Different diseases of the ear

Different diseases of the ear 

Types of Cancer in the ear.

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Ostosclerosis

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Ménière's disease

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Otitis media

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Mastoiditis

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Perilymphatic Fistula

Different diseases of the ear Different types: 

Types of Cancer in the ear.

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Ostosclerosis

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Ménière's disease

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Otitis media

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Mastoiditis

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Perilymphatic Fistula

What is an ear disease? 

Definition: Hearing loss can happen for many reasons. Some people may be born with hearing loss while others may lose their hearing slowly over time. There are diseases, infections and cancers that affect specific parts of the ear and can lead to hearing loss in children and adults.

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Characteristics: Approximately 36 million American adults report some degree of hearing loss. Consider these facts: About 2 to 3 out of every 1,000 children in the United States are born deaf or with hearing loss.

Nine out of every 10 children who are born deaf are born to parents who can hear.

One in three people older than 60 and half of those older than 85 have hearing loss.

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People can develop cancer diseases, otitis, Ménière's disease and many others that are terrible for the our body.

Cancer of the ear Cancers of the ear usually occur on the skin of the outer ear. Cancers of the ear can develop inside the ear too, but these are very rare. There are different types of cancers (carcinomas and melanomas) that can affect the ear. Most ear cancers are squamous cell carcinoma on the outer ear, but basal cell carcinoma and malignant melanoma can also occur inside the ear. 

There are three types of cancer in the ear.

A) Cancer of the outer ear Symptoms: A scabbed area of skin that is jagged and irregular with crusting and oozing— usually on the upper edge of the outer part of the ear. This area may be present for many years and may or may not be associated with a swelling or lump in the neck.

Cause: Long periods of time in the sun.

Treatment for people with small cancers of the skin of the ear includes surgery to remove the affected area. Often no further treatment is required, especially if the cancer is confined to the outer edge of the ear.

B) Cancer of the Auditory canal Symptoms: Discharge from the ear canal, often tinged with blood Hearing loss Sometimes facial paralysis on the side of the affected ear Earache Cause: Unknown—but may be more common in adults with long history of outer ear infections.

Treatment for people with cancer of the auditory cancel includes surgery to remove parts of the middle ear.

C) Cancer of the Middle Ear Symptoms: 

Discharge from ear for long period of time,

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Recent blood stained discharge

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Hearing loss

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Sometimes facial paralysis

Cause: Unknown—but may be more common in adults with history of discharge from ears for long periods of time.

Treatment of people with cancer of the middle ear includes surgery and radiation, which targets rays of energy at small areas of cancer cells that

Otosclerosis Otosclerosis is the buildup of spongy or bone-like tissue in the middle ear that prevents the ossicles, namely the stapes in the middle ear, from working properly. The impaired movement and function reduces the sound that actually reaches the ear. Otosclerosis usually results in conductive hearing loss, a hearing loss caused by a problem in the outer or middle ear.

If the buildup of tissue spreads to the inner ear, it is called Cochlear Otosclerosis. This can cause permanent sensorineural hearing impairment due to interference with how the nerves in this part of the ear work.

Scientists aren’t sure about the exact cause but there is some research suggesting a relationship between otosclerosis and the hormonal changes associated with pregnancy and also with viruses.

Treatment For people who are diagnosed with otosclerosis depends on the extent of hearing loss and may include surgery to replace some or all of the ossicles with artificial ones. It is important to discuss the risks and possible complications of this and any procedure, as well as the benefits, with a doctor and a surgeon.

If the hearing loss is mild, surgery may not be an option but a properly fitted hearing aid may help some people with otosclerosis. A hearing aid is designed to compensate for a hearing loss by amplifying sound.

There are various methods to treat otosclerosis. However the method of choice is a procedure known as Stapedectomy. Early attempts at hearing restoration via the simple freeing the stapes from its sclerotic attachments to the oval window were met with temporary improvement in hearing, but the conductive hearing loss would almost always recur. A stapedectomy consists of removing a portion of the sclerotic stapes footplate and replacing it with an implant that is secured to the incus. This procedure restores continuity of ossicular movement and allows transmission of sound waves from the eardrum to the inner ear. A modern variant of this surgery called a stapedotomy, is performed by drilling a small hole in the stapes footplate with a micro-drill or a laser, and the insertion of a piston-like prothesis.

