Disease of the inner ear

1
Disease of the inner ear
2
(No Transcript)
3
(No Transcript)
4
(No Transcript)
5
Disease of the inner ear

• Congenital
• Trauma
• Deafness and noise
• Infection
• Miscellaneous conditions of the inner ear

6
congenital

• Hereditary
• ???????????????????
• Natal
• neonatal

7
trauma

• Fracture base of skull
• Longitudinal fracture
• Transverse fracture
• Concussion of labyrinth

8
Deafness and noise

• Acoustic trauma
• Noise-induced hearing loss
• Labyrinthine window rupture
• Trauma due to compression

9
Infection

• Otitis labyrinthitis
• Circumscibed lab.
• Diffuse serious lab.
• Manifest diffuse purulent lab.
• Dead lab.
• Other forms of infective labyrinthitis
• Meningitis
• Hematogenous spread
• Syphilis labyrinthitis
• Vestibular neuritis

10
Miscellaneous conditions of the inner ear

• Menieres disease
• Presbycusis
• Ototoxicity
• Hearing loss due to vascular insufficiency
• Psychogenic deafness
• Hysterical ( functional )
• Mallingering
• Psychogenic overlay
• Tinnitus
• Benign paroxysmal positional vertigo
• Acoustic neurilemmoma

11
Noise-induced hearing loss

• ????????? sensorineural hearing loss ???
  prolonged exposure ??????????? ????
  ?????????????????? ???????????
• ??????????????????????????????
  ?????????????????????????????????
  ?????????????????????????????????????????? ??
  temporary threshold shift ??????????? (
  ??????????????????? )
• ????????????????????? ( permanent loss )
  ????????????????????????????? basal turn ???
  cochlea ??????????????????????????? ?????? 4 KHz
  ???????????????? outer hair cell ????
• ????????????????????????????????????????????????
  ??????

12
(No Transcript)
13
(No Transcript)
14
Noise-induced hearing loss

• Treatment
• Rest
• drug increase peripheral blood flow to inner
  ear
• Vitamin B complex
• Prevention
• screening in high risk person
• ear plug/muff
• avoid exposure

15
Presbycusis

• ?????????????????????????? ???????????????????????
  ??? 55 ??
• ??????????????? vascular insufficiency ???
  thrombosis ????sclerosis ?????? exposure
  ??????????????????????

16
pathological

• Atrophy of epithelial tissue ?????? basal turn
  ??? cochlea ????? hair cell ???? ?????? high tone
  loss
• Atrophy of neural tissue ?? spiral ganglion cell
  ??????? high tone loss speech discrimination
  ????
• Atrophy of stria vascularis ?? flat audiogram (
  metabloic presbycusis )
• Loss of elasticity of basilar membrane
  ????????????????? spiral ligament

17

• Signs symptoms
• ???????????????????????????????????????????
• ??????????????????????????????????????????????
• ???????????????????????????????????????????????
• High freq. hearing loss
• Treatment
• ??????????????????? ????????????????????????
  ???????????????

18
ototoxicity

• ??????????????????????????????????????????????????
  ?????????????????????????
• ?????????????????????????????????????????????????
• ?????
• ??????????????????????
• ?????????????????????????????????????
• ?????????????????????????????? 1 ????

19
ototoxicity

• ??????????????????????????? cochlear
  ???vestibular part
• 1.Aminoglycoside
• -streptomycin,gentamycin ??????? vestibular
• -neomycin,vancomycin,ganamycin,
• framycetin,bramycin ??????? cochlear

20
ototoxicity

• 2.Diuretics ?????? ethacrenic acid,furosemide
• 3.Antiprotozoal ?????? quinine,chloroquine
• 4.Analgesic antipyretic ?????? saliclate ,
  NSAID
• 5.Cisplatin

21
ototoxicity

• Signssymptoms
• 1.tinnitus ??????????????
• 2.hearing loss ???????high tone ???????low tone
• 3.vertigo
• treatment
• -?????? ??????????????????????????????
• -??????clearance????? ???? ?????????????????????
• -???? audiogram ????????

22
Hearing loss due to vascular insufficiency

• ??????????????????
• Vasculitis
• Embolization
• Thrombosis
• Hypoxia

23
Hearing loss due to vascular insufficiency

• Pathology
• ?????????????????????? degeneration ???
  ganglion cell ,stria vacularis , spiral ligament
• Clinical
• ??????
• ?????????????? ?????????? ?????????

24
Hearing loss due to vascular insufficiency

• Treatment
• ?????????????????????????????? vasodilator
• ???????????????????? low molecular weight
  infusion

25
Acoustic neurilemmoma
26
Acoustic neurilemmoma

• benign tumor
• schwann cell of superior vestibular branch
• unilateral 95
• Internal auditory canal ? cerebellopontine
• angle

27
Acoustic neurilemmoma

• Symptoms vary with the size and location of the
  tumor
• As the tumor grows along the vestibular nerve it
  may cause this nerve to quit working
• If the tumor becomes large enough, it may
  compress and affect the cranial nerves at
  cerebellopontine angle, or even the cerebellum
  and brain stem

28
Acoustic neurilemmoma
29
Sign Symptom

• Unilateral SNHL, tinnitus, fullness in the ears,
  vertigo, unsteadiness
• 2. Facial numbness and tingling, facial
  paralysis
• 3. Incoordination , staggering gate
• 4. Headache, vomiting, papilledema
• 5. Dysarthria,dyaphagia,respiratory depression

30
Investigation

• Screening test
• 1.Brainstem ERA
• 2.Bithermal caloric test
• 3.Tomogram of internal acoustic canal
• - ??????????????????? 2??3 ????? CTscan ???
• - ???????????????????????????????????????????????
  ?? 3-6?????????? 3 ??
• ?????????????? CT scan air contrast ???? MRI

31
CT scan
32
MRI
33
Treatment

• Conservative (wait and see)
• - periodic monitoring with serial hearing tests
  and/or MRI scans
• - usually reserved for tumors of less than one
  centimetre in size
• Radiation
• - when the risk of surgery is high because of
  other medical problems
• Surgical removal
• - preferred treatment option in most cases and
  may also allow preservation of hearing.

34
TREATMENT

• SURGERY
• 1.Translabyrinthine approach
• 2.Middle cranial fossa approach
• 3.Retrosinus approach
• 4.Suboccipital approach

35
Tinnitus

• ??????????????????????????????????????????????????
  ????????????????
• ?????
• - ????????????????
• - ???????????????????????????? presbycusis ???
• Menieres disease
• - warning symptom ??? ototoxicity,
• acoustic trauma, noise-induced hearing
• loss
• - palsatile tinnitus ???? glomus tumor

36

• - ???????????????????
• - ???????????????? ???? sepsis, migraine,
• tumor, vascular disease
• ???????? reassurance
• minor transquilizer
• tinnitus masker

37
QA
38
????? Inner ear disease
39
???????? Acoustic trauma ??? noise induced
hearing loss ??????????

• ???????????????????????? ???? ????????????????????
  ??????????? ???? ???????????????? ??????????
  noise-induced hearing loss
• ???????????????????????????? ???? ?????? ???
  ?????????? acoustic trauma ???????

40
????????????????????????????? presbycusis ?? 5 ???

• ?????????????????? ?????????????????????????? 55
  ??
• ???????????????????????????????????????????
• ??????????????????????????????????????????????
• ???????????????????????????????????????????????
• High freq. hearing loss

41
????? test ???????????? psychogenic deafness

• ABR

42
Thank you