Eustachean Tube and some other middle ear disease
Eustachian Tube :
# 26 mm in length
# Outer 12 mm bony , inner 14mm cartilaginous
# At birth it is a horizontal tube .
# In adult it makes an angle of 45 degree with the horizontal
# It opens 1.25 cm behind the posterior end of inferior turbinate . Closure of the tube is apassive process .
# It opens during swallowing with the help of tensor tympani muscle
Eustachian Tube Test :
1) Tympanometry (Best)
2) ET catheterization
3) Politzerization
4) Valsalva
SAFE CSOM :
# Tubotympanic CSOM
# Characterised by presence of permanent central perforation , some margin of Tympanic membrane left all around the perforation
#
Marginal perforation is seen in unsafe CSOM
C/F : 1) Ear discharge : Mucopurulent , not foul smelling , not blood stained , no bone erosion , no granulation
2) Hearing loss : Conductive
# Middle ear polyp formation may be seen ( pale polypi)
# Ossicular erosion may be seen
Note : Most common ossicle to be eroded is long process of incus b/o least blood supply
Ossicular erosion will increase hearing loss
Investigation : Pure Tone Audiometry
Treatment of Choice : Tympanoplasty
Myringoplasty
Myringoplasty : It is the repair of tympanic membrane perforation using a graft .
Temporalis fascia is most commonly used Ear should be dry for at least 6 weeks before surgery
Tympanoplasty : It is inspection and repair of middle ear ossicles in addition to myringoplasty.
5 types : Type 1 : All ossicles found normal
Type 2 : Malleus eroded . Graft is placed over incus
Type 3 : Malleus and Incus eroded . Graft is placed Stapes , a/k/a Myringo Stapedioplasty = Columella Tympanoplasty
Type 4 : Malleus , incus and stapes head eroded , only foot plate is eroded . Graft is placed over round window , done to maintain the phase difference between 2 windows .
Type 5: Fenestration operation , not done now a days . It is treatment of otosclerosis
Ossicular replacement prosthesis::
# These are artificial ossicles .
# made of Titanium or Teflon
# 2 types : 1) Partial for type 3
2) Total for type 4
# 26 mm in length
# Outer 12 mm bony , inner 14mm cartilaginous
# At birth it is a horizontal tube .
# In adult it makes an angle of 45 degree with the horizontal
# It opens 1.25 cm behind the posterior end of inferior turbinate . Closure of the tube is apassive process .
# It opens during swallowing with the help of tensor tympani muscle
Eustachian Tube Test :
1) Tympanometry (Best)
2) ET catheterization
3) Politzerization
4) Valsalva
SAFE CSOM :
# Tubotympanic CSOM
# Characterised by presence of permanent central perforation , some margin of Tympanic membrane left all around the perforation
#
Marginal perforation is seen in unsafe CSOM
C/F : 1) Ear discharge : Mucopurulent , not foul smelling , not blood stained , no bone erosion , no granulation
2) Hearing loss : Conductive
# Middle ear polyp formation may be seen ( pale polypi)
# Ossicular erosion may be seen
Note : Most common ossicle to be eroded is long process of incus b/o least blood supply
Ossicular erosion will increase hearing loss
Investigation : Pure Tone Audiometry
Treatment of Choice : Tympanoplasty
Myringoplasty
Myringoplasty : It is the repair of tympanic membrane perforation using a graft .
Temporalis fascia is most commonly used Ear should be dry for at least 6 weeks before surgery
Tympanoplasty : It is inspection and repair of middle ear ossicles in addition to myringoplasty.
5 types : Type 1 : All ossicles found normal
Type 2 : Malleus eroded . Graft is placed over incus
Type 3 : Malleus and Incus eroded . Graft is placed Stapes , a/k/a Myringo Stapedioplasty = Columella Tympanoplasty
Type 4 : Malleus , incus and stapes head eroded , only foot plate is eroded . Graft is placed over round window , done to maintain the phase difference between 2 windows .
Type 5: Fenestration operation , not done now a days . It is treatment of otosclerosis
Ossicular replacement prosthesis::
# These are artificial ossicles .
# made of Titanium or Teflon
# 2 types : 1) Partial for type 3
2) Total for type 4
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