Monday, July 31, 2017

Important Clinical Findings In The Tympanic Membrane and Middle Ear

“Chalk” patches. White areas of tympanosclerosis are common findings on examination of the ear drum. They are of little significance in themselves, and the hearing is often normal.

A past history of otorrhea in childhood or grommet insertion is usual. Chalk patches do occur with no
apparent past otitis media. Extensive tympanosclerosis with a rigid drum is a sequela of past otitis media, and the ossicles, too, may be fixed or noncontinuous.

Scarring of the drum. A gossamer-thin membrane can be seen to close this previously well-defined central perforation (arrow).


At first sight with the auriscope, a central perforation would appear to be the diagnosis; more careful
examination with a pneumatic otoscope will show that this thin membrane moves and seals the defect, giving reassurance that the drum is intact.

Scarring of the drum with retraction onto the round window, promontory, and incus is also evidence of past otitis media.

It is sometimes difficult to be sure whether this type of drum is intact; a thin layer of epithelium indrawn onto the middle-ear structures may seal the middle ear, and examination with the operating
microscope may be necessary to be certain of an intact drum.

Scarred tympanic membrane. A scarred tympanic membrane in which the drum has become atelectatic and indrawn onto the long process of the incus and promontory.


A retracted tympanic membrane which is thin and indrawn onto the long process of the incus (a), head of the stapes (b), promontary (c), and round window (d).

The stapedius tendon is also seen in this panoramic view obtained with a fiberoptic endoscope.


Traumatic perforation. A blow on the ear with the hand is a common cause of traumatic perforation
which has an irregular margin.

Pain and transient vertigo at the time of injury are followed by a tinnitus and hearing loss.

Healing perforation. Almost all traumatic perforations heal spontaneously within two months, a thin
membrane growing across the defect.
Traumatic perforations are usually central, but if the perforation extends to the annulus, healing may not occur. The extremely large traumatic perforations may also fail to close spontaneously.


Taking care to avoid water entering the middle ear and avoiding inflating the middle ear with the Valsalva maneuver are the only precautions the patient
need take.
A middle-ear infection with discharge is the commonest complication, usually settling with a course of topical and systemic antibiotics.
Blast injuries, barotrauma, foreign bodies or their careless removal, and even over-enthusiastic kissing of the ear may also cause traumatic perforations.

Central perforation. Acute otitis media with pus under pressure in the middle ear may rupture the drum, and although healing usually occurs, a permanent perforation can result. These perforations are usually central.

A small perforation may be symptom-free, but episodes of otorrhea with head colds and after swimming are common, along with a conductive hearing loss.
The otorrhea tends to be profuse and mucopurulent, and may be intermittent or persistent.
This type of central perforation, when dry, is successfully closed with a fascial graft (myringopalsty).
Other complications with central perforations are rare, so they are described as “safe” perforations. A
central perforation may persist after an episode of acute otitis media and otorrhea in childhood. Myringoplasty is usually delayed in children since closure by puberty is common. If, however, the
upper respiratory tract is free of infection, and the perforation is the site of recurrent infections with impaired hearing, these are indications to proceed with myringoplasty in childhood.

A posterior marginal perforation of the eardrum, taken with the fiberoptic camera, showing the round window and head of the stapes. A thin fibrous connection can be seen (arrow) which connects to the necrotic long process of the incus.


This type of ossicular discontinuity is a common cause of conductive hearing loss following otitis
media (with or without a perforation). Ossicular reconstruction surgery will restore the hearing.

Squamous epithelium on the incus. The marginal perforation may enable squamous epithelium to
migrate into the middle ear. In this ear, white squamous epithelium has formed on the incus.

Marginal perforations, therefore, are described as “unsafe” since there is a risk of cholesteatoma.

Attic perforation. Debris adherent to the pars flaccida of the drum (arrow) suggests an underlying
attic perforation.

Perforations of the pars flaccida (attic perforations) are invariably associated with cholesteatoma formation.

Cholesteatoma. The debris, when removed, exposes a white mass of epithelium characteristic of a
cholesteatoma (arrow).

