Otosclerosis total hearing loss,tinnitus sound therapy download mp3 ello,ear wax removal for 6 year old virgin - Step 1

14.04.2014
La otosclerosis es una enfermedad que afecta el hueso del oido interno que causa perdida auditiva, tiende a tener un componente hereditario, es decir, que es frecuente existan familiares con la misma enfermedad y es posible transmitir a los hijos la predisposicion a esta enfermedad. Debemos primero recordar que el oido esta dividido en tres partes: oido externo, oido medio y oido interno. El oido externo (pabellon auricular, conducto auditivo externo) se encarga de recolectar el sonido y conducirlo hacia la membrana del timpano y el oido medio. El oido medio (martillo, yunque y estribo) transmite y transforma las ondas acusticas (aereas) hacia el oido interno (ondas en liquido).
En el oido interno estas ondas de liquido estimulan las terminaciones nerviosas y por medio de impulsos electricos transmite la informacion hacia el cerebro donde interpretado como un sonido comprensible. La cirugia del estribo o estapedectomia consiste en reemplazar el hueso del estribo que se encuentra fijo por el proceso de otosclerosis por una protesis que imita el movimiento del estribo.
Para realizarla se efectua una incision en el conducto auditivo externo y se levanta la piel de su pared posterior junto con la membrana del timpano, se expone asi el interior del oido medio. Se identifica el estribo y su union con el oido interno (ventana oval – platina del estribo).
Despues de comprobar su estado de movilidad se extrae el estribo total o parcialmente, se coloca la protesis que se ancla al hueso del yunque y se aboca a la apertura del oido interno (ventana oval), a fin de que la protesis transmita la vibracion hacia la coclea. July 1, 2009The aim of this presentation is to demonstrate imaging findings of common diseases of the temporal bone. CT is the imaging modality of choice for most of the pathologic conditions of the temporal bone, especially for those of the middle ear.
Disease processes in the pontine angle and in the internal acoustic meatus are not discussed.
There are several normal variants which may simulate disease or should be reported because they can endanger the surgical approach. A cochlear cleft is a narrow curved lucency extending from the cochlea towards the promontory.
On the left an example of bilateral cochlear cleft in a one-year old boy with congenital hearing loss. The petromastoid canal or subarcuate canal connects the mastoid antrum with the cranial cavity and houses the subarcuate artery and vein. If this patient would be a trauma victim, the canal could easily be confused with a fracture line (arrow). The cochlear aqueduct is a narrow canal which runs towards the cochlea in almost the same direction as the inner auditory canal, but situated more caudally. The jugular bulb is often asymmetric, with the right jugular bulb usually being larger than the left. It can be accidentally lacerated during a mastoidectomy and therefore should be mentioned in the radiological report when present. The vestibular aqueduct is a narrow bony canal (aqueduct) that connects the endolymphatic sac with the inner ear (vestibule).
This progression is reportedly associated with minor head trauma, which exposes the inner ear to pressure waves via the large vestibular aqueduct. The large vestibular aqueduct is associated with an absence of the bony modiolus in more than 90% of patients. In external ear atresia the external auditory canal is not developed and sound cannot reach the tympanic membrane.
The extent of ossicular chain malformation can vary from a fusion of the mallear head and incudal body to a small clump of malformed ossicles, which is often fused to the wall of the tympanic cavity. The mastoid portion of the facial nerve canal can be located more anteriorly than normal and this is important to report to the ENT surgeon in order to avoid iatrogenic injury to the nerve during surgery. Early developmental arrest leads to an inner ear that consists of a small cyst, the so-called Michel deformity. Developmental arrest at a later stage leads to more or less severe deformities of the cochlea and of the vestibular apparatus. Instead of the normal two-and-one-half turns, there is only a normal basal turn and a cystic apex.
A minor deformity of the cochlear apex is visible – there is no separation of the second and third turn and the bony modiolus is absent.
Malformations of the vestibule and semicircular canals vary from a common cavity to all these structures to a hypoplastic lateral semicircular canal.
During embryogenesis the lateral semicircular canal is the last structure to form, thus in malformations of the semicircular canals the lateral canal is most commonly affected. On the left a 16-year old boy, examined preoperatively for a cholesteatoma of the right ear.
