Causes of acute conductive hearing loss quotes,can hypnosis cure tinnitus quickly,ringing in the ears and fainting,fluttering noises in my ear opiniones - PDF Review

Author: admin, 26.10.2015. Category: Cure Ringing Ears

When otolaryngologists, audiologists, and hearing healthcare professionals evaluate patients with hearing loss, one of the most important characteristics to determine is the nature of the hearing loss. Finally, a comprehensive audiogram is performed to determine thresholds for hearing—the minimum sound intensity at which a patient can hear a tone or repeat a spoken word. In adults, far and away the most common type of hearing loss is sensorineural—a problem in the inner ear (cochlea) or hearing nerve (Figure 3).
Conductive hearing loss refers to a problem with the conduction or transmission of sound energy into the inner ear. Stiffness in the eardrum can often be diagnosed with a test called a tympanogram, which measures the compliance, or stiffness, in the eardrum and middle ear system (Figure 7). Otosclerosis can cause varying degrees of conductive hearing loss, and if the disease involves the cochlea, or inner ear, can cause a mixed (combined conductive and sensorineural) hearing loss. Repair can also be technically challenging, such as replacing a destroyed ossicle with an artificial ear bone, removing the stapes bone and replacing it with an artificial ear bone, or opening an ear canal that never developed. At times, a conventional hearing aid can amplify sound enough to overcome the conductive hearing loss as the amplified sound simply drives the system harder to get sound energy (mechanical energy) to the cochlea. Prior to joining the faculty of the Otolaryngology Department at the University of Virginia, Dr. The most characteristic feature of this illness is a prolonged case of discharging from the ear and of hearing impairment.
Discharge in the acute phase is white and creamy, possibly purulent, while in the time following the acute symptoms it is mucous, but odorless at all times. Inflammation is largely limited to the mucous membrane, although in rare cases the bony parts of the middle ear – the auditory ossicles and the mastoid bones, e.g. Various factors can affect the development of the process, such as the decreased functioning of the tissue of the mucous membrane, different kinds of pathogens of varying sensitivity, the anatomical characteristics of the middle ear, the aeration state of the osseous system, the quality of the functioning of the Eustachian tube, septal deviation, and chronic maxillary sinusitis. An important factor is the patient’s state of general well-being, including allergies, immune deficiency, pathologic thinnes, diabetes, etc. A successful diagnosis can be aided by details of the history revealing recurring ear dischanging and hearing impairment. The microscopic image of the ear is very characteristic: a small hole is visible in the middle of the eardrum, often surrounded by small scars. In case of an acute discharge, small polips also often appear due to the swelling and thickening of the mucous membrane.Discharge is mucous or mucous and purulent, but always odorless. X-rays (or Schuller’s X-ray pictures) show a blocking of the aeration of the mastoid process. The illness has to be differentiated from cholesteatoma, which involves a small hole at the edge of the eardrum and stenchy rather than odorless discharge. Similar changes characterize the middle-ear infection that develops due to tuberculosis, but that involves multiple perforations of the central region of the eardrum and hearing impairment is severe. In case of a malignant tumor of the middle ear, eardrum perforation occurs at the edge of the ear drum, in which case extensive growth of tissue extends to the auditory canal and bone destruction at the wall of the auditory canal also occurs. In the case of discharging from the ear, the first step is conservative treatment with the aim of “drying up” the middle ear. The auditory canal has to be cleaned periodically and the discharge drained from the tympanic cavity. After the ear is dried up, surgical treatment should aim to remove inflammatory foci in the temporal bone and the tympanic cavity and to reconstruct the damaged auditory conduction system, the eardrum, and the auditory ossicles. If hearing impairment reaches the point where a hearing aid is necessary, tympanoplasty should nevertheless be performed since otherwise continuing discharge from the ear will make it impossible for the patient to wear the hearing aid. This type of otitis is characterized by a stenchy discharging from the ear, gradually declining hearing, and ear ache and fever during acute flare-ups of the disease. The central feature of the disease is that the peeling epithelial cells of the keratinized pavement epithelium collect and form keratin pearls or cholesteatomas, which can trigger pathological processes when collected in greater numbers in places between tissues or in body cavities. There are different reasons why keratin pearls or cholesteatomas can develop in the middle ear. Least resistant parts – such as its postero-superior quadrant or the Shrapnel’s membrane – develop a small keratin sac, which deepens and develops further into a cholesteatoma if the keratinized cells can no longer empty from it. A cholesteatoma applies constant pressure to its environment, causing the bony substance to slowly erode, forms closed to the outside to open up in time, and, sooner or later, the cholesteatoma gets infected.
The deposited keratin starts to decompose and, because pathogens are various and anaerobic putrifying bacteria are very frequent, the discharge is stenchy. The products of inflammation, bacterial enzymes and enzymes developing in epithelial tumors (such as collenase) and bony structures eroding under the pressure of the cholesteatoma are constantly decomposing, and the cholesteatoma extends the purulence process to the destroyed areas (increasing the danger of complications).
This process of destruction causes the auditory ossicles to erode as well, causing a dramatic impairment of hearing.
Pars tensa type cholesteatoma: It develops from a sac in the postero-superior quadrant of the pars tensa.