Cholesteatoma is not a neoplasm; it is simply squamous epithelium in the middle ear. If ignored, it increases in size, becomes infected, and is associated with a scanty, fetid otorrhea. It may erode bone, leading to serious complications.
Extension to involve the dura with intracranial infection may occur, and the facial nerve and labyrinth too may be eroded. The extent of the cholesteatoma determines the danger:
A small attic pocket of epithelium is relatively harmless, and can be removed with suction, but an extensive mass of epithelium is dangerous and needs exploration and removal via a mastoidectomy
approach.
A chronic discharging ear is not painful, and persistent pain and headache, or severe vertigo, strongly
suggest an intracranial complication or labyrinth.

Mastoid abscess. A red, acutely tender swelling filling the
postauricular sulcus , and pushing the pinna conspicuously forwards and outwards, is characteristic of a mastoid abscess.

In the past, mastoidectomy was needed for an acute mastoid abscess complicating acute otitis media. This was extremely common in the preantibiotic era, and required exenteration of the mastoid air cells (cortical mastoidectomy).
The operation is now rarely performed in countries where antibiotics are available

28 comments:

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  8. God bless Dr. Omolowa for his marvelous work in my life, I was diagnosed of HERPES since 2018 and I was taking my medications, I wasn't satisfied i needed to get the HERPES out of my system, I searched out some possible cure for HERPES i saw a comment about Dr. Omolowa, how he cured HERPES,DIABETES,HIV,and CANCER with his herbal medicine, I contacted him and he guided me. I asked for solutions, he started the remedy for my health, he sent me the medicine I took the medicine as prescribed by him and 14 days later i was cured from HERPES, Dr. Omolowa truly you are great, do you need his help also? Why don’t you contact him through his EMAIL: dr.omolowa@gmail.com call or whatsApp him on +2347014035034

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  11. I am so Happy to be writing this article in here, i am here to explore blogs forum about the wonderful and most safe cure for HERPES SIMPLEX VIRUS.I was positive to the Virus called HERPES and i lost hope completely because i was rejected even by my closet friends. i searched online to know and inquire about cure for HERPES and i saw testimony about DR Ebhota online on how he cured so many persons from Herpes Disease so i decided to contact the great herbalist because i know that nature has the power to heal everything. i contacted him to know how he can help me and he told me never to worry that he will help me with the natural herbs from God! after 2 days of contacting him, he told me that the cure has been ready and he sent it to me via FEDEX or DHL and it got to me after 4 days! i used the medicine as he instructed me (MORNING and EVENING) and i was cured! its really like a dream but i'm so happy! that's the reason i decided to also add more comment of Him so that more people can be saved just like me! and if you need his help,contact his Email: (drebhotasoltion@gmail.com) You can contact him on WhatsApp +2348089535482 He also have the herb to cure difference cure for any sickness (1) HERPES,
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    (6) IMPOTENCE,
    (7) BARENESS/INFERTILITY
    (8) DIARRHEA
    (9) ASTHMA..

    ReplyDelete
  12. Always, anywhere and anytime,I feel very comfortable now all to the work of Dr Ebacol,the Herbalist who prepare for me the remedies to my health challenges.i could feel more comfortable when he explained to me how dangerous it's caring Herpes with me getting affected easily with Other sexually transmitted infections. Genital sores increases my risk of transmitting or contracting other sexually transmitted infections, including AIDS.
    Newborn infection. ...nd a lover who ran into it and had a shock on me after the checkup and develop stroke.
    This has been my earnest prayers for the physician therapist to come in with positive solutions to remedies Herpes and most
    Bladder problems. ...
    Meningitis. ...
    Rectal inflammation (proctitis).
    I was so scared when he says that because I fou viral infections. I'm now free and I thank God for leading me to see others getting cured with Herbs. I decided to try and found out that the best way I would have done was to get rid of it and give my testimony. Glory to God I became free after I received his medicine from the DHL and applied as instructed. Till date I had no SYMPTOMS nor virus to detect of me, I called him and thankful for what he did,and ask if he could cure my stroke boyfriend,he said yes and did the same preparation to my boyfriend for his stroke and Recovered from it. Nothing is impossible with Herbs IN CURES, you're the next if you will be willing to apply his medicine and instructions on how to manage.
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    ReplyDelete
  13. HOW I GOT CURED OF HERPES DISEASE
    I'm here to testify about what DR. OSO did for me. I have been suffering from (HERPES) disease for the past 5 years and had constant pain,especially inside my body. During the first year,I had faith in God that I would be healed someday. This disease started circulating all over my body and I have been taking treatment from my doctor, few weeks ago I came across a testimony of one lady on the internet testifying about a Man called DR. OSO on how he cured her from herpes disease. And she also gave the email address of this man and advised anybody to contact him for help for any kind of sickness that he would be of help.so I emailed him telling him about my (HERPES) he told me not to worry that i was going to be cured!! Well I never believed it,, well after all the procedures and remedies given to me by this man few weeks later i started experiencing changes all over me as DR. OSO assured me that I will be cured,after some time. I went to my doctor to confirm if I had finally healed Behold, it was TRUE,the test came out negative. So friends my advice is if you have such sickness or any other at all you can contact DR. OSO for help.

