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OTITIS MEDIA Otitis media (OM) may be defined as inflammation of the middle ear due to any cause.
OTITIS MEDIA -- DIAGNOSIS Children with acute otitis media frequently present with sudden onset of fever, ear pain, and fussiness.
OTITIS MEDIA -- COMPLICATIONS Complications of acute otitis media were common in the pre- antibiotic era.
HEARING LOSS Conductive hearing loss Cerumen impactions Swelling of the external auditory canal Tympanic membrane perforation Middle ear fluid Ossicular chain abnormalities Sensorineural hearing loss Injury to hair cells in the cochlea or neural elements innervating the hair cells.
HEARING LOSS -- AUDIOMETRY Hearing threshold levels are determined between 250 and 8000 Hertz (Hz) for pure tones and measured in decibels (dB).
HEARING LOSS -- AUDIOMETRY A conductive hearing loss in the left ear due to otitis media with effusion.
HEARING LOSS -- AUDIOMETRY This audiogram suggests noise exposure that may be encountered occasionally in younger individuals who have been exposed to hazardous or “toxic” noise. HEARING LOSS -- TYMPANOGRAM Tympanometry is commonly used to evaluate the tympanic membrane (TM) and middle ear status. Three tympanograms demonstrating change in compliance of the middle ear (vertical axis) with changes in ear canal pressure. OTITIS EXTERNA Otitis externa (OE) is an inflammation or infection of the external auditory canal (EAC), the auricle, or both This condition can be found in all age groups. OTITIS EXTERNA -- CONSIDERATIONS Ramsay Hunt syndrome, more accurately known as herpes zoster oticus, is caused by varicella-zoster virus (VZV) infection. OTITIS EXTERNA -- TREATMENT Commonly used topical eardrops are acetic acid drops (which decrease pH), antibacterial drops, and antifungal preparations. DIZZINESS Patients frequently present with a complaint of “dizziness,” including symptoms such as disequilibrium, syncope, lightheadedness, ataxia, and vertigo. DIZZINESS – VESTIBULAR TESTING Vestibular testing can be performed to help determine whether the problem exists within the vestibular (balance) portion of the inner ear. DIZZINESS – VESTIBULAR TESTING There are four main parts to ENG testing Calibration test, which measures rapid eye movements Tracking test, which evaluates the ability of the eyes to track a moving target Positional test, which measures responses due to head movements Caloric test, which measures responses to warm and cold water introduced to the ear canal.
BENIGN PAROXYSMAL POSITIONAL VERTIGO (BPPV) One of the most common causes of vertigo is benign paroxysmal positional vertigo (BPPV). BENIGN PAROXYSMAL POSITIONAL VERTIGO (BPPV) BPPV can usually be successfully treated with a canolith reposition maneuver (Epley or Semont maneuver) in the office setting. Bedside maneuver for the treatment of a patient with benign paroxysmal positional vertigo (BPPV) affecting the right posterior semicircular canal.
LABRYNTHITIS -- TREATMENT Treatment is symptomatic Vestibular suppressant medications (meclizine) Antiemetics Short, tapering course of oral steroids It may take several weeks for symptoms to completely resolve Residual vestibulopathy that persists for months or even years is not uncommon, and is best managed with vestibular rehabilitation. Connexin 26 (Cx26) is a protein found on the (GJB2) gene and is the most common cause of congenital sensorineural hearing loss. Connexin 26 mutations are genetically transmitted from parent to child in a recessive manner, which means that an affected individual must inherit one copy of the non-functioning gene from each parent. Connexin 26 mutations are non-syndromic, meaning that the mutation produces only isolated hearing loss. Connexin 26 mutations produce a pre-lingual hearing loss, because it affects the child before they are old enough to develop speech.
Recent medical evidence has shown that there is an additional complexity to Connexin 26 mutations.
The GJB2 gene contains the instructions for manufacturing a number of proteins, including Connexin 26. Connexin 26 mutations occur primarily in Caucasians, Ashkenazi Jews, and some Asian populations.