As a result of the auditory ossicles (most often in the joint connecting the incus and the stapes), conductive hearing loss results. Flaccid part type cholesteatoma: Microscopic analysis can detect a Shrapnell perforation, often covered by crust, removal of which often discloses the erosion of the outer wall of the tympanic cavity.
An important characteristic of the disease is that in Schuller X-rays the air content of bones is inhibited, and the orifice of the mastoid process is rarefied – this cavity is called the cholesteatoma cavity. The calcification of the osseous walls of the main veins inside the skull (the sinus sigmoideus) (i.e.
Auditory examination may detect conductive hearing impairment or inner ear damage (mixed type of hearing impairment). During the examination of the organ of balance, as long as its bony wall is intact, spontaneous and stimulated symptoms are absent.
During diagnosis, the disease needs to be differentiated from inactive chronic mesotympanal otitis (purulent mucous membrane), scarry accretion of the eardrum, auditory canal cancer, and middle ear tuberculosis. During treatment, due to the nature of the process, conservative methods are not successful, and the treatment of the cholesteatoma is possible only surgically, due to the danger of complications. A modern form of surgical treatment is tympanoplasty, whose aim is the assanation of the disease and the subsequent restoration of the hearing function.
The main aim is the full removal of the cholesteatoma together with the matrix and the perimatrix, and the subsequent restoration of the auditory chain between the eardrum and auditory ossicles. This involves the closing of the eardrum perforation (from the fascia of the temporal muscle or the perichondrium of the auditory canal), as well as the restoration of direct communication between the eardrum and the stapes base. Auditory ossicles can be replaced by “short” and “long” ossicles, bone columella, cartilage columella, or plastic prosthesis.
In certain cases (due to the positioning and extent of the cholesteatoma, complications, or social factors), open tympanoplasty, conservative radical surgery, or classic radical surgery can also be performed.
In the case of these surgical procedured the most important goal is the safe removal of the disease, with no subsequent restoration of hearing. Cholesteatoma is a very dangerous form of otitis, which can cause serious, life-endangering complications affecting the skull at any time and without symptoms signaling the danger. The tuning fork test allows the clinician to sort out the nature of the hearing loss: conductive or sensorineural (Figure 1). Any difference between the air-conducted and bone-conducted thresholds represents the degree to which the ear canal and middle ear (the eardrum and the three ear bones, or ossicles) are not efficiently conducting the sound energy to the inner ear. A smaller subset of patients (approximately 5-10% of all adult with hearing loss) will be found to have a conductive hearing loss—a problem with the ear canal, eardrum, or middle ear (Figure 4). As noted, the anatomic location of the problem in patients with conductive hearing loss lies in the ear canal, eardrum, or middle ear (space on the other side of the eardrum where the ear bones, or ossicles, are located (Figure 4).
The narrowing of the ear canal either from trauma or birth can be a difficult condition to correct as surgery sometimes causes scar tissue to build, which can cause the ear canal to narrow again. Causes of stiffening of the eardrum include fluid in the middle ear (serous otitis media or otitis media with effusion) or a stiffness in the ossicles: the malleus (hammer), incus (anvil), and stapes (stirrup). Fluid in the middle ear causes stiffness not just in the eardrum but also in the ear bones as well. A history of prior infections, trauma, or surgery along with a white, chalky appearance to the eardrum (Figure 8) generally indicates this cause of conductive hearing loss. Otosclerosis (of unknown cause) is a condition whereby the third bone of hearing, the stapes bone, becomes fixed or stuck. The diagnosis is made based on the hearing test (audiogram) and a normal physical exam (normal appearing ears, eardrum, and middle ear space). The outer layer of the eardrum is skin, and when the skin of the eardrum migrates into the middle ear, the skin causes infection and erosion. The most common site of traumatic ossicular disruption is, again, the incudostapedial joint. Many times, medical or surgical therapy can rehabilitate a conductive hearing loss, by removing the obstruction in the ear canal, surgically repairing a perforated eardrum, or clearing fluid from the middle ear space.
Certain hearing devices, called bone-conducting hearing devices, hold promise in restoring hearing through the conduction of sound energy through the bone of the skull. The odorless discharge, which can be mucous or mucous and purulent, causes considerable discomfort to patients suffering from it. Patients are often confused by a lack of pain and a state of general well-being, which makes it difficult for them to realize that they are suffering from a serious illness. Due to the grave scarry disfigurations of the tissue under the mucous membrane, blood vessels can be blocked, causing a secondary metabolic disturbance in the surrounding bone tissue. In the acute phase the discharge should be submitted to bacteriological examination, and, based on the antibiogram, aimed systemic and local treatment should be applied. Tympanoplasty should be performed as soon after preparation as possible, since malformations of the auditory conduction system will get gradually worse due to recurring inflammations.