As a coincidental finding, there is a plump lateral semicircular canal (yellow arrow) and an absence of the superior canal (blue arrow). For the ENT-surgeon the differentiation between chronic otitis media and cholesteatoma is important. Erosion of the lateral wall of the epitympanum and of the ossicular chain is common in cholesteatoma (around 75%). Cholesteatoma can present with a non-dependent mass while chronic otitis shows thickened mucosal lining. However, in both diseases the middle ear cavity can be completely opacified, obscuring a cholesteatoma.
A small amount of soft tissue (arrow) is visible between the scutum and the ossicular chain but no erosion is present.
There is calcification of the eardrum (white arrow) and calcific deposits on the stapes and the tendon of the stapedius muscle (black arrow).
CT shows a tympanostomy tube (yellow arrow) and almost opacification of the tympanic cavity and mastoid air cells with soft tissue. CT shows the tympanostomy tube (yellow arrow) and complete opacification of the tympanic cavity and mastoid air cells with soft tissue. Large cholesteatomas can erode the auditory ossicles and the walls of the antrum and extend into the middle cranial fossa. CT demonstrates a soft tissue mass between the ossicular chain and the lateral tympanic wall, which is eroded.
Pars flaccida cholesteatomaThe lesion starts anterosuperiorly in 'Prussaks space', the area just below the scutum, which is limited by the tympanic membrane, the malleus, and the lateral ligament of the malleus.


A cholesteatoma will then extend laterally towards the ossicular chain and into the epitympanum. The cholesteatoma begins posterosuperiorly and extends posteriorly towards the facial recess and tympanic sinus, and medially towards the ossicular chain. On the left a large cholesteatoma in the right middle ear with destruction of the lateral wall of the tympanic cavity.
On the left images of a cholesteatoma, which has eroded the ossicular chain and the wall of the lateral semicircular canal (arrows). A large cholesteatoma has resulted in a so called 'automastoidectomy', with severe erosion of the lateral tympanic cavity wall and destruction of the ossicular chain. On the left images of a 50-year old man who presented with a left- sided retraction pocket and otorrhoea. All these findings favor the diagnosis of a cholesteatoma, but at surgery, chronic mastoiditis was found and no cholesteatoma was identified. The CT shows erosion of the wall of the lateral semicircular canal (arrow) due to cholesteatoma. The right ear shows a soft tissue mass medial to the ossicular chain with lateral displacement of the incus with erosion of its lenticular process and of the stapes, compatible with a pars tensa cholesteatoma (arrow).
Cholesteatomas are of mixed intensity on T1-weighted pulse sequences and of high intensity on T2-weighted pulse sequences. After intravenous contrast MRI can distinguish granulation tissue from effusions.Diffusion weighted MR can differentiate between a cholesteatoma, which has a restricted diffusion, and other abnormalities - especially granulation tissue - which have normal diffusion characteristics (figure). It is sometimes called otospongiosis because the disease begins with an otospongiotic phase, which is followed by an otosclerotic phase when osteoclasts are replaced by osteoblasts and dense sclerotic bone is deposited in areas of previous bone resorption.
When this process involves the oval window in the region of the footplate, the footplate becomes fixed, resulting in conductive hearing loss. Conductive hearing loss develops early in the third decade and is considered to be the hallmark of the disease. However, involvement of other portions of the otic capsule can result in mixed sensorineural hearing loss.
The process starts in the region of the oval window, classically at the fissula ante fenestram, i.e.
There is a subtle otosclerotic focus in the characteristic site: the fissula ante fenestram (arrows). On CT the detection of otosclerosis can be difficult to the inexperienced eye because the spread of the disease is often symmetrical. Sometimes the whole otic capsule is surrounded by these 'otospongiotic' foci, forming the so-called fourth ring of Valvassori. There is a lucency anterior to the oval window (arrow) and between the cochlea and the internal auditory canal.
On the left a patient with a well-positioned metallic stapedial prosthesis: medially it touches the oval window and laterally it connects with the long process of the incus. Notice the lucency between vestibule and cochlea as a manifestation of otosclerosis (arrow).
