- Perforation of the tympanic membrane may result
from foreign bodies, excessive pressure, or infection. Deafening may
- Skull fractures, may be accompanied by meningeal
tear and perforation of tympanic membrane. In this case, severe bleeding
and/or escape of CSF through the ruptured membrane, and external auditory
meatus (CSF otorrhea ) occur.
- Sometimes, a fracture may involve the bony part of
the external auditory meatus, and cause bleeding and/or loss of CSF
via external auditory meatus, even when the tympanic membrane is intact.
- When the tympanic membrane, has to be incised e.g.
to drain pus from the tympanic cavity; the incision is made postero
inferiorly . This is because the superior part is more vascular, and
the chorda tympani nerve and ear ossicles may be damaged.
- Inflammation in the tympanic cavity is called otitis
media. It (the infection) may spread to the mastoid antrum, or through
meningitis and/ or cerebritis and even a brain abcess. Through veins,
the infection may also reach the superior petrosal, sigmoid, and the
other venous sinuses.
- Ear ache, may be referred from distant sites from
distant sites e.g.:
- The oral cavity-tongue, dental abcess e.t.c,
via the Mandibular nerve
- Pharynx, including palatine tonsils via the
- Larynx, via the vagus nerve.
Earache due to otitis media is not worsened by movements
of tragus in adults (it may be in infants and children). However, because
the cartilage in the tragus is continous with that in the external acoustic
meatus; the pain of otitis externa is made much worse by movement of
- The auditory tube forms a route through which infections may pass from the nasopharynx to the tympanic cavity, especially in
Swelling of its mucous membrane easily blocks the auditory
tube. When this happens, residual air in the tympanic cavity is usually
absorbed into the mucosal blood vessels. This results in lowering of
pressure in the tympanic cavity; retraction of the tympanic membrane,
and interference with its movement. This affects hearing. Fluid may
exude into the tympanic cavity (serous otitis).
Outstanding Auricle / Bat Ear
These are unduly prominent ears. This feature becomes less prominent with development of mastoid process. In marked cases. Plastic surgery is performed.
Congenital Aural Fistulae
This is an opening usually found in the helix or tragus. It leads to a fine blind canal. It is a remnant of the 1st branchial cleft. It may block and lead to a cyst or abscess. Treated by excision
Hematoma of auricle
Results from injury. Blood accumulates under the perichondrium forming a swelling on the lateral or anterior surface of the auricle. Considerable pain is experienced. Inflammation may result in destruction of cartilage and finally swelling of the auricle
- A diffuse inflammation of the external auditory meatus. Most common mode of infection is by scratching / poking the ears with contaminated fingers/ objects. Common also with ill fitting hearing aids
- Because of tight adherence of skin to the cartilage/ bone, the condition is very painful
A sense of heat is felt owing to the increased vascularity Soon thee walls of the meatus begin to weep, giving some relief to the pain
Ear wax is sufficiently fluid to be removed at each washing. Accumulation is precipitated by:
- Undue narrowness of the passage
- Presence of infection in the meatus
- Excessive or abnormally thick secretion
- Presence of foreign body
- Abnormal body/ cartilaginous growth causing blockage
- Irregular/ inappropriate cleaning of ears.
Foreign bodies in the ear
- These are usually introduced by patients themselves especially children. They include:
- Inanimate objects such as beans and peas which swell with moisture or beads, buttons and shells which do not swell with moisture.
- Care must be taken when attempting removal as this may push them deeper. They may be harmless and remain there for years if the ear drum is not damaged.
- On the other hand, they may block the meatus and cause deafness or trigger inflammation. Some get badly infected.
- Animate foreign bodies include insects and maggots.
- Meatal Atresia and Stenosis
- Usually congenital but can be caused by chronic inflammation
Traumatic rupture may be caused by:
- Accidentaly pushing in objects
- When attempting to clean
- Fall on side of head
- Unskillful attempts to remove foreign bodies
- A kiss on the ear
- Forceful and careless syringing
Otitis media refers to inflammation of the middle ear. Infection frequently spreads to middle ear from the pharynx through auditory tube. From the middle ear the infection can spread in various directions:
- To the mastoid process to cause mastoiditis
- To cranial cavity and cause meningitis, encephalitis and brain abscess
- To the jugular vein leading to venous thrombosis
- To the inner ear and cause labyrinthitis
- To bone and cause osteomyelitis
- Pharyngeal abscess secondary to otitis media may develop in two ways:
Directly from tympanic auditory tube
Indirectly through mastoid air cells or from an extradural abscess – the pus first forming in the suboccipital regiona deep to digastric muscle
Caries of the ossicles: Caries and necrosis of the ossicles may occur in chronic otitis media
Plast reconstruction of middle ear to overcome conduction deafness resulting from complications of otitis media
This is an ear ache. It can occur when ear is healthy. Because the ear is supplied by twigs from fifth, seventh, nineth and tenth cranial nerves, painful stimuli from the ear cause pain to be experienced in the ear for example:
- Disease of lower molars
- Throat diseases like tonsilits
- Diseases in the posterior cranial fossa
- Affections of sphenoidal sinuses
- Geniculate ganglionitis
Injury to laryngeal nerves
- Surgery such as thyroidectomy
- Compression by tumors
- Compression from goitre
- Weakening or paralysis of laryngeal muscles with consequent impaired voice production
- Anaesthesia of laryngeal mucosa, impairing protective reflexes. Foreign bodies may then easily enter the larynx
Cancer of larynx
- Common in smokers
- Presents with persistent hoarseness often associated with ear ache and dysphagia
- Removal of larynx may be performed in severe cases of laryngeal cancer
- Vocal rehabilitation is then accomplished by the use of electrolarynx, a tracheo-esophagel prosthesis or esophageal speech (regurgitation of inspired airs)
Age changes in the larynx
1) At puberty in boys because of testosterione the larynx enlarges due to :
- Enlargement of allcartilages
- Doubling of anteroposterior diameter doubles
- lengthening and thickening of Vocal folds
This growth accounts for pubertal voice changes
2) In old age say after 60 yrs, the large cartilages even ligaments may ossify. This may explain the voice changes occurring in old age/
Fractures of laryngeal skeleton
- These may occur in traffic accidents or sports
- Produce submucous hemorrhage and edema, respiratory obstruction, hoarseness and temporary inability to speak.
Acute inflammation due to viral or bacterial infection or allergy may cause mucosal edema severe enough to cause dysphagia or aphonia (loss of voice)