages of antibiotics as a preventitve course Second peak of OM 4 5 uears when you start school Facts about OM AOM OME Most common infection for which antibiotics ar prescibedd 2 98 billion per year in direct and indirect costs 2 2 million diagnosed episodes per year in the US estimated cost of 4 0 bilion per year in direct and indirect costs Hearing loss associated with OM can be transient and flutate changes from day to day Tympanic Membrane