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3 Otosclerosis
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Otosclerosis is a progressive disease with a marked familial tendency that affects bone surrounding the inner ear Lesions involving the footplate of the stapes result in increased impedance to the passage of sound through the ossicular chain, producing conductive hearing loss This may be corrected through surgical replacement of the stapes with a prosthesis (stapedectomy) When otosclerotic lesions impinge on the cochlea ( cochlear otosclerosis ), permanent sensory hearing loss occurs Some evidence suggests that cochlear otosclerosis level of hearing loss may be stabilized by treatment with oral sodium fluoride over prolonged periods of time (Florical 83 mg sodium fluoride and 364 mg calcium carbonate two tablets orally each morning) Fluorides have minimal adverse effects other than occasional mild gastric irritation, which may be eliminated by ingesting the drug with meals
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Siddiq MA Otosclerosis: a review of aetiology, management and outcomes Br J Hosp Med (Lond) 2006 Sep;67(9):470, 472 6 [PMID: 17017609]
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E Sigmoid Sinus Thrombosis
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Trapped infection within the mastoid air cells adjacent to the sigmoid sinus may cause septic thrombophlebitis This is heralded by signs of systemic sepsis (spiking fevers, chills), at times accompanied by signs of increased intracranial pressure (headache, lethargy, nausea and vomiting, papilledema) Diagnosis can be made noninvasively by magnetic resonance venography Treatment is with intra-
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4 Trauma to the Middle Ear
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Tympanic membrane perforation may result from impact injury or explosive acoustic trauma Spontaneous healing occurs in the great majority of cases Persistent perforation may result from secondary infection brought on by exposure
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to water Patients should be advised to wear earplugs while swimming or bathing during the healing period Hemorrhage behind an intact tympanic membrane (hemotympanum) may follow blunt trauma or extreme barotrauma Spontaneous resolution over several weeks is the usual course When a conductive hearing loss greater than 30 dB persists for more than 3 months following trauma, disruption of the ossicular chain should be suspected Middle ear exploration with reconstruction of the ossicular chain, combined with repair of the tympanic membrane when required, will usually restore hearing
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Ohlrogge M et al Temporal bone fracture Otol Neurotol 2004 Mar;25(2):195 6 [PMID: 15021784]
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CMDT 2008
and dental referral Repeated episodes of severe lancinating otalgia may occur in glossopharyngeal neuralgia Treatment with carbamazepine (100 300 mg orally every 8 hours) often confers substantial symptomatic relief Severe glossopharyngeal neuralgia, which is refractory to medical management, may respond to microvascular decompression of the ninth cranial nerve Infections and neoplasia that involve the oropharynx, hypopharynx, and larynx frequently cause otalgia Persistent earache demands specialty referral to exclude cancer of the upper aerodigestive tract
Shah RK et al Otalgia Otolaryngol Clin North Am 2003 Dec;36(6):1137 51 [PMID: 15025013]
5 Middle Ear Neoplasia
Primary middle ear tumors are rare Glomus tumors arise either in the middle ear (glomus tympanicum) or in the jugular bulb with upward erosion into the hypotympanum (glomus jugulare) They present clinically with pulsatile tinnitus and hearing loss A vascular mass may be visible behind an intact tympanic membrane Large glomus jugulare tumors are often associated with multiple cranial neuropathies, especially involving nerves VII, IX, X, XI, and XII Treatment may require surgery, radiotherapy, or both Pulsatile tinnitus thus warrants magnetic resonance angiography and venography to rule out a vascular mass
Durvasula VS et al Laser excision of glomus tympanicum tumours: long-term results Eur Arch Otorhinolaryngol 2005 Apr;262(4):325 7 [PMID: 15316822]
DISEASES OF THE INNER EAR 1 Sensory Hearing Loss
Diseases of the cochlea result in sensory hearing loss, a condition that is usually irreversible Most cochlear diseases result in bilateral symmetric hearing loss The presence of unilateral or asymmetric sensorineural hearing loss suggests a lesion proximal to the cochlea Lesions affecting the eighth cranial nerve and central auditory system are discussed in the section on neural hearing loss The primary goals in the management of sensory hearing loss are prevention of further losses and functional improvement with amplification and auditory rehabilitation
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