Answers:
A medical student comes to your office because his friend was practicing his head and neck exam on him and noticed "there's something in you ear!". On routine exam you notice chalky white patches present on the TM bilaterally. The patient denies any hearing loss, otalgia or otorrhea. What is the most likely diagnosis?
A)Cholesteatoma
B)Myringosclerosis
C) Otomycosis
D)Otitis Externa
MC Questions:
Longitudinal fracture of the temporal bone result in CHL via all of the following mechanisms except:
A) Hemotympanium
B) Disruption of otic capsule
C) Perforation of TM
D) Ossicular Chain Disruption
E) Longitudinal fractures cause CHL by all of the above
A)Cholesteatoma
B)Myringosclerosis
C) Otomycosis
D)Otitis Externa
Myringosclerosis is a form of tympanosclerosis that is restricted to the TM. Tympanosclerosis is collagenesis/hyalinization that causes abnormal deposition of calcium in the ear. It is often a reactive response to infection/inflammation. Usually this condition only causes hearing loss (CHL) if it involves the middle ear.
Name 3 of the classic signs and/or symptoms of cholesteatoma.
-TM retraction
-TM perforation
-Recurrent ear infections (often w/ pseudomonas aeruginosa)
-"Trail sign" = keratin/crusting along canal to a possible perf.
-Keratin debris in middle ear
-Progressive CHL
-TM perforation
-Recurrent ear infections (often w/ pseudomonas aeruginosa)
-"Trail sign" = keratin/crusting along canal to a possible perf.
-Keratin debris in middle ear
-Progressive CHL
Longitudinal fracture of the temporal bone result in CHL via all of the following mechanisms except:
A) Hemotympanium
B) Disruption of otic capsule
C) Perforation of TM
D) Ossicular Chain Disruption
E) Longitudinal fractures cause CHL by all of the above
Free Response Question:
Name four surgical procedures used to treat various forms of CHL.
Quick Facts:
Tympanic Membrane
-3 layers:
-Outer = from ectoderm, squamous epithelium.
-Inner = endoderm, cuboidal epithelium
-Middle = from mesenchyme (aka middle fibrous layer), has both radial and circumferential fibers, add TM strength
-Oval shape, sloped so sup aspect is lateral to inf aspect., tented medially by long process of malleus.
-Around circumference is fibrous annulus (in the tympanic sulcus - groove in bone at medial end of EAC)
-Annulus is incomplete sup to ant. and post maleal folds.
-Pars Flaccida (aka Shrapnell membrane) is above ant. and post maleal folds, pars tensa is inf to folds and is stronger.
-Pars flaccida can retract inward and is common starting point for cholesteatomas.
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