A 30-year old male presents with gradually progressive hearing loss for 6 months but no other complaints.The tympanic membrane is normal to examination.Systemic examination is normal.The pure tone audiogram shows bilateral moderate mixed hearing loss with an air-bone gap of 30 dB on either side,and the acoustic reflexes are intact.Suggest the most appropriate line of investigation ( I ) and treatment ( T ).
I - 1]serial audiograms
I - 2]HRCT Temporal bone
I - 3]MRI Brain
I - 4]serum alkaline phosphatase
T - 1]reassurance and close follow-up
T - 2]oral sodium fluoride
T - 3]hearing aids
T - 4]stapedotomy
B-NOSE:true ( T ) or false ( F )
1]endarteritis obliterans is the predominant histological feature
2]acetic acid(vinegar) and liquid paraffin are instilled alternately to loosen and remove crusts
3]Young's closure is never done bilaterally at the same sitting
4]aggressive nasal surgery is a major risk factor
C-THROAT:single best answer
All of the following may be combined with uvulopalatopharyngoplasty(UPPP) in the treatment of obstructive sleep apnoea(OSA) except
4]tongue base resection www.entindia.net
Dr Srinivas (Bangalore)
Dr. Prahlada N.B(Bangalore)
Dr. Rishi Gautam Aggarwal (Ambala)
Dr. Deepak Dalmia(Mumbai)
In some patients, an outwardly bulging, thin atrophic area or "herniation" of the tympanic membrane will be encountered. These “pulsion hernias” are asymptomatic and do not seem to interfere in any way with normal epithelial migration along the surface of the tympanic membrane.
There appear to be two prerequisites necessary for the development of a pulsion hernia.
The first is a preexisting defect in the fibrous middle layer of the pars tensa of the tympanic membrane.
The second is the presence of positive pressure within the middle ear, which forces the thinned portion of the tympanic membrane laterally into the canal (the pulsion).
If the fibrous middle layer of the pars tensa were intact, the tympanic membrane would be unable to herniated laterally to any significant extent.
The thinness of the pars tensa of the tympanic membrane over the pulsion pocket suggests that the herniation of the tympanic membrane occurred in an area where the fibrous middle layer of membrane has disappeared (e.g., the site of a previous, healed perforation or retraction pocket), leaving an area where the membrane consists of only two layers (a dimeric membrane). www.entindia.net
Am J Otolaryngol. 2011 Mar-Apr;32(2):100-4. Epub 2010 Apr 13.
Impact on hearing of routine ear suctioning at the tympanic membrane.
OBJECTIVE: Patient and equipment safety has become increasingly scrutinized in today's medical care. Routine otolaryngologic evaluation often involves suctioning with Frazier-type suction devices in the ear canal for improved visualization, but data are limited on the potential acoustic trauma from ear canal suction devices. This study intends to document the objective and subjective effects of ear canal suctioning to identify any risk for hearing threshold shifts or other potential negative effects.
PATIENTS AND METHODS: Prospective study on 21 healthy volunteers enlisted for evaluation. Presuctioning tympanogram, audiogram, and otoacoustic emissions data were obtained. Spectrum analyses were recorded during ear canal suctioning with a probe microphone placed lateral to the tympanic membrane. Subjective data were recorded, and a follow-up audiogram and otoacoustic emissions were obtained to identify any temporary threshold shifts.
RESULTS: Spectrum analyses revealed a high degree of variability between subjects. A peak intensity of 111 dB sound pressure level was recorded. All patients tolerated suctioning, and none reported hearing loss. No threshold shifts were observed. Subjective data failed to correlate with the objective recorded intensities.
CONCLUSIONS: Clinicians and patients need to be acutely aware of potential risks and benefits from any medical intervention. Routine ear canal suctioning can be extremely loud and uncomfortable for patients. This study failed to document objective proof of hearing detriment from ear canal suctioning, although the possibility exists during office and surgical intervention. Further study and potential alternative suctioning methods deserve attention.
Heinrich Adolf Rinne (January 24, 1819 - July 26, 1868) was a German otologist born in Vlotho an der Weser. He received his doctorate from the University of Göttingen and practiced medicine in the city of Göttingen. Later he was a physician in Sandstadt near Stade (1857) and Hildesheim (1860).
In 1855 Rinne described the combined conductive process of the tympanic membrane and the ossicles of the middle ear. He is known for the eponymous Rinne test. The Rinne test is a hearing test conducted with a tuning fork, and is used to test and compare a patients' hearing via air conduction (normal process) or by way of bone conduction (sound to the inner ear through the mastoid). He reasoned that if a person hears a sound for a longer period of time through bone conduction than through air conduction, a disease is present somewhere in the conduction apparatus.
Despite his research, Rinne's test wasn't generally recognized until after his death, when otologists Friedrich Bezold and August Lucae (1835-1911) publicized Rinne's work in the early 1880s. www.entindia.net
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