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Ear Treatment
Ear Treatment
Causes of earache
Local causes
External ear: furuncle, impacted wax, otitis externa, otomycosis, myringitis bullosa, herpes zoster, malignant neoplasms.
Middle ear: acute otitis media, Eustachian tube obstruction, mastoiditis, extra dural abscess, aero-otitis media.
Referred causes
As ear receives nerve supply from 5 th(auriculotemporal), 9 th (tympanic branch ), 10 th auricular branchfrom c2 (lesser occipital ) c2 and c3 ( greater auricular)
1)Via 5th –
a)Dental- carries teeth, apical abscess, impacted molar, mal occlusion, costen syndrome.
b)Oral cavity –benign or malignant ulcerative lesions of oral cavity or tongue.
c)Temporomandibular joint disorder
Bruxism, osteoarthritis, recurrent dislocation, ill-fitting denture
Costen syndrome
It is due to abnormality of temporo-mandibular joint with defective bite. It is associated with tinnitus, vertigo, earache
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Causes of earache
2)Via 9th cranial nerve
Acute tonsillitis, peri-tonsillar abscess, tonsillectomy, ulcers of soft palate, tonsils and its pillars
Base of tongue- tuberculosis or malignancy
Elongated styloid process
3)Via 10th cranial nerve
Malignancy , ulcerative lesion of vallecula, epiglottis, larynx, laryngo-pharynx and esophagus
4) Via c2 and c3 spinal nerves
Cervical spondylosis, injuries of cervical spine and caries spine.
Psychogenic causes
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Causes of earache
2)Via 9th cranial nerve
Acute tonsillitis, peri-tonsillar abscess, tonsillectomy, ulcers of soft palate, tonsils and its pillars
Base of tongue- tuberculosis or malignancy
Elongated styloid process
3)Via 10th cranial nerve
Malignancy , ulcerative lesion of vallecula, epiglottis, larynx, laryngo-pharynx and esophagus
4) Via c2 and c3 spinal nerves
Cervical spondylosis, injuries of cervical spine and caries spine.
Psychogenic causes
Tinnitus
Ringing sound in one or both ears. Tinnitus is basically perception of sound when there is no actual sound.
Causes of tinnitus
Subjective
- Otologic
- Impacted wax, fluid in the middle ear, acute otitis media ,chronic otitis media
- Metabolic
- Hypothyroidism, hyperthyroidism, obesity, hyperlipidemia
- Neurologic
- Head injury ,temporal bone fractures, multiple sclerosis
Objective
- Vascular
- AV shunts
- Arterial bruit- carotid aneurysm, carotid stenosis,
- Patulous Eustachian tube
- Palatal myoclonus
- Tensor tympani myoclonus
Causes of Deafness
(Organic)
Conductive hearing loss
congenital:
meatal atresia, fixation of stapes footplate, fixation of malleus head, ossicular discontinuity, congenital cholesteatoma.
Acquired:
Any obstruction in ear canal-wax, foreign body
Middle ear- perforation of tympanic membrane, fluid in middle ear, mass in middle ear, disruption of ossicles, fixation of ossicles(otosclerosis, tympanosclerosis, adhesive otitis media.),Eustachian tube blockage
sensorineural
results from lesions of cochlea,8 th nerve or central auditory pathways.
It may be congenital or acquired.
Congenital:
it is present at birth and it is result of anomalies of inner ear or damage to the hearing apparatus.
Acquired:
- infections of labyrinth
- trauma to labyrinth
- noise induced hearing loss
- ototoxic drugs
- presbycusis
- Meniere’s disease
- Acoustic neuroma
- Sudden hearing loss
- Familial progressive SNHL
- Systemic disorders – diabetes ,hypothyroidism, kidney disease,multiple sclerosis,, blood dyscrasias.
(Organic)
Conductive hearing loss
congenital:
meatal atresia, fixation of stapes footplate, fixation of malleus head, ossicular discontinuity, congenital cholesteatoma.
Acquired:
Any obstruction in ear canal-wax, foreign body
Middle ear- perforation of tympanic membrane, fluid in middle ear, mass in middle ear, disruption of ossicles, fixation of ossicles(otosclerosis, tympanosclerosis, adhesive otitis media.),Eustachian tube blockage
sensorineural
results from lesions of cochlea,8 th nerve or central auditory pathways.
It may be congenital or acquired.
Congenital:
it is present at birth and it is result of anomalies of inner ear or damage to the hearing apparatus.
Acquired:
- infections of labyrinth
- trauma to labyrinth
- noise induced hearing loss
- ototoxic drugs
- presbycusis
- Meniere’s disease
- Acoustic neuroma
- Sudden hearing loss
- Familial progressive SNHL
- Systemic disorders – diabetes ,hypothyroidism, kidney disease,multiple sclerosis,, blood dyscrasias.
(Non-Organic)
- here there is no organic lesion.
- It is due to malingering or is psychogenic.
- degree of hearing loss
- mild impairment 26-40 dB
- moderate impairment 41-55 dB
- moderately severe 56-70 dB
- severe 71-91 dB
- profound more than 91 dB total
Vertigo
Causes of vertigo:
- peripheral vestibular disorders –
- which involves vestibular end organs and their first order neurons.
- Meniere’s disease
- Benign paroxysmal positional vertigo
- vestibular neuronitis
- labyrinthitis
- vestibulotoxic drugs
Central vestibular disorders
- vertebrobasilar insufficiency
- postero-inferior cerebellar artery syndrome
- basilar migraine
- cerebellar diseaese