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    you can also email me for more information about DR oso via smithmorgan2777@gmail.com ALL THANK TO DR OSO ................  

    ReplyDelete
  14. I am here to express my profound warm gratitude to the Natural Herbal Medicine, which i got from Dr Lawson, he has done a great thing in my life, 4months ago i was diagnosed with Herpes virus and ever since then i have been very unhappy, i was so down broken everyday, until one day when i came across a shocking testimony about how Dr Lawson cured someone of his herpes and other virus, without wasting much time i contacted him immediately on his whatsApp number +2348154635774 and after i explain myself to him about how terrible i have been, and he assure me that he will help me to cure my Herpes virus,after he has prepared the herbal medicine he sent it to me and when i have received it and started using it i was totally cure within 2weeks i am forever grateful to Dr Lawson for helping me out with his herpes prescription that cured my virus. contact his email address: dr.lawsonherbalhome@gmail.com or you can call or whatsApp his Mobile number +2348154635774, you can follow him or message him on Instagram for more information @dr_lawson9 and also here's his website https://drlawsonherbalhome.weebly.com is also capable of curing other diseases like Fibroid Hiv Herpes Copd Diabetes etc Save life’s today by sharing this testimony

    ReplyDelete
  15. Happiness is all i see now I never thought that I will be cured from HERPES virus again. I have been suffering from a deadly disease (HERPES) for the past 3 years now, I had spent a lot of money going from one places to another, from churches to churches, hospitals have been my home every day residence. Constant checks up have been my hobby not until this faithful day, I was searching through the internet, I saw a testimony on how DR agaba helped someone in curing his HERPES disease, quickly I copied his email which is Dragabasolutionhome@gmail.com just to give him a test I spoke to him, he asked me to do some certain things which I did, he told me that he is going to provide the herbal cure to me, which he did, then he asked me to go for medical checkup after some days after using the herbal cure, behold I was free from the deadly disease, he only asked me to post the testimony through the whole world, faithfully am doing it now, please brothers and sisters, he is great, I owe him in return. if you are having a similar problem just email him on : Dragabasolutionhome@gmail.com or WhatApp: +2349074536486 

    ReplyDelete
  16. I am so Happy to be writing this article in here, i am here to explore blogs forum about the wonderful and most safe cure for HERPES SIMPLEX VIRUS.I was positive to the Virus called HERPES and i lost hope completely because i was rejected even by my closet friends. i searched online to know and inquire about cure for HERPES and i saw testimony about DR Ebhota online on how he cured so many persons from Herpes Disease so i decided to contact the great herbalist because i know that nature has the power to heal everything. i contacted him to know how he can help me and he told me never to worry that he will help me with the natural herbs from God! after 2 days of contacting him, he told me that the cure has been ready and he sent it to me via FEDEX or DHL and it got to me after 4 days! i used the medicine as he instructed me (MORNING and EVENING) and i was cured! its really like a dream but i'm so happy! that's the reason i decided to also add more comment of Him so that more people can be saved just like me! and if you need his help,contact his Email: (drebhotasoltion@gmail.com) You can contact him on WhatsApp +2348089535482 He also have the herb to cure difference cure for any sickness (1) HERPES,
    (2) DIABETES,
    (3) HIV&AIDS,
    (4) URINARY TRACT INFECTION,
    (5) HEPATITIS B,
    (6) IMPOTENCE,
    (7) BARENESS/INFERTILITY
    (8) DIARRHEA
    (9) ASTHMA..

