By Mario, M.D. Sanna

Univ. of Chieti, Italy. Atlas of otologic and neurotologic prognosis and therapy. contains a choice of otoscopic perspectives of a number of lesions. high quality, full-color images and illustrations. Emphasis is put on how the view and medical photo might impact the alternative of therapy and surgical strategy. For clinicians. DNLM: Ear Diseases--diagnosis atlases.

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Anteroinferior perforation. Two tympanosclerotic plaques are appreciated: one anteromalleolar and the other retromalleolar. The middle ear mucosa is normal. The hypotympanic air cells are seen through the perforation. 13 Right ear. Anteroinferior perforation. The posterior and anterior residues of the tympanic membrane show tympanosclerosis. The anteroinferior residue of the drum is de-epithelialized. The tubal orifice is also visible. 15 Right ear. Large tympanic membrane perforation. The tubal orifice, the hypotympanic air cells, the promontory, the round and oval windows, and the intact stapes can be viewed.

In children, hyperplasia of the adenoid tissue is the most common predisposing factor, and nasopharyngitis is the most frequent cause of secretory otitis media. In adults, the condition is much less common and the presence of persistent unilateral otitis media with effusion can be due to a nasopharyngeal tumor that occludes the tubal opening, or a neoplasm that compresses or infiltrates the tube along its course. In cases that do not resolve despite proper medical treatment (nasal and systemic decongestants, mucolytics, and antibiotics) or in cases with persistent conductive hearing loss (see Figs.

At the time of myringoplasty, freshening of the edge of the perforation not only favors the attachment of the graft but also greatly reduces the risk of leaving entrapped skin on the undersurface of the drum, which may lead to iatrogenic cholesteatoma. Conductive hearing loss caused by tympanic membrane perforation has two main causes: 1) Reduction of the tympanic membrane surface area on which the acoustic pressure exerts its action. 2) Reduction of the vibratory movements of the cochlear fluids because sound reaches both windows at nearly the same time without the dampening and phase-changing effect of the intact tympanic membrane.

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