1. Otology Eleanor Houghton

2. Objectives 1.Differentiate between: a)sensorineural and conductive deafness b)subjective, objective, physiological and pathological tinnitus 2. The student should be able to perform and interpret Rinnes and Weber tuning fork tests 3.Interpret pure tone audiograms and tympanograms

3. Conductive deafness

4. Conductive hearing loss Otitis media Foreign body Perforated ear drum Otosclerosis

5. Sensorineural deafness

6. Sensorineural hearing loss Presbyacusis Acoustic neuroma Noise induced hearing loss Ramsay hunt syndrome

7. Tinnitus Objective: there is an acoustic stimulus which is generated from within the head Subjective: there is no acoustic stimulus Physiological: short term tinnitus (<15 minutes) due to excessive hair cell activation in the cochlear

8. Rinne’s Air conduction vs bone conduction 512Hz tuning fork Place on mastoid, then 1 inch from external meatus.

9. Rinne’s positive

10. Rinne’s negative

11. Weber’s Compares bone conduction in both ears Place 512Hz tuning fork in centre of forehead Patient asked if the sounds is louder on a particular side.

12. Weber’s: conductive hearing loss

13. Weber’s: sensorineural HL

14. Example Weber’s lateralises to the L – ? L conductive hearling loss OR ? R sensorineural hearing loss Rinne‘s - on L Rinne’s + on R CONDUCTIVE HEARING LOSS ON THE LEFT

15. Pure tone audiometry Type and degree of hearing loss Measures the quietest sound a person can hear and different pitches Compares bone and air conduction

17. Audiograms

18. Sensorineural hearing loss: no significant difference between bone and air conduction Conductive hearing loss: bone conduction is better than air conduction

19. Example

25. Tympanometry It measures the pressure in the middle ear, the compliance of the tympanic membrane and the volume of the external auditory canal

26. Tympanometry

27. Pressure in ear canal = ambient pressure = middle ear pressure Maximum pressure transmitted when ear canal pressure = pressure in middle ear.

28. Tympanogram: type A Pressure in middle ear = pressure in external auditory canal Compliance Pressure

29. Tympanogram: Type Ad Peak at 0 Excess compliance Compliance Pressure

30. Tympanogram: type B Poor compliance of the drum throughout all pressures Compliance Pressure

31. Tympanogram: type C Pressure in the middle ear is negative Ear drum being sucked in Compliance Pressure

32. Thank you!