Ménière's disease Meniere’s disease describes a set of episodic symptoms including vertigo (attacks of a spinning sensation), hearing loss, tinnitus (a roaring, buzzing, or ringing sound in the ear), and a sensation of fullness in the affected ear. Episodes typically last from 20 minutes up to 4 hours. Hearing loss is often intermittent, occurring mainly at the time of the attacks of vertigo.

Loud sounds may seem distorted and cause discomfort. Usually, the hearing loss involves mainly the lower pitches, but over time this often affects tones of all pitches. After months or years of the disease, hearing loss often becomes permanent. Tinnitus and fullness of the ear may come and go with changes in hearing, occur during or just before attacks, or be constant.

WHAT ARE THE CAUSES? Although the cause is unknown, Meniere’s disease probably results from an abnormality in the volume of fluid in the inner ear. Too much fluid may accumulate either due to excess production or inadequate absorption. In some individuals, especially those with involvement of both ears, allergies or autoimmune disorders may play a role in producing Meniere’s disease. In some cases, other conditions may cause symptoms similar to those of Meniere’s disease.

People with Meniere’s disease have a sick inner ear and are more sensitive to factors, such as fatigue and stress that may influence the frequency of attacks.

HOW IS A DIAGNOSIS MADE? Your physician will take a history of the frequency, duration, severity, and character of your attacks, the duration of hearing loss or whether it has been changing, and whether you have had tinnitus or fullness in either or both ears. When the history has been completed, diagnostic tests will check your hearing and balance functions

For hearing: An audiometric examination (hearing test) typically indicates a sensory type of hearing loss in the affected ear. Speech discrimination (the patient’s ability to distinguish between words like sit and fit) is often diminished in the affected ear.

HOW IS MÉNIÈRES DISEASE TREATED? Although there is no cure for Meniere’s disease, the attacks of vertigo can be controlled in nearly all cases. Treatment may include: 

A low salt diet and a diuretic (water pill)

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Anti-vertigo medications

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Intratympanic injection with either gentamicin or dexamethasone.

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An air pressure pulse generator

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Surgery

Your otolaryngologist will help you choose the treatment that is best for you, as each has advantages and drawbacks. In many people, careful control of salt in the diet and the use of diuretics can control symptoms satisfactorily.

Intratympanic injections involve injecting medication through the eardrum into the middle ear space where the ear bones reside. This treatment is done in the otolaryngologist’s office. The treatment includes either making a temporary opening in the eardrum or placing a tube in the eardrum. The drug may be administered once or several times. Medication injected may include gentamicin or corticosteroids. Gentamicin alleviates dizziness but also carries the possibility of increased hearing loss in the treated ear that may occur in some individuals.

Otitis media Infections of the middle ear are one of the most common reasons for children to see a doctor. Three out of 4 children experience ear infection (otitis media) by the time they are 3 years old. Children are more likely to have ear infections like otitis media that come from bacteria or viruses than adults because of their developing ear anatomy. The middle ear is connected to the back of the nose by the auditory tube (also called the eustachian tube) and its location allows easier access to germs. This may lead to a buildup of fluid and pressure, painful infections, and even hearing loss. Infections in children can affect early speech and language development.

If the infection is due to bacteria, treatment is possible with antibiotics but if the infection is viral, antibiotics won’t work. Surgery is another treatment option, especially for children with ongoing infections. Small tubes placed inside of childrens' ears help fluid drainage and relieve pressure in the ears so that hearing improves.

Chronic otitis media can affect adults, too. It is a long-lasting middle ear infection that can damage the ossicles (middle ear bones), and even lead to a perforation in the eardrum. Perforations can heal but when a chronic infection is present this is less likely and hearing loss can occur.

Long-term antibiotics, while they decrease rates of infection during treatment, have an unknown effect on long-term outcomes such as hearing loss. This method of prevention has been associated with emergence of antibiotic-resistant otitic bacteria. They are thus not recommended.

Antibiotics should be prescribed for severe bilateral or unilateral disease in all infants and children with severe signs and symptoms, such as moderate to severe ear pain and high fever.

For bilateral acute otitis media in infants younger than 24 months of age, without severe signs and symptoms, antibiotics should be prescribed. When non-severe unilateral acute otitis media is diagnosed in young children either antibiotic therapy is given or observation with close follow-up based on joint decision making between parent(s)/caregiver in infants 6 to 23 months of age. If the child worsens or fails to improve in 2 to 3 days antibiotics should be administered.