A specialized interdisciplinary team of professionals is necessary to treat all of the issues associated with a Connexin 26 mutation. The California Ear Institute is a leading global center for otological, otolaryngological and audiological treatment. If it is the desire of the family for their child to hear and speak as normally as possible, it is necessary to seek medical evaluation as soon as possible after birth of a child who is referred by their newborn hearing screening program for additional testing, regardless of whether or not Connexin 26 is suspected to be the source of the hearing loss. Patients searching the internet for information about Connexin 26 mutation or any other medical issue should know when reading about individual case histories, that generally it is the patients with the most severe symptoms who either post their own experiences or are included in medical review journals.
Putcha GV, Bejjani BA, Bleoo S, Booker JK, Carey JC, Carson N, Das S, Dempsey MA, Gastier-Foster JM, Greinwald JH Jr, Hoffmann ML, Jeng LJ, Kenna MA, Khababa I, Lilley M, Mao R, Muralidharan K, Otani IM, Rehm HL, Schaefer F, Seltzer WK, Spector EB, Springer MA, Weck KE, Wenstrup RJ, Withrow S, Wu BL, Zariwala MA, Schrijver I. Medical Website Design - Websites for Doctors of Otology, Audiology, Ears & Hearing by Vital Element, Inc. This website is dedicated to sharing the story of Super Baby Faith and her progress.  Born full term on September 10, 2009, in Austin, Texas, Faith has bilateral anophthalmia (no eyes) and is completely blind. Faith and her parents(Mike and Bridget)  moved from Kyle, TX back to their home state of Missouri(St. Mike and Bridget are so grateful to their great friends in TX who have been so loving and supportive.


First Genetic Disease linked to a DNA mutation1949 Sickle-cell disease was discovered to occur as a result of an abnormality in the hemoglobin, by Linus Pauling. Single Gene Defects As genetic sequencing technologies evolved, the amount of diseases for which genetic testing became available expanded. Microarrays and their role in diagnosingMicroarrays revolutionized medicine by being able to pinpoint a very specific disease or the susceptibility to it.
One of the other cases involves two brothers, ages 22 and 24, with profound intellectual disability and autism. Due to: persistent noise exposure, age-related (presbycusis), genetic factors, and infectious or postinflammatory processes. The 0-dB level is “normalized” to young, healthy adults and doesn’t mean there is absence of detectable sound.
Note that bone conduction thresholds are normal in both ears, but air conduction on the left is 30 dB poorer than that measured on the right. Note that low-tone thresholds are relatively normal, with a drop in thresholds at higher frequencies. This test assesses the mobility of the TM and its response to pressure changes in the external auditory canal. Type A is normal, with the greatest compliance at the point where the pressure in the ear canal is equal to that of atmospheric pressure (peak is at 0).
If the condition does not respond to treatment as expected, an otolaryngologist should evaluate the patient. It is characterized by facial nerve paralysis and sensorineural hearing loss, with bullous myringitis and a vesicular eruption of the concha of the pinna and the external auditory canal (EAC).
True vertigo (an illusion of motion) is primarily associated with the balance organs of the inner ear.
BPPV is caused by sediment, such as calcium carbonate crystals, that have become free floating within the inner ear. Dislodged otoliths repositioned into the vestibule is about 80 percent effective in eliminating symptoms of BPPV.
The presumed position of the debris within the labyrinth during the maneuver is shown in panels A–D. It is thought to be caused by inflammation, secondary to a viral infection, of the vestibular portion of the eighth cranial nerve or of the inner ear balance organs (vestibular labyrinth). Connexin 26 mutations are responsible for at least 20% of all genetic hearing loss and 10% of all childhood hearing loss. A multicenter study of the frequency and distribution of GJB2 and GJB6 mutations in a large North American cohort. The Wildschuetz’s are settled in Missouri and are surrounded by supportive family and friends that are helping them with the everyday challenges. Since the discovery that mutations in DNA are the causes of genetic disorders, diagnosing has become more and more advanced. They discover the concept that codons, consisting of three nucleotides, code for one of the 20 amino acids used to make up proteins. There are two common variants: (1) acute otitis media (AOM) and (2) otitis media with effusion (OME).
There is decreased movement of the eardrum on pneumatic otoscopy (insufflation of air into the ear canal). Mastoiditis -- Patients with acute mastoiditis present with fever, ear pain, and a protruding auricle.
Some patients hear 0 dB, but reaching the threshold of hearing usually requires louder test signals. This is a consequence of the normal aging process and may vary widely from patient to patient.
Type B demonstrates very poor compliance at any frequency, suggestive of a tympanic membrane (TM) immobilized by fluid in the middle ear or a TM perforation (no peak).
