Ear Nose and Throat, Ear Tubes, Allergy, Tonsils, Ear Ringing, Tinnitus, Hearing Loss, Larynx Cancer, Kevin Kavanagh
Middle Ear and Eardrum Photographs of Ear Tubes, Infections, Cholesteatomas, and Acute Otitis Media  Kevin Kavanagh
   
Ear Infections, Acute Otitis Media, Serious Otitis Media, Cholesteatoma, Retraction Pockets and Ear Drum Perforations             Click on colored text for word definitions !!
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Normal Eardrum     

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Tympanosclerosis: 
This is a condition where the eardrum has calcium plaques which form as a result of old infections.  It is of no significance unless the plaques bind the
malleus (the ear bone which attaches to the eardrum) with the ear canal, thus preventing the drum from vibrating.  The picture on the far left shows an ear with severe tympanosclerosis and a perforation.. 
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Retraction of The Eardrum:  This is the first step in the formation of a cholesteatoma Negative pressure builds up in the middle ear from eustachian tube dysfunction.  (The tube that leads from the ear to the back of the nose no longer lets enough air into the middle ear.)  Long term negative pressure will cause collapse of the eardrum.
   
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Serous Otitis Media Negative pressure builds up in the middle ear from eustachian tube dysfunction.  (The tube that leads from the ear to the back of the nose no longer lets enough air into the middle ear.)  Short term negative pressure often causes clear fluid to build up behind the eardrum.
 
 
    


To the left is an ear
with serous fluid and
a normal light reflex.

  
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Retraction Pocket Formation:  Long term retraction of the eardrum will cause erosion of the ear canal and forms a deep pocket.  Eventually the pocket may trap skin, forming a skin cyst or cholesteatoma.   Further progression of retraction pockets can cause destruction of the eardrum.  Many of theses eardrums have tympanosclerosis or white plaques on the eardrum.
   

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Chronic negative pressure can also cause erosion of the
middle ear bones or ossicles.  Shown in this photograph is erosion of the incus with the eardrum starting to attach to the stapes.  

Erosion of Incus 14.jpg (25724 bytes)





The picture on the right shows an eardrum which has eroded through the long process of the
incus and head of the stapes and is now attaching to the top of the stapes' cura.

 

  
Treatment
of
eustachian tube dysfunction & eardrum retraction pockets by placing an ear tube in the eardrum.  To the right is shown a pre-operative ear with chronic serous otitis media and retraction pocket formation, the "glue" which was suctioned out of the ear and the post-operative result.
          

ear_tube_titanium9.jpg (35464 bytes)eardrum_tube_2000.jpg (9912 bytes)Search PubMed for Myringotomy Tubes


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tube_perforation_8.jpg (30981 bytes)Complications of Ear Tubes:  Perforation:  Sometimes when a tube comes out of the eardrum a perforation is left.  Shorter acting tubes cause perforations in about 1% to 2% of patients.  If a T-tube or long-acting tube is used, up to 20% to 30% of eardrums will eventually develop perforations. 


monolaryer_8.jpg (25260 bytes)monolaryor_0301.jpg (25212 bytes)Monolayer:  Sometimes when the ear tube comes out, the eardrum heals in a very thin layer.  This condition is called a monolayer and can mimic a perforation of the eardrum.  It is usually of no pathological significance and does not need treatment.

The eardrum shown on the right is shown in two views, as seen using a handheld otoscope and a close up using the operating microscope.  Notice the thin membrane of eardrum, mimicking a perforation,  in the close up photograph.

 
ear_tube_healed_in_drum9.jpg (32933 bytes)A tube may heal into the middle ear instead of healing outward.  This is a very rare complication.  It usually occurs after a severe infection.  Treatment of this is usually not needed, if the middle ear is aerated and the eardrum is not retracted.

Rarely, a myringotomy tube may cause a cholesteatoma from skin being trapped in the middle ear.


Cholesteatoma:  A skin cyst caused by a long standing retraction pocket of the eardrum into the middle ear.  This is a serious condition.  The cyst slowly erodes bone and can cause  facial paralysis, hearing loss, dizziness and, if left untreated, can slowly erode into the brain cavity.
 