Children 24 months or older with non-severe disease can have either an-

Mastoiditis One of the most important structures in your inner ear is the mastoid bone. Although it’s called a bone, the mastoid doesn’t have the typical structure associated with other bones in the human body. The mastoid bone is made of air sacs and resembles a sponge, rather than being solid and rigid like most bones.

The mastoid must receive air from other parts of the ear, including the Eustachian tube, to function properly. Your Eustachian tube connects your middle ear to the back of your throat. If an infection develops in your middle ear and blocks your Eustachian tube, it may subsequently lead to an infection in the mastoid bone.

This serious infection is known as mastoid bone infection of the skull, or mastoiditis.

The most common cause of mastoiditis is a middle ear infection that has been left untreated. It can spread to the inner ear, invading the sacs of the mastoid bone, without treatment. This can cause the mastoid bone to begin to disintegrate.

Although the condition is most common in children, it can also occur in adults.

The symptoms of mastoiditis are similar to those of an ear infection. They include: 

drainage from the affected ear

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ear pain

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fever

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headache

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hearing loss in the affected ear

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redness, swelling, and tenderness behind the affected ear

In some cases, mastoiditis may result in the development of a brain abscess or other complications involving the skull. The symptoms of these conditions include severe headaches and swelling behind the eyes. This swelling is known as papilledema.

If you have symptoms of an ear infection, your doctor will examine your ears and head to determine if the infection has spread to your mastoid bone.

Diagnosis The mastoid bone is located in the inner ear and may not be visible due to the infection. Your doctor may perform other tests to confirm the diagnosis. These include: 1.

a white blood cell count to confirm the presence of an infection

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a computerized tomography (CT) scan of your ear and head

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an magnetic resonance imaging (MRI) of your ear and head

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an X-ray of your skull

Treatment If the tests confirm a diagnosis of mastoiditis, your doctor may also perform a lumbar puncture (spinal tap). This test will allow your doctor to determine if the infection is present in your spinal column.

Mastoiditis is a potentially life-threatening condition. Initial treatment for a severe infection may include hospitalization. You will receive antibiotic medication through a vein in your arm (intravenously) while at the hospital. You will need to take oral antibiotics at home for several days after leaving the hospital.

Perilymphatic Fistula Perilymphatic or labyrinthine fistula is a condition in which an abnormal communication is present between the perilymphatic space of the inner ear and the middle ear or mastoid. The manifestations of this disease vary in severity and complexity, commonly ranging from very mild to incapacitating. Perilymphatic fistulas (PLFs) may induce hearing loss, tinnitus, aural fullness, vertigo, disequilibrium, or a combination of these symptoms. The vagueness of symptoms caused by perilymphatic fistula (PLF) and the overlapping symptoms of other disease processes make the diagnosis elusive.

Diagnosis The indications for exploratory tympanotomy are controversial. Accurate diagnosis is difficult. If the patient's history is suggestive of perilymphatic fistula (PLF), objective testing should be used to reinforce or reject the initial assessment. The signs and symptoms of perilymphatic fistula (PLF) are relatively nonspecific and overlap greatly with those seen in other otolaryngologic and neurologic diseases.

Perilymphatic fistula (PLF) can be particularly difficult to differentiate from MÊnière disease. Histologically, the two diseases are similar.

Treatment The definitive treatment of perilymphatic fistula (PLF) is surgical exploration with grafting of the fistula. Early repair of PLF offers the potential for resolution of vestibular symptoms and preservation of residual auditory function.

Intraoperative details The procedure can be performed with the patient under local or general anesthesia . A standard tympanomeatal flap is designed, incised, and elevated. Generally, curetting away the posterior bony overhang (scutum) is necessary to permit adequate visualization of the round and oval window niche. These areas are then very carefully observed for the accumulation of clear fluid. However, even intraoperative observation can be inconclusive. Transudates from middle ear mucosa, irrigation, or injected anesthetic materials can collect within the dependent areas of the round window or oval window niche. The absence of detectable fluid in these areas does not exclude an intermittent or recurrent perilymphatic fistula (PLF). Use of intravenous fluorescein is not helpful because it can accumulate in the round window niches as a transudate from middle ear tissues.

Postoperative care is directed at maintaining the integrity of the graft.

Patients are instructed to avoid heavy lifting, straining, and activities that place the head in a dependent position, all of which could lead to increasing intracranial pressure. Stool softeners are given for the first 10 postoperative days. Antinausea medications are used as necessary. Air flight is well tolerated in the immediate postoperative period because the middle ear space is filled with transudated blood, therefore providing no air-filled space upon which pressure can act.