بسم الله الرحمن الرحيم

1. بسم الله الرحمن الرحيم

2. Disease of The tympanic Membrane Prof.Dr. Ahmed Allam Anatmy & physiology Review

3. The external Ear The Auricle The External Auditory Canal The Tympanic Membrane • Shape; • oval, about 1 cm in diameter • Concave laterally • Two unequal pars: • 1- Pars flaccida (small upper part ) 2- Pars tensa (major lower part) • Site : - At the medial part of the external canal - Separates the external ear from the middle ear

4. Structure of the tympanic membrane THREE LAYERS 1-Outer skin layer; contineous with the skin of the external canal 2- Middle fibrous layer: well formed in Pars tensa while poorly formed in Pars flaccida 3 Inner mucosal layer : contineous with the mucosa of the middle ear

5. Physiology of Hearing Conductive component Sensorineural component

6. The conductive component • Auricle • External canal • Drum • Ossicles • ET • Tympanic muscles

7. The SN component • Cochlea • Cochlear nerve

9. Traumatic Drum Perforation Or Rupture Tympanic Membrane

10. Etiology Indirect trauma Direct trauma Hand Slap Otitic barotrauma Explosion • FB • Self inflicted • Ear wash • Longitudinal temporal bone fracture دبوس شعر

11. Symptoms Historyof trauma Earache at the time of trauma Mild bloody otorrhea at the time of trauma Air coming from the ear on nose blowing Hearing loss & Tinnitus

12. Signs The perforation Tunning fork : Conductive deafness

13. What is difference between traumatic and pathological drum perforation

14. Conservative - Antibiotic - No forcible blowing - No ear wash - No ear drops - Put ear plug or piece of cotton soaked in ointment during head Wash قطنه بفازلين في الأذن قبل الاستحمام Surgical بعد 3 شهور واذا لم يحدث استجابه Myringoplasty Treatment

15. Discuss the different colors of the drum and different sites ofdrum perforation in middle ear diseases 1-  Otitic barotrauma:  i.e middle ear trauma due to rapid and  marked decrease of middle ear pressure below the atmospheric pressure  In mild cases the drum is retracted and hyperaemic, in moderate cases the drum shows  middle ear effusion while in severe cases the drum is ruptured

16. 2-Bullous myringitis: reddish bullae on the drum & external canal 3-Acute otitis media in adult:  in stage of hyperaemia the drum is hyperaemic at the periphery and along the handle of malleus giving car wheel appearance,  in stage of suppuration the drum is bulging red with loss of landmarks as the cone of light and handle of malleus 4-Acute otitis media in children: the tympanic membrane is hyperaemic with loss of luster but it resists bulging because it is thicker than that of the adult Bulging drum

17. 5- Secretory otitis media:  the drum is amber yellow to dull gray 6- otosclerosis: rarely the tympanic membrane has the flamingo red tinge called Shwartz sign which indicates active otosclerosis 7- Glomus tympanicum :  a red mass behind an intact drum which blanches on compression by the pneumatic otoscope or Seigle’s speculum 8- Glomus jagulari: gives the characteristic sun rising appearance 9- tympanosclerosis White patches in the drum Glomus Jagulare Secretory OM tympanosclerosis

18. Sites of drum perforation  Central perforation • in acute otitis media: • in chronic suppurative otitis mediatubotympanic),   • traumatic drum perforation Marginal perforation:   Attic perforation:

19. ِشكرا لحسن استماعكم