On the left images of a 68-year old woman who experienced a traumatic head injury 50 years ago. The consequences of the intracranial injuries dominate in the early period after the trauma. A temporal bone fracture can manifest itself with acute signs like bleeding from the ear or acute facial paralysis. Longitudinal fractures generally spare the inner ear, which is more often breached by transverse fractures. However, many temporal bone fractures are neither longitudinal nor transverse and a comprehensive description of the structures which are crossed by the fracture is needed. A longitudinal fracture is visible, which courses anteriorly to the cochlea through the region of the geniculate ganglion (arrows).
Posttraumatic conductive hearing loss can be caused by a hematotympanum or a tear of the tympanic membrane. In persistent conductive hearing loss there is usually a disruption of the ossicular chain. The most common disruption is a dislocation of the incudostapedial joint which is often a subtle finding. Fractures of the long process of the incus or the crura of the stapes are difficult to diagnose.
Longitudinal fracture (yellow arrow) coursing through the mastoid towards the region of the geniculate ganglion.
On the left images of a man who had suffered a traumatic head injury two months previously. There is a longitudinal fracture (yellow arrow) coursing through the mastoid towards the region of the geniculate ganglion. There is a dislocation of the incus with luxation of the incudo-mallear and incudo-stapedial joint (blue arrow). On the left images of a 54-year old male several years after head trauma, followed by left-sided hearing loss. The lateral semicircular canal is partially filled with dense material, compatible with labyrinthitis ossificans.
In acute posttraumatic paralysis a fracture line through the facial nerve canal - usually in the tympanic part - can be observed, sometimes with a bony fragment impinging on the canal. In delayed facial paralysis the nerve is probably edematous and fracture lines can be absent. On the other hand, a fracture line may be seen to cross the facial nerve canal without any associated nerve dysfunction. A vascular anomaly can be suspected if the patient complains of pulsatile tinnitus or when there is a reddish or bluish mass behind the eardrum. In patients with an aberrant internal carotid artery the cervical part of the internal carotid artery is absent. It is replaced by the ascending pharyngeal artery which connects with the horizontal part of the internal carotid artery.
On the right side the internal carotid artery is separated from the middle ear (blue arrow).


Exostoses of the external auditory canal are usually multiple, sessile, and bilateral and can cause severe narrowing of the external auditory canal. On the left images of a 57-year old male with a slowly progressive glomus jugulotympanicum tumor, visible as a mass on the floor of the tympanic cavity (arrow). At CT, the glomus jugulotympanic tumor manifests as a destructive lesion at the jugular foramen, often spreading into the hypotympanum. Large tumors have a 'salt and pepper' appearance at MRI due to their rich vascularity with flow voids. On the left angiographic images of the left external carotid artery before embolisation and the common carotid artery after embolisation (blue arrow).
Glomus tumors arise from paraganglion cells which are present in the jugular foramen and on the promontory of the cochlea around the tympanic branch of the glossopharyngeal nerve. EndoLymphatic Sac Tumor: destructive process of the dorsal temporal bone, with some calcification (arrow). At CT a destructive process is seen on the dorsal surface of the petrosal part of the temporal bone with punctate calcifications. Es la inflamacion del Oido Medio (cavidad Timpanica y Mastoides), generalmente acompanada de infeccion. El tratamiento requiere la utilizacion de antibiotico por via oral a dosis optimas, asociado generalmente a antiinflamatorios no esteroideos (pe. Se denomina asi a la presencia de liquido en el oido medio detras de la Membrana Timpanica, entidad frecuente sobre todo en ninos.
En ninos pequenos puede pasar desapercibido siendo los sintomas de sospecha el retraso en la adquisicion del lenguaje debido a los problemas de audicion del nino. Suele ser consecuencia de Otitis mal curadas o por traumatismos externos (balonazo, explosiones…). Las infecciones se suelen producir por la entrada de agua a traves de la perforacion, por lo que la proteccion del Conducto Auditivo Externo es de obligado cumplimiento.
Cuando se produce una inflamacion cronica del Oido Medio que no tiende a la curacion, se denomina Otitis Media Cronica.
El tratamiento puede ser medico mediante gotas oticas, o quirurgico segun la evolucion de la enfermedad. Es la lesion en el Oido Medio producido por cambios bruscos de presion atmosferica en los que no ha sido posible una compensacion de la presion en el Oido Medio a traves de la trompa de Eustaquio.
Se produce generalmente tras viajes en avion o por la practica de submarinismo, favoreciendo su aparicion la presencia de un cuadro catarral previo.