Discharging from the ear is sometimes very minor or even absent, but when present it is never transparent and mucous as in the case of chronic mesotympanal otitis. Due to a damage in the functioning of the Eustachian tube, negative pressure develops and persists in the middle ear, with the eardrum being sucked in towards the tympanic cavity as a result, which destroys its fibrous system and parts of the eardrum atrophy.
Rarely it happens that keratinized cells get into the tympanic cavity as a result of puncture, the fracture of the petrous bone, or other damage to the eardrum (e.g.
Even more rarely, non-keratinized pavement epithelium lining the inside of the cavity system keratinizes and forms a cholesteatoma.
Inflamed granulation tissue called “guard polyp” often develops at the edge of the perforation. In the tympanic cavity inflamed granulation tissue and cholesteatoma laminae are found and strongly odorous discharge is detected. If the process spreads into the inner auditory canal, declining neural hearing impairment occurs, resulting in complete deafness (neuritis statoacoustica) accompanied by paralysis of the facial nerve. In case of the damage of the lateral semi-circular canal, change in pressure elicits a revolving kind of dizziness.
In the first sitting the removal of the cholesteatoma, the assanation, and the closing of the tympanic cavity are performed.
If there is a hearing loss, the audiologist will next test the hearing with the probe tightly applied to the mastoid bone behind the ear. A hole in the eardrum allows sound energy to pass through without efficiently vibrating the entire eardrum.
Patients complain of a fullness and loss of hearing as though they are down in a barrel or in a hole.
When the stapes is fixed, it does not vibrate and does not conduct sound energy to the inner ear. Treatment includes observation, a trial of a hearing aid, or surgery to remove the stapes and replace it with an artificial ear bone (stapedectomy). The most common site of erosion is the joint between the second and third bones of hearing (the incudostapedial joint). Patients can try a hearing aid or have exploratory surgery to attempt to restore sound conduction using a PORP or TORP depending on the site of discontinuity.
Bone-conducting devices can be worn attached to a headband that encircles the head or can be affixed to an implant surgically placed in the skull.
This type of otitis can have completely symptom free periods alternating with periods of acute recrudescence of symptoms. Some antibiotics may damage the inner ear, which needs to be taken into account when assigning treatment.
Polips should be removed from the tympanic cavity, and any inflammations in the nasopharynx and the accessory sinuses should also be treated.
Such cholesteatomas usually develop on the inside of the utricle, the center of balance, and only more rarely in the cavity system of the middle ear. This is accompanied by strong odor, the discharge contains cholesteatoma laminae, and the surrounding bones (the postero-superior portion of the wall of the auditory canal) erode. Conductive hearing impairment occurs, and the inner ear is also damaged in more dvanced cases. The air content of the mastoid process and the folds of the mucous membrane determine the direction in which the cholesteatoma develops. Facial nerves can also be damaged in case of the erosion of the bony facial nerve canal or of spreading into the inner auditory canal. In the second sitting (usually half a year after the first), the tympanic cavity is examined and the chain of the auditory ossicles is restored. If there is a difference in the hearing thresholds between sound conducted through air (the probe in the ear) and sound conducted through bone (the probe on the mastoid bone), we call that an air bone gap, an indication of a conductive hearing loss (Figure 2). This loss of sound energy as it passes through the perforation causes an inefficiency in the auditory system and as a result, conductive hearing loss. Many times, medical treatment (nasal sprays, decongestants) will hasten the resolution of the middle ear fluid, but on occasion, otolaryngologists will place ventilation tubes in the eardrum after making an incision in the eardrum (myringotomy) and suctioning out the fluid. When this joint has eroded, sound energy is not transmitted efficiently to the stapes and inner ear, resulting in a conductive hearing loss.
The patient who has conductive hearing loss will review with the otolaryngologist or audiologist the various options for hearing rehabilitation to determine the best individual plan that fits the desires and expectations of the patient to rehabilitate hearing.
Treatment for cholesteatoma is surgical, primarily to remove the cholesteatoma and secondarily to attempt to replace the lost ear bone(s) with an artificial ear bone, a partial or total ossicular replacement prosthesis (PORP or TORP) to restore sound conduction to the cochlea.



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