    ReplyDelete
  17. I do not normally like giving my views about certain matters, but the Herpes treatment solution that i ordered from Dr Olori is simply too great not to share due to its fast and effective outcomes. I saw a massive development right after just a couple weeks. This morning I tested negative, email droloriherbalcenter@gmail.com .
     You can place orders via https://drolorimiraclemedicine.weebly.com/

    ReplyDelete
  18. I GOT CURED FROM HERPES VIRUS I was diagnosed of HERPES virus and i have tried all I can to get cured but all to no avail,,until I saw a post in a health forum about a herbalist man who prepare herbal medications to cure all kind of diseases including #HERPES virus,at first I doubted if it was real but decided to give it a try,when I contacted this herbalist via his email and he prepared a #HERPES herbal cure and sent it to me via DHL delivery company service, when I received this herbal medicine, he gave me step by direction on how to apply it,after applying the way I was instructed,I was totally cured of this deadly disease called HERPES, all thanks to Dr OGODO Email this great herbal doctor via his email Ogodoherbalhomesolution@gmail.com
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    HE CAN ALSO CURE SICKNESS LIKE
    {1}HIV/AIDS
    {2}DIABETES
    {3}EPILEPSY
    {4} BLOOD CANCER
    {5} HPV
    {6} ALS
    {7} HEPATITIS
    {8}LOVE SPELL
    {9} SICKLE AND ANEMIA
    Only DR OGODO Can Help You I Love You Father.

    ReplyDelete


  19. I am so Happy to be writing this article in here, i am here to explore blogs forum about the wonderful and most safe cure for HERPES SIMPLEX VIRUS.I was positive to the Virus called HERPES and i lost hope completely because i was rejected even by my closet friends. i searched online to know and inquire about cure for HERPES and i saw testimony about DR Ebhota online on how he cured so many persons from Herpes Disease so i decided to contact the great herbalist because i know that nature has the power to heal everything. i contacted him to know how he can help me and he told me never to worry that he will help me with the natural herbs from God! after 2 days of contacting him, he told me that the cure has been ready and he sent it to me via FEDEX or DHL and it got to me after 4 days! i used the medicine as he instructed me (MORNING and EVENING) and i was cured! its really like a dream but i'm so happy! that's the reason i decided to also add more comment of Him so that more people can be saved just like me! and if you need his help,contact his Email: (drebhotasoltion@gmail.com) You can contact him on WhatsApp +2348089535482 He also have the herb to cure difference cure for any sickness (1) HERPES,
    (2) DIABETES,
    (3) HIV&AIDS,
    (4) URINARY TRACT INFECTION,
    (5) HEPATITIS B,
    (6) IMPOTENCE,
    (7) BARENESS/INFERTILITY
    (8) DIARRHEA
    (9) ASTHMA..

