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revesion of external and middle ear pathologies.pptx

  1. Revision of external & middle ear pathologies DR AHLAM ALZUWAY
  2. Tympanic membrane anatomy 0⁰ degree otoscope view of normal Rt tympanic membrane
  3. Normal anatomy of medial aspect of Rt tympanic membrane
  4. Preauricular sinus/pit Preauricular appendages. Skin-covered tags between tragus and angle of mouth
  5. Abscess of the pinna, complicating a traumatic haematoma Cauliflower ear.
  6. Squamous cell carcinoma of the pinna. Perichondritis.
  7. Disorders of External ear canal: Exostoses
  8. Cerumen
  9. Trauma of the ear canal
  10. A&B -Furuncle(acute otitis externa) C –Acute diffuse otits externa D –Necrotizing (malignant) otitis externa
  11. Acute diffuse otitis externa Furuncle
  12. Chronic eczema of external auditory canal
  13. Otomycosis (fungal otitis externa)
  14. CSOM with cholesteatoma otomycosis superimposed with fungal infection
  15. Otomycosis candida Same ear after 10 days therapy infection a central perforation seen in TM
  16. Post-inflammatory stenosis of External ear canal
  17. Acute myringitis
  18. Bullous myringitis Granulomatous myringitis
  19. Aural polyp cholesteatoma of EAC
  20. Pleomorphic adenoma with extension into the external auditory canal
  21. Fibrous dysplasia of the temporal bone. The lesion completely obliterates the external auditory canal causing CHL
  22. Sequemous cell ca of external auditory canal
  23. Seq cell ca
  24. Seq cell ca
  25. Secretory otitis media with effusion
  26. *0titis media with effusion* Lt ear show air/fluid lt ear show air level bubbles in ME
  27. Acute otitis media
  28. Vesicle on the posterior part of the tympanic membrane caused by bullous myringitis.
  29. Adhesive otitis media • Right ear. Grade I atelectasis with the malleus slightly medialized. • An epitympanic retraction pocket is also seen. A yellowish middle ear effusion can be appreciated. • Pure tone audiogram revealed a 40-dB conductive hearing loss , whereas the tympanogram was type B, i.e., typical of middle ear effusion . • In this case, the insertion of a ventilation tube is indicated to avoid further retraction of the tympanic membrane, to aerate the middle ear, and to improve hearing.
  30. Adhesive otitis media • Left ear. Grade II atelectasis with marked epitympanic retraction. • The tympanic membrane touches the incus. The malleus is medialized. • Air-fluid level is seen in the anteroinferior quadrant. • The insertion of a ventilation tube is necessary to restore normal conditions.
  31. Adhesive otitis media Rt ear. Grade III atelectasis. The tympanic membrane, being adherent to the long process of the incus, caused erosion of the latter with subsequent conductive hearing loss. Part of the tympanic membrane adheres to the promontorium, so the round window is visible in transparency. A tympanoplasty should be performed with reinforcement of the tympanic membrane and incus interposition between the handle of the malleus and the stapes.
  32. Adhesive otitis media • Rt ear. Grade III atelectasis. • The tympanic membrane completely adheres to the long process of the incus (slightly eroded) and the stapes. • The second portion of the facial nerve is visible under the incus. • There is also a retraction pocket of the anterosuperior quadrant. In this case, placement of a ventilation tube is indicated to prevent further erosion of the ossicular chain and the formation of a cholesteatoma.
  33. Cholesterol granuloma
  34. CSOM Rt ear shows perforation at the posterior quadrants through which the long process of incus, incudostapedial joint, stapedius tendon ,pyramid &oval window are visible.. The remaining ant quadrants of tm are tympanosclerotic Rt ear shows perforation at post quadrants through it the head of stapes &the round window are visible ,long process of incus necrotized..the remaining of ant quadrants of tm show areas of atrophy & tympanosclerosis
  35. CSOM Lt ear. Posterior nonmarginal perforation. The incudostapedial joint, the promontory, and the round window are all visible Lt ear. Perforation of the post quadrants of the tympanic membrane. The skin advances along the posterosuperior border of the perforation toward the incudostapedial joint. The middle ear mucosa appears hypertrophic
  36. CSOM with Cholesteatoma • Large epitympanic erosion with cholesteatoma. The head of the malleus and the body of the incus are eroded. CT, coronal view. The cholesteatoma is located in the epitympanic area, lateral to the malleus. The middle ear is free.
  37. CSOM with Cholesteatoma
  38. •Epitympanic cholesteatoma
  39. CSOM with Cholesteatoma Lt ear. Cystic retrotympanic cholesteatoma situated posterior to the malleus. The tympanic membrane shows bulging at the level of the pars flaccida and slight retraction with tympanosclerosis in the posterior quadrants. Same case during an acute inflammatory episode. Note the increase in size of the cholesteatomatous cyst.
  40. Congenital cholesteatoma
  41. • case of congenital cholesteatoma (type A/B) evolved slowly in a 40-year-old female patient with no history of otitis. The patient referred to medical center for the worsening of a left subjective hearing loss. She had never had ENT consultations before. CT scan of the same case, axial view. The cholesteatoma involves both the epitympanic and slightly the mesotympanic area. The mastoid is free from the disease (arrow).
  42. • Case of congenital cholesteatoma evolved slowly in a 36-year-old male patient with no history of otitis. In this case, the patient complained of fullness and hearing loss CT scan, coronal view, The cholesteatoma involves the posterior epitympanum and the mesotympanic area. The hypotympanum seems free from the disease.
  43. Rare Retrotympanic Masses Meningioma • Left ear. This patient presented with dysphagia as her only symptom. A nonpulsating retrotympanic mass was noticed. The mass was whitish rather than the reddish color characteristic of glomus tumor. CT scan and MRI demonstrated an en- plaque meningioma invading the posterior surface of the temporal bone.
  44. Rare Retrotympanic Masses Facial nerve tumors • Left ear. A whitish retrotympanic mass is seen causing bulging of the posterior quadrants of the tympanic membrane. • A small reddish mass is visible in the posterior inferior regions of the external auditory canal (i.e., lateral to the annulus). • The patient complained of left hearing loss and nonpulsating tinnitus of 2 years’ duration. • In the last 3 months before presentation, left facial nerve paresis started to appear
  45. Rare Retrotympanic Masses Facial nerve tumors • Left ear. Pinkish retrotympanic nonpulsating mass. • The patient showed slight worsening of facial nerve function (grade II House–Brackmann scale). • Neuroradiological investigations suggested the presence of a facial nerve tumor affecting the mastoid segment. • In this case, a wait-and-scan protocol was adopted. • Exostoses of the external auditory canal can also be noted
  46. Rare Retrotympanic Masses High jagular bulb • Left ear. A high and uncovered jugular bulb reaching up to the level of the round window is visible through a posterior tympanic membrane perforation CT scan, coronal view. The high jugular bulb can be observed.
  47. Rare Retrotympanic Masses High jagular bulb • Right ear. high jugular bulb covered by a thin bony shell in a young male patient with a skull base malformation CT scan, axial view. The jugular bulb protrudes into the middle ear
  48. Rare Retrotympanic Masses High jagular bulb • Another case of high jugular bulb. • A posterior tympanic retraction pocket with myringoincudopexy is also visible CT scan of the same case, axial view, showing high and uncovered jugular bulb in the middle ear
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