Middle ear

At typical indoor concentrations, COj is not thought to be a direct cause of adverse health effects however, COj is an easily-measured surrogate for other occupant-generated pollutants. Eye, nose, and throat irritation headaches lung cancer may contribute to heart disease buildup of fluid in the middle ear increased severity and frequency of asthma episodes decreased lung function. ETS is also a source of odor and irritation complaints. 

Decongestants are used to treat the congestion associated with rhinitis, hay fever, allergic rhinitis, sinusitis, and the common cold. In addition, they are used in adjunctive therapy of middle ear infections to decrease congestion around the eustachian tube Nasal inhalers may relieve ear block and pressure pain during air travel. Many can be administered orally as well as topically, but topical application is more effective than the oral route. 

Grote JJ. Reconstruction of the middle ear with hydroxylapatite implants Long-term results. Ann Otol Rhinol Laryngol, 1990, 99(144), 12-16. 

Another well-established area of mechanical finite-element analysis is in the motion of the structures of the human middle ear (Figure 9.3). Of particular interest are comparisons between the vibration pattern of the eardrum, and the mode of vibration of the middle-ear bones under normal and diseased conditions. Serious middle-ear infections and blows to the head can cause partial or complete detachment of the bones, and can restrict their motion. Draining of the middle ear, to remove these products, is usually achieved by cutting a hole in the eardrum. This invariably results in the formation of scar tissue. Finite-element models of the dynamic motion of the eardrum can help in the determination of the best ways of achieving drainage without affecting significantly the motion of the eardrum. Finite-element models can also be used to optimise prostheses when replacement of the middle-ear bones is necessary. 

Figure 9.3. The human ear is divided into three main parts. The outer ear collects sound and directs it down the ear canal towards the eardrum. The size of the eardrum, comhined with the lever action of the three hones of the middle ear, ensures the efficient conduction of sound from the ear canal, which is filled with air, to the inner ear, which is filled with a liquid. Very small muscles, not shown here, are cormected to these bones to protect the ear from very lond sounds. The inner ear consists of two parts. Only the cochlea is shown, which is the part of the human ear that is responsible for converting sound into electrical signals in the auditory nerve. The other part of the inner ear, the vestibular organ, is involved in balance.

Although viral infections are important causes of both otitis media and sinusitis, they are generally self-limiting. Bacterial infections m complicate viral illnesses, and are also primary causes of ear and sinus infections. Streptococcus pneumoniae and Haemophilus influenzae are the commonest bacterial pathogens. Amoxycillin is widely prescribed for these infections since it is microbiologically active, penetrates the middle ear, and sinuses, is well tolerated and has proved effective. 

Otitis media, or inflammation of the middle ear, is the most common reason for prescribing antibiotics in children. It usually occurs after a viral infection of the nasopharynx and can be subclassified as acute otitis media or otitis media with... 

A 15-month-old girl presents to the pediatric clinic with 2 days of fever (38.9°C), runny nose, and fussiness. Her mother states that she is more irritable than usual and cries many times throughout the night. She is not as interested in eating today. She attends day care and has a 5-year-old brother who recently had a cold. Physical examination reveals erythema and bulging of the right tympanic membrane and the presence of middle ear fluid. The left tympanic membrane is obscured with cerumen. 

Bacteria frequently are isolated from middle ear fluid in children with AOM, but viruses also play a predominant role. 

Multiple factors play a role in the development of AOM. Viral infection of the nasopharynx impairs eustachian tube function and causes mucosal inflammation, impairing mucociliary clearance and promoting bacterial proliferation and infection. Children are predisposed to AOM because their eustachian tubes are shorter, more flaccid, and more horizontal than adults, which make them less functional for drainage and protection of the middle ear from bacterial entry. Clinical signs and symptoms of AOM are the result of host immune response and damage to cells caused by inflammatory mediators such as tumor necrosis factor and interleukins that are released from bacteria.4... 

Otorrhea (middle ear perforation with fluid drainage) uncommon... 

Opaque or cloudy tympanic membrane obscuring or reducing visibility of middle ear... 

Middle ear effusion findings with pneumatic otoscopy... 