Suele producir dolor, presion otica importante, perdida de audicion y zumbidos en los oidos de aparicion subita, y relacionada con la actividad que la produce.
Se trata de la fijacion de uno de los huesecitos del Oido Medio que se encargan de la transmision del sonido desde el Timpano hasta el Oido Interno.
Es mas frecuente en mujeres jovenes y  Segun el grado de hipoacusia (perdida de audicion) el tratamiento varia desde la abstencion terapeutica hasta la solucion quirurgica mediante una estapedectomia. La Paralisis Facial Periferica es la afectacion del Nervio Facial que ocasiona un cuadro agudo de disminucion total o parcial de la movilidad de la musculatura facial. De cara a la posibilidad de recuperacion, la electromiografia Facial proporciona informacion pronostica de gran utilidad, del grado de lesion del Nervio. El pronostico mejora segun la precocidad de la instauracion de la medicacion, por lo que se considera una urgencia dentro de la patologia Otorrinolaringologica, sobre todo si se asocia a Otitis previa. Comments: 91 yr old F with stapes footplate mobilization, removal of superstructure and placement of Polyethylene Tube Prosthesis at age 50 for otosclerosis.
El nervio facial transcurre en forma muy cercana al sitio de la cirugia, por lo que una alteracion anatomica de este o inflamacion del mismo puede causar debilidad facial en el postoperatorio, que generalmente es temporal. El nervio del gusto (llamado cuerda del timpano) es movilizado durante la cirugia, hasta el 30% de los pacientes se quejan de alteraciones del gusto en la mitad de la lengua del mismo lado operado, en pocos casos es permanente. The examination shows a mass with mixed intensity on sagittal T1 and high intensity on transverse T2 weighted images. Dislocation of the incus with luxation of the incudo-mallear and incudo-stapedial joint (blue arrow).
Si se produce rotura del Timpano desaparece esta sintomatologia y aparece supuracion a traves del oido pasando a ser una OTITIS MEDIA AGUDA SUPURADA. En estos casos predomina el taponamiento otico y la perdida de audicion, sin dolor ni fiebre. Es importante un buen control de esta patologia en la infancia para evitar posibles secuelas en la edad adulta. Generalmente no producen ningun tipo de sintomatologia excepto en periodos de infeccion que sera causa de supuracion a traves del oido. Suele cursar con otorrea (supuracion a traves del Conducto Auditivo) persistente o intermitente de larga evolucion, y a menudo se asocia a perforacion timpanica. Se comporta como un quiste (tumoracion benigna), destruyendo las estructuras a su alrededor conforme va creciendo.
La etiologia no esta claramente definida, aunque se produce una inflamacion del VII par craneal (N.
Si la recuperacion no se produce en las primeras semanas, los ejercicios de Rehabilitacion facial consiguen resultados muy satisfactorios. Ocurre cuando la enfermedad se extiende hacia el oido interno, la coclea, en este caso la sordera que se produce es neurosensorial, este dano en general es permanente y puede haber otros sintomas asociados como acufeno (ruido en el oido), vertigo o mareo. Anteriormente se habian utilizado los suplementos de fluor como una medida para impedir el progreso de la enfermedad, aunque el tratamiento es prolongado con efectos secundarios a nivel gastrico en forma importante. Es en la actualidad el tratamiento idoneo para la otosclerosis que cursa con sordera de tipo conductivo, con un porcentaje de exito de hasta el 90 % de los casos. Se indica ya cuando existe una perdida neurosensorial irreversible o el paciente no desee someterse a cirugia, o bien que exista una contraindicacion para la misma. It has a high intensity on diffusion weighted images, which indicates restricted diffusion. Esto ocurre cuando la enfermedad se extiende hacia el estribo, el ultimo de los tres huesecillos del oido medio, lo que impide su libre movimiento, esto ocasiona que no se puedan transmitir las ondas sonoras hacia el oido interno, se provoca asi una sordera de transmision o conductiva y es susceptible a ser tratada con cirugia al remover el estribo y colocar en su lugar una pequena protesis que imita el movimiento del estribo.



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Comments Otosclerosis total hearing loss

  1. TANK
    Middle ear bone stapes lowered.
  2. Akulka
    But it can also be buzzing, clicking the severity of the head noise is not just.