Slide 19/1 (part 2/3)

1) Perforations

SUBTOTAL PERFORATION

TRAUMATIC PERFORATION-irregularities of peroration's margin

Types of perforations: From http://www.ent.com.hk/diagnosis/ear_diagnosis.html#2

Perforation at margin of the eardrum This is a perforation that occurs at the margin of the eardrum - where the eardrum and ear canal come together. In some cases, skin from the ear canal can grow through the perforation into the middle ear, forming a cholesteatoma.
Central eardrum perforation A perforation can occur in any location on the eardrum. The size of the perforation varies from a small opening like the one shown, to a total (entire) eardrum perforation.
Attic perforation of the eardrum This is a perforation in the superior part of the eardrum. This is sometimes referred to as an attic perforation. A perforation in this location may be associated with a deep retraction pocket or cholesteatoma into the mastoid.

2) BARATRAUMA

Tentang Baratrauma yang diambil dari http://www.ent.com.hk/diagnosis/ear_diagnosis.html

During diving and flight elevation or landing, the pressure is changing To adapt to it, pressure of middle ear should be changed accordingly by opening up the eustachian tube. Besides swallowing or chewing action, sometimes Valsava maneuver may be needed.  

Barotrauma with Blood in Middle Ear Cavity

However if the eustachian tube function is impaired or the change of depth or height level is too fast, pressure of middle ear cavity cannot be equalized and barotrauma may result. It may injury the ear drum resulting inperforation, middle ear cavity mucosa resulting in bleeding and fluid collection, even the inner ear through the round window causing severe sensorineural hearing loss.

Diagnosis and Treatment:

How to diagnose barotrauma?

• history of recent flight or diving would be hint for diagnosis.
• Otoscopic or microscopic examination of the eardrum would show blood or fluid inside the middle ear cavity.  Sometimes perforation of ear drum may occur
• Pure tone audiogram is necessary as it usually shows conductive hearing loss.  However if inner ear is involved, sensorineural hearing loss may be seen.

How to treat barotrauma?

• For ear drum perforation, observation is suggested.  If it is not healed up after 3 months eventually, repair by surgical operation is recommended
• For blood or fluid in the middle ear, observation is suggested.  But it can be drained by myringotomy if it is not subsided after a period of time.

If there is inner ear injury, conservative management such as bed rest and drugs is recommended.  But if hearing deteriorates progressively, surgical exploration and operation would be suggested.

3) CHOLESTEATOMA

ATTIC CHOLEASTEATOMA

4) MASTOID FISTULA 

MASTOID FISTULA 

A fistula exposing the mastoid bone: Caused by a dangerous middle ear infection

6) HEMOTYMPANUM

HEMOTYMPANUM is taken from 

http://www.biomedsearch.com/nih/Bilateral-spontaneous-hemotympanum-case-report/17020609.html

[Figure ID: F1]	Figure 1 Otoscopic images of bilateral spontaneous hemotympanum, after intake of anticoagulants. Upper: hemotympanum of the left ear; lower: hemotympamum of the right ear.
[Figure ID: F2]	Figure 2 CT scan of the mastoid demonstrating bilateral opacity of the tympanic cavity (white arrows).