    ReplyDelete
  20. We tried to get pregnant for a few years in a local clinic. There were no results. We've tried everything possible but nothing. We were recommended to use donor eggs. I knew we have to try herbal made medicine. I was terrified. I didn't know how to go about it and where to begin my search. When my friend recommended me to Dr Itua herbal medicine in Western African. I thought she was joking. I knew nothing about that country and I was afraid  with shame I must say I thought it was a little bit...wild? Anyway she convinced me to at least check it out. I've done the research and thought that maybe this really is a good idea. Dr Itua has reasonable prices. Also it has high rates of successful treatments. Plus it uses Natural Herbs. Well I should say I was convinced. My Husband gave it a try and now we can say it was the best decision in our lives. We were trying for so long to have a child and suddenly it all looked so simple. The doctors and staff were so confident and hopeful they projected those feelings on me too. I am so happy to be a mother and eternally thankful to Dr Itua  and Lori My Dear Friend. Don’t be afraid and just do it! Try Dr itua herbal medicine today and sees different in every situation.Dr Itua Contact Info...Whatsapp+2348149277967/drituaherbalcenter@gmail.com Dr Itua have cure for the following diseases.All types of cancer,Liver/Kidney inflammatory,Fibroid,Infertility.Diabetes,Herpes Virus,Diabetis,Bladder cancer,Brain cancer,Esophageal cancer,Gallbladder cancer,Gestational trophoblastic disease,Head and neck cancer,Hodgkin lymphoma. Intestinal cancer,Kidney cancer,Leukemia,Liver cancer,Lung cancer,Melanoma,Mesothelioma,Multiple myeloma,Neuroendocrine tumors. Non-Hodgkin lymphoma,Oral cancer,Ovarian cancer,Sinus cancer,Skin cancer,Soft tissue sarcoma,Spinal cancer,Stomach cancer. Testicular cancer,Throat cancer,Thyroid Cancer,Uterine cancer,Vaginal cancer,Vulvar cancerBipolar Disorder, Bladder Cancer,Colorectal Cancer,HPV,Breast Cancer,Anal cancer.Appendix cancer.,Kidney Cancer,Prostate Cancer,Glaucoma., Cataracts,Macular degeneration,Adrenal cancer.Bile duct cancer,Bone cancer.Cardiovascular disease,Lung disease.Enlarged prostate,OsteoporosisAlzheimer's disease,Brain cancer.Dementia.Weak Erection,Love Spell,Leukemia,Fribroid,Infertility,Parkinson's disease,Inflammatory bowel disease ,Fibromyalgia.

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  25. I started on COPD Herbal treatment from Ultimate Health Home, the treatment worked incredibly for my lungs condition. I used the herbal treatment for almost 4 months, it reversed my COPD. My severe shortness of breath, dry cough, chest tightness gradually disappeared. Reach Ultimate Health Home via their website at www.ultimatelifeclinic.com I can breath much better and It feels comfortable!

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  26. My names are Julia moreton I’m a citizen of UK, My younger sister was sicking of
    breast cancer and her name is Florence   I and my family have been taking her
    to all kind of hospital over here(UK) still yet no good result. I decided to go to
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    called Sophia Charlotte,   she testifies to the world about the goodness of a
    herbal man who has the roots and herbs to cure all kind of disease and the
    herbal man email was there. So I decided to contact the herbal man @ kokobiherbalremedycentre@gmail.com for my
    younger sister to see if he can cure her from the ailment that has befallen her(breast cancer). I contacted him and told him
    my problem he told me that I should not worry that my sister will be
    cure, he told me that there is a medicine that he is going to send give to me to cook and give it to my sister to drink for one week, so I ask how
    can I receive the cure that I am in UK, he told me
    That I will pay for the delivery service. The courier service can
    transport it to me so he told me the amount I will pay, so my dad paid for
    the delivery fee. two days later I receive the cure from the courier
    service so I used it as the herbal man instructed me to, before the week runs out, my sister cancer was healed and it was like a dream to me not
    knowing that it was physical I and my family were very happy about the
    miracle of Doctor kokobi. my dad wanted to pay him 5 million  dollars as token of our appreciation towards his good work but the
    herbal man declined the offer which I don't know why, he only say that I should tell the world about him
    and the miracle he perform so am here now to tell the world about him if
    you or your relative is having any kind of disease that you can't get a solution to from
    the hospital please contact kokobiherbalremedycentre@gmail.com or WhatsApp him
    +254746618873 or call him via his calling line +2348114448587 . And if you need more information about the doctor you can send me an mail @
    juliamoreton78@gmail.com@gmail.com 

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  28. I was depressed when the doctor told me that I have been diagnosed with HERPES and HIV disease… I thought about my Family, I know my Family will face a serious problem when I'm gone, I lost hope and I wept all day, but one day I was searching the internet and I found Dr.0sagie contact number. +2347030465649 I called him and he guided me. I asked him for solutions and he started the remedies for my health. Thank God, now everything is fine, I'm cured by Dr.obudu herbal medicine, I'm very thankful to Dr.obudu and very happy with my hubby and family. email him on (drosagiesolutiontemple@gmail.com OR DROSAGIESOULTIONTEMPLE@YAHOO.COM ) o or you can also reach him through WhatsApp number+2347030465649 He can also cure so many sickness

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