 
 
 
 
   

      EarCholesteoma.jpg (53789 bytes)attic_cholesteoma_0401.jpg (24063 bytes)   
   

    

        

         Search PubMed for Cholesteatoma

 

cholesteatomawnltm.jpg (57036 bytes)A cholesteatoma can also form from a perforation.  In this picture, squamous epithelium is growing around the top of a 100% eardrum perforation.   (Left Picture)

Sometimes a cholesteatoma can exist in the upper part of the eardrum, with the remainder of the eardrum being normal.  (Right Picture)
 
    
   
Cholesteoma_18.jpg (26998 bytes)In the picture on the left, a cholesteatoma can be seen behind the eardrum with granulation tissue in the region of the attic (Left Picture - Top of the Eardrum).
 
In the picture on the right, a cholesteatoma is hidden behind granulation tissue covering the posterior eardrum.  (Right Picture)

     
Although cholesteatomas are treated with surgery, there can be exceptions.  The picture on the right shows a large cholesteatoma with a very large and open attic retraction pocket, and a central perforation of the eardrum.  The patient was elderly and had very poor hearing in this ear.  However, this ear was also the patient's only hearing ear and there was not a history of pain or drainage.  Thus, it was elected to follow the cholesteatoma very carefully and for now delay performing surgery. 
  
Congenital Cholesteatoma:  This picture shows an 11 month old who had multiple skin cysts on her eardrum.  These cysts can also reside in the middle ear and posterior fossa (brain cavity).
Perforation:  Eardrums can also have holes in them.  The right picture shows an eardrum with a single hole.  The left picture shows an eardrum with three holes and destruction of the middle ear bones ( ossicles ).  Repair of these eardrums can be accomplished with an operation called a " tympanoplasty ".    






   
 

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This picture shows a dry central perforation though which the tympanic nerve can be seen.  The tympanic nerve is part of a nerve plexus which transmits impulses which controls salivary secretion.

This picture shows a marginal perforation of the eardrum.  Squamous epithelium (the skin on the outside of the body) has grown into the
middle ear through the perforation.  This is a rare cause of a cholesteatoma.

Chronic Otitis Media:  This picture shows an eardrum with a large perforation and a chronically infected middle ear.  The manubrium(part of the malleus, outermost middle ear bone, which is attached to the eardrum) is adheased to the promontory (the medial wall of the middle ear) of the middle ear and the mucosa (lining) of the middle ear is inflammed. 

healing_perforation.jpg (22467 bytes)Healing Perforation:  Shown on the right is a freshly healed perforation with a reparative granuloma over the previous perforation site.

traumatic_perforation_0601.jpg (23609 bytes)trauma perforation.jpg (25855 bytes)Traumatic Perforation:  Trauma is a common cause of an eardrum perforation.   It is important to note if the patient is dizzy.  If dizziness is present, then the 
inner ear may be damaged and middle ear exploration for a inner ear to middle ear fistula should be considered.  An audiogram should also be obtained, since this will help determine if there is damage to the inner ear and middle ear bones.   If due to a water injury, i.e. falling during water skiing, the risk of infection is high and antibiotic ear drops should be used.  Over 90% of all traumatic perforations will heal spontaneously.

Acute Otitis MediaThis is a very common and painful ear infection which is usually found in children.  Treatment usually consists of a ten day course of antibiotics.  After the acute infection, serous ear fluid may persist for weeks. 


    
    
 
 
 
  



 


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tm_hemorrhage.jpg (26644 bytes)Eardrum Hemorrhagic Blister:   This is a rare condition which may be seen with trauma, severe bacterial infections and viral infections ( Herpes Zoster ).  This patient did not respond to antibiotics and was placed on antiviral agents.


Eardrum Abrasion:   This picture is from a 14 year old child who complained of a hearing loss in her left ear.  Audiometric testing reveiled a 25 dB conductive hearing loss in this ear.  On examination, the eardurm had a circular abrasion in the posterior superior quadrant,  The middle ear was air containing.  On further questioning, she admitted to using cutips and experiencing sever pain after one recent use.  A diagnosis of partial ossicular discontinuity was suspected.

 

glomus tumor.jpg (20448 bytes)Glomus Tympanicum, Paraganglioma Tumor: This is a rare tumor which is highly vascular and arises in the middle ear or jugular vein.  The photo to the right shows a large mass behind the eardrum which can be seen pulsating with the heart beats.

 
Another patient with a Glomus Tympanicum showing the appearance of the eardrum and tumor's blood flow from the Posterior Auricular Artery demonstrated on angiography.  The picture on the left shows the tumor at the time of operation.
         

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