Skull base osteomyelitis occurs most often in patients who are diabetic or immunocompromised. Rotatory chair testing is the “gold standard” for diagnosing bilateral vestibular weakness.
Turning the head quickly or into a certain position, causes this free- floating material to move the endolymph in the inner ear, stimulating the vestibular division of the eighth cranial nerve. In some ethnic populations, more than 80 percent of cases of nonsyndromic recessive deafness result from a mutated Connexin 26 gene. One report from a prospective study of 50,000 newborns found an incidence of microphthalmia of 0.22 per 1,000 live births. Due to the ongoing needs of Faith, Mike and Bridget felt that it was very important to be close to family as both Mike and Bridget’s families are in the St.
Decoding the DNA would allow us to see any differences in the sequence, and if those mutations cause any adverse effects.


We now know this is inaccurate, because humans produce more than 100,000 proteins and there are less the 25,000 genes. This was a chance for them to take because DNA sequencing had never been proven to lead to treatment. Ears Otitis media Hearing loss Otitis externa Vertigo Nose Sinusitis Allergic rhinitis Epistaxis Throat Strep. Common bacteria that cause acute OM in children are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.
Meningitis With increasing antibiotic resistance, especially Streptococcus pneumoniae, these complications may again become more common. Type C represents a tympanogram in which the compliance of the membrane is greatest at a point where the pressure in the canal is 200 mm of water below that of atmospheric pressure (peak shifted to the left).
The patient is slowly spun in a rotating chair and dizzinessis is measured with optokinetic testing and a fixation test. The Dix-Hallpike test is performed with the patient’s head rotated 45? toward the right ear, and the neck slightly extended with the chin pointed slightly upward. The patient will usually awaken with room-spinning vertigo that will gradually become less intense over 24–48 hours. Children born with bilateral (both ears) severe to profound sensorineural hearing losses are typically referred for genetic testing for Connexin 26 mutations. Over 50 investigators from nine different institutions, working together as The Huntington's Disease Collaborative Research Group, isolated an expandable, unstable DNA segment on chromosome 4 that can vary from generation to generation and even among affected siblings.
In healthy children older than two years of age who present with less severe symptoms, observation for 48 hours may be considered.
This suggests inefficient eustachian tube function with persistent negative pressure in the middle ear. The diagnosis is strongly suggested by a history of diabetes mellitus, severe otalgia, cranial neuropathies, and characteristic EAC findings. Moving platform posturography is a method of quantifying balance, but should not be used alone to diagnose vestibular disorders. Medical therapy with vestibular suppressants is ineffective because the episodes of vertigo are so fleeting, and should be discouraged.
The combination of the various manifestations that can result from this mutation is often referred to as SOX2 anophthalmia syndrome. About 10 percent to 15 percent of people with anophthalmia in both eyes have SOX2 syndrome. With three exceptions, each codon encodes for one of the 20 amino acids used in the synthesis of proteins. During the audiogram, independent thresholds are determined for each ear for both air conduction (conductive hearing) and bone conduction (sensorineural hearing).
It is most useful in quantifying balance improvement (or worsening) following treatment for a particular problem, and can help identify the functional dizzy patient. Once the vertigo and the nystagmus provoked by the Dix-Hallpike test cease, the patient’s head is rotated about the rostral-caudal body axis until the left ear is down (panel B). Faith also has bilateral sensorineural hearing loss, feeding issues which resulted in the placement of a G-tube, global developmental delays, and a severe sleep disorder. This was an extremely significant moment in the history of DNA sequencing, because before it had generally been thought of as a research tool.
ECOG is not really a test of the vestibular system, but is a useful test of hearing in the evaluation of Meniere’s disease.
Faith also has neurological issues resulting from brain abnormalities, as well as endocrine and gastrointestinal issues. Bridget resigned from her teaching position in Texas and is taking an extended leave from her teaching career to keep up with all of Faith’s appointments and needs. The test is a variant of brainstem audio-evoked response and, if possible, should be performed during active Meniere’s attacks.
Faith’s family takes one day at a time and continues to keep the faith as they deal with the daily challenges! With the head kept turned toward the left shoulder, the patient is rought into the seated position (panel D). Once the patient is upright, the head is tilted so that the chin is pointed slightly downward.



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