Viscous middle ear effusions caused by allergy or irritant exposure may contribute to impaired mucociliary clearance and AOM in susceptible individuals.4 OME occurs chronically in atopic children, and effusion can persist for months after an episode of AOM. Children with chronic OME usually require tympanostomy tube placement to reduce complications such as hearing and speech impairment and recurrent otitis media. 

Presence of middle ear effusion in the absence of symptoms is not an indicator of treatment failure. Children who complete therapy and are otherwise healthy should be reevaluated after 3 months for the presence of effusion that requires a hearing evaluation. Preschool-aged and younger children may need reexamination 3 to 6 weeks after therapy because speech and hearing impairment is more difficult to assess in this age group. 

Measles, also known as rubeola, is characterized by a rash that is often complicated by diarrhea, middle ear infection, or pneumonia. Encephalitis occurs in 1 of every 1000 reported cases. Individuals who recover from encephalitis usually have permanent brain damage. Death occurs in 1 to 2 of every 1000 reported measles cases.8... 

Acute otitis media Inflammation of the middle ear accompanied by fluid in the middle ear space and signs or symptoms of an acute ear infection. 

Cholesteatoma A mass of keratinized epithelial cells and cholesterol resembling a tumor that forms in the middle ear or mastoid region. 

Myringotomy A surgical incision in the tympanic membrane to relieve pressure and drain fluid from the middle ear. 

Tympanocentesis Puncture of the tympanic membrane with a needle to aspirate middle ear fluid. 

Tympanostomy tube A small plastic or metal tube inserted in the eardrum to keep the middle ear aerated and improve hearing in patients with chronic middle ear effusion. 

Otitis media is an inflammation of the middle ear. Acute otitis media involves the rapid onset of signs and symptoms of inflammation in the middle ear that manifests clinically as one or more of the following otalgia (denoted by pulling of the ear in some infants), hearing loss, fever, or irritability. Otitis media with effusion (accumulation of liquid in the middle ear cavity) differs from acute otitis media in that signs and symptoms of an acute infection are absent. 

Risk factors contributing to increased incidence of otitis media include the winter season, attendance at a daycare center, non-breast-feeding in infants, aboriginal or Inuit origin, early age at first infection, and nasopharyngeal colonization with middle ear pathogens. 

Acute bacterial otitis media usually follows a viral upper respiratory tract infection that causes eustachian tube dysfunction and mucosal swelling in the middle ear. 

Pneumatic otoscopy or tympanometiy demonstrates an immobile eardrum 50% of cases are bilateral. Draining middle ear fluid occurs (<3% of patients) that usually reveals a bacterial etiology. 

This disease was first observed in the mid- to late-1970s when several patients presented with recurrent bacterial infections, primarily of the skin and subcutaneous tissues, middle ear and oropharyngeal mucosa. When examined in vitro, the neutrophils from these patients had defects in chemo-taxis, phagocytosis, particle-stimulated respiratory-burst activity and granulation. Some patients also had a leukocytosis, and many had a delayed umbilical cord separation. Treatment is by prophylactic antibiotic therapy and aggressive antibiotic therapy during infections, but mortality rates are very high. 

Pneumococcal Disease In October 2002, the FDA approved the use of Prevnar for immunization of infants and toddlers against otitis media— middle ear infection. Prevnar is a pneumococcal seven-valent conjugate vaccine. It is formulated with a sterile solution of saccharides conjugated to the antigen, Streptococcus pneumoniae. 

Otitis media is inflammation or infection of the middle ear and is not usually associated with back pain. Osteoporosis is a condition occurring mostly in postmenopausal women and is characterised by brittle bones caused by reduced bone mass. It is presented with pain. If it occurs in the vertebral structure the condition may be associated with chronic back pain. Pregnancy may be associated with back pain because of an increase in weight and the increased strain. 

Otitis media inflammation or infection of the middle ear Paget s disease non-metabolic disease of the bones Paraesthesia numbness and tingling sensation Parkinson s disease progressive degenerative neurological disease characterised by tremors and muscle rigidity Periodontitis inflammation of the periodontium Peripheral neuropathies disorders of the peripheral nervous system... 

Middle ear symptoms occurred significantly more frequently among Danish furniture workers exposed to dust levels above 5 mg/mk Other illnesses, such as sinus inflammation, long-lasting colds, asthma, nosebleed, and sneezing, also occurred more frequently in the higher-exposure group. 

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