Babak Saedi . MD
Assistant professor of Tehran university
OTOLARYNGOLOGY
Ear anatomy & physical
examination
 External ear
 Middle ear
 Internal ear
EAR ANATOMY
http://www.earaces.com/anatomy.htm#Cross%20Section%20Of%20Ear
Normal TM
 Malleus (short process
and handle
 Cone of light
 Incus
 Pars tensa
 The unbelievable
UMBO
Right TM
Middle Ear
 The inner ear communicates with the
acoustic environment outside of the body by
means of a funnel (pinna), a short tube (the
EAC), a thin membrane TM and three small
bones.
 The purpose of the middle ear and ossicular
chain is to overcome the impedance
mismatch of going from an air filled outer ear
to a fluid filled inner ear.
Middle Ear
http://www.iurc.montp.inserm.fr/cric/audition/english/ear/fear.htm
Ossicles
Impedance Mismatch
 The purpose of the middle ear and ossicular
chain is to overcome the impedance
mismatch of going from an air filled outer ear
to a fluid filled inner ear.
 Like yelling to someone underwater. About a
30 dB loss.
Inner Ear
Basic Structures
 There are three sections of
the inner ear: semicircular
canals (superior, lateral,
posterior), vestibule (midsection) and the cochlea
(snail shaped).
 The vestibule and
semicircular canals serve to
function in balance not
hearing.
 The cochlea functions in
hearing, by changing fluid
energy into neural energy.
http://oto.wustl.edu/cochlea/intro1.htm
http://www.neurophys.wisc.edu/h%26b/auditory/anatomy/a09.html
Cerumen in canal
 May advise parents to
soften first
 May remove yourself in
office
 At the VA: May
remove a lot of ear wax
in the ER
Differential


Diagnosis
external otitis or furunculosis
of external auditory meatus:
post auricular tenderness.
bullous myringitis: the
earache may be intense but
deafness only slight, the
membrane may be obscured
by a large hemorrhagic bleb or
blebs.
Otitis Media
 Red, Bulging
 Hyperemia
 Dullness of light reflex
 Opaque
ASOM
 Acute suppurative otitis media is one of the
most common infections of childhood. It may
accompany any upper respiratory tract
infection such as the common cold, measles,
scarlet fever, or influenza. When virulent
bacteria invade the middle ear, an acute
suppuration occurs.
Bacteriology
 The hemolytic streptococcus, staphylococcus ,
the pneumococcus and hemophilos are most
commonly responsible for the infection.
Serous OM
 Bulging, amber drum
 Decreased mobility
Tympanic Membrane
Perforation
CSOM OR COM
 Neglected or recurrent infection of the middle ear may
eventually produce a chronic change in the mucosa of the
ear or destruction of the periosteum covering the ossicles,
The infection then tends to become chronic. Chronic
infection of the middle ear is much more common in
persons who had ear disease in early children. Disease of
the ear in infancy and early children may arrest the normal
pneumatization of the mastoid. It is possible that the
same process alters the mucosa of the middle ear, so that
it is more susceptible to recurrent infection than is the
normal ear.
Cholestatoma
 Epithelium work as a tumor
 Complications :meningitis, labyrantitis ,
facial paralysis and brain abscess
 tympanomastoidectomy
Tumor
 Benign : osteoma , chondroma ,glumous
 Malignant : SCC , BCC ,ACC and metastasis
Ear:
Squamous cell carcinoma
Hearing loss
 Conductive
 Sensory neural
 Mixed
 Diagnosis :PTA , TYMPANOMETRY , SDS , &
SRT
 TRETMENT
Conductive
 COM
 Otosclerosis
 Trauma
 Congenital
Sensory neural
 Congenital
 Trauma
 Infection
 Presbucosis
 Drugs
 Tumor
 Menier
 occupational
Congenital
 Rubella
 Syphilis
 Toxoplasmosis
 Kernicterus
 Drugs
 Anoxia
NASAL ANATOMY
Bony Structure
Ethmoid
Maxilla
Palatine
Lacrimal
Pterygoid plate of
Sphenoid
Nasal
Inferior Turbinate
Arterial Supply
External Carotid
Maxillary A.
Sphenopalatine
Internal Carotid
Ophthalmic A.
Ant. Ethmoid
Post. Ethmoid
Supraorbital
Supratrochlear
Facial Analysis
Analysis of nose is very
important
Sinus




Maxillary
Frontal
Ethmoid
Sphenoid
Ethmoid Bulla
Uncinate Process
Hiatus Semilunaris
Function of Nose & Paranasal Sinuses
 Humidifying and warming inspired air
 Regulation of intranasal pressure
 Increasing surface area for olfaction
 Lightening the skull
 Resonance
 Absorbing shock
 Contribute to facial growth
Nasal & sinus disease
 Infection
 Rhinitis
 Epitasis
 Tumor
 Trauma
Viral Rhinosinusitis
 Most upper respiratory infections are viral
 Short lived, last less than 10 days
 Sinus mucosa as well as nasal mucosa is involved
 Most will clear without antibiotics
 Treatment: decongestants, nasal lavage, rest, fluids
Classification of Bacterial
Sinusitis
 Acute bacterial sinusitis- infection lasting 4
weeks, symptoms resolve completely (children
30 days)
 Subacute bacterial sinusitis- infection lasting
between 4 to 12 weeks, yet resolves completely
(children 30-90 days)
 Chronic sinusitis- symptoms lasting more than
12 weeks (children >90 )
Bacteria Involved in Acute
Bacterial Sinusitis
 Streptococcus pneumoniae
30%
 Haemophilus influenza
20%
 Moraxella catarrhalis
10%
Antibiotics for Acute Bacterial
Sinusitis
 Amoxicillin 500 mg tid for 10-14 days
 First line choice in most areas
 Local differences in antibiotic resistance occur
 Where beta-lactamase resistance is an issue
 Amoxicillin/clavulanate
 Cefuroxime
 Cefexim
 Cefprozil
CT Scan Maxillary and Ethmoid
Sinuses
Sinusitis
Sinus endoscopy
Allergic Rhinitis
Nasal Polyp
Septal deviation
Foreign body
Malignant tumor