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The outer ear consists of the auricle (unlabelled), the external auditory canal, and the lateral surface of the tympanic membrane (TM). There are several other audiological tests that are also commonly abnormal in persons with conductive hearing loss. Tympanometry usually is either flat (as shown below), or shows an abnormally large volume (indicating a perforation). Other tests that may be helpful in confirming conductive hearing loss are OAE testing and temporal bone CT scan.
Causes include a buildup of ear wax, a foreign body in the ear canal, otosclerosis, typanosclerosis (as shown above), superior canal dehiscence (which can also cause a conductive hyperacusis), external or middle ear infections (otitis externa or media), allergy with serous otitis media (fluid in middle ear), trauma to the ossicular chain such as temporal bone fracture, tumors of the middle ear such as a glomus tumor, erosion of the ossicular chain (cholesteatoma) and perforation of the tympanic membrane.
A hole in the ear drum, which is called a tympanic membrane perforation, causes a conductive hearing loss. It is generally attributed to previous ear infections or trauma (such as a tube insertion).
The last step in the chain of signal transmission between sound in the air and movement of fluid in the inner ear is the middle ear.
There are three small bones interposed between the large ear drum, and the small hole (oval window) across which sound is transmitted into the inner ear.
Complete ossicular chain discontinuity usuall results in a large, flat conductive hearing loss. Characteristically, hearing aids work well for conductive hearing loss, and very good hearing results can be obtained. Surgical treatment is also generally available for conductive hearing loss as it is always due to a mechanical problem.
Most surgical treatments for otosclerosis or middle ear disease involve opening of the middle ear and repair under direct vision.
However, in our opinion (which is not representative of general opinion of ear surgeons), we think it is preferable to use a hearing aid until hearing becomes unservicable, and then move onto an implanted hearing aid, and skip the middle ear surgery part altogether. A 7 year old boy from Remote village presented with complains of vomiting 4-5 episodes per day for 3 months, inability to walk without support for 20 days and loss of vision in both eyes for 12 days. According to the parents, the child developed vomiting , without associated Nausea, which was aggravated in the morning after arising from bed. He complains of headache, tight in nature, more prominent in early morning and later localized to nape of the neck and was aggravated on movement of the head ( turning the head ). Child used to tilt his head and started complaining of loss of vision which progressed to complete blindness since last 10-12 days.

Although the child has bladder and bowel sensation and parents have been helping him, he often passes urine and stool in bed. There is no history of frequency of micturation neither there is any complain of burning sensation or urgency. There is no history of Loss of consciousness , seizure or any localized abnormal body movements. For this problem he had gone to Zonal Hospital where investigations were done – CT scan and Lumbar puncture done.
But due to economical problem they presented late , ie after 2 months after the symptoms were severe  and disabiling. CN II Optic nerve- No perception of light, papillary reflex present bilaterally both direct and consensual.
CN III,IV and VI- Extraocular movement could not be examined due to complete loss of vision.
Motor system examination- Bulk, tone, power – Normal bilaterally, Gait- could not be tested, co-ordination-Normal, Reflexes were Normal.
CT scan showed- dense white large infratentorial mass in the posterior fossa, in the midline occupying nearly 70% of the posterior fossa , without any calcification or hemorrhage. 1.Abrasion of Teeth with Notching -Biting surface of teeth are abraded or notched by recurrent trauma (holding nails or opening bobby pins). A sialogram is an x-ray of the salivary ducts and glands.The salivary glands are located on each side of the face and send saliva into the mouth. Sialography RT 2343D rendering of a sialogram showing sialectasia Sialectasia is inflammation of the salivary gland acini.
The middle ear includes the medial surface of the eardrum, the ossicular chain of bones, the eustachian tube.
These can be immensely troublesome because their removal can be difficult, and infections are common.
It is more accurate to say that there is a hearing reduction, as generally hearing is not greatly affected -- a 10 db drop is typical.
There also seems to be a weak association with increased serum calcium (de Carvalho et al, 2006) . When these bones are fused (otosclerosis, or ossicular fixation) or broken (ossicular chain discontinuity), a conductive hearing loss is the inevitable result. When combined with a sensorineural hearing loss, this pattern may look superficially like a conductive hearing loss, because there is an air-bone gap.

Persons with LVAS may develop hearing loss as well as be unusually vulnerable to inner ear disease associated with head injury. Recently some groups (Kakehata et al, 2006) are using endoscopy for repair of ossicular chain disturbances -- in our opinion, this is still very investigational and somewhat unreasonable -- when working inside a tiny space, one needs as good an exposure as one can manage. Carhart Notch 2-kHz Bone Conduction Threshold Dip: A Nondefinitive Predictor of Stapes Fixation in Conductive Hearing Loss With Normal Tympanic Membrane.
Vomiting was projectile in nature and 2-3 episodes per day, progressively increasing to 4-5 episodes per day. Then he started having unsteadiness while walking , progressively leading to inability to walk without support.
After the reports were suggestive of Brain tumor- Medulloblastoma they referred him to Higher centre for further management 2 months back.
Content (text, audio, video) on this website is only intended to provide general information to the reader and for academic purpose of medical students.
If the inflammation persists, the acini are destroyed, and the contrast that is injected through the Stenson's duct pools in the gland, and can be seen in this video as 'globules' at the end of the ducts, especially in the inferior portion of the gland.
These are most easily removed using an examining microscope, but in some instances, surgical removal is needed. It is presently thought that persons taking calcium supplements are not at increased risk, and also that there is no risk from calcium channel blocker medications.
The most common ones are cholesteatoma associated with chronic ear infection (it is not a true tumor) and glomus tumors. This rendering was produced by 3D volume rendering of a sialogram of a normal parotid gland This is a normal parotid gland imaged with intraductal contrast on a cone beam CT unit. Practically, this is a very uncommon situation, of much more interest to diagnosticians than patients. The saliva moves slowly and stagnates in ducts that look like this, predisposing the patient to retrograde infections of the duct, further exacerbating the symptoms. The salivary glands are located A sialogram is performed to diagnose blockage of the salivary flow. Jump to: navigation, search Sialogram or sialography is imaging of the salivary glands using x-ray[1].

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