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Thread: Normal Tympanic Membrane - Ear Pictures

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    Default Normal Tympanic Membrane - Ear Pictures

    Pathophysiology
    Regarding diseases of the TM, discussion of pathophysiology includes the concrete causes, mechanisms, and common regularities of source, development, and termination of myringitis.

    Myringitises can develop as self-maintained primary disease of the TM (primary myringitis) or as an effect of an inflammatory process of adjacent tissues of the external or middle ear (secondary myringitis). The etiology and pathogenesis of primary myringitis and secondary myringitis are significantly different, and they require different treatments. Therefore, they should be considered separately.

    History
    Generally, the patient presents with a 2- to 3-day history of ear congestion and mild hearing loss. Patients often have a history of self-cleaning of the EAC, trauma, or penetration of water into the EAC. Sensations of heaviness and slight pain in the ear are common. Sometimes an itch is present in the EAC, or discharge from it is noted.

    Physical
    The TM has long been recognized as the true mirror of the middle ear, with all its changes reflected on the surface of the TM. In the case of AOM, examining the changes related to all stages of inflammation on the surface of the TM is possible. Otoscopy allows examination of the tensed grey-blue membrane with reflected light directed into the lower front section. The TM has identifiable items, such as the light reflect, the umbo, the handle of the malleus, the lateral process of the malleus, the lenticular process of the incus, and the anterior and posterior plicae of the TM.
    Normal Tympanic Membrane Pictures attachment.php?s=7796c1b003b2576fde8b79cedb4437f2&attachmentid=2034&d=1441658037

    Surgical Care
    Untreated chronic perforation may result in exacerbation of COM and myringitis. Closure of perforations is also indicated in patients who enjoy water activities. Surgical closure of the TM perforation is called myringoplasty. Today, myringoplasty has made such viable progress that, in 70-90% of cases, a new TM is actually formed.

    Methods of partial surgical closure of TM perforations have been proposed. They consist of removing the epithelium from the edges of the perforation, covering it with film or paper on which the epidermis and the mucosa continue to grow, and, occasionally, blocking the perforation. However, such film is very thin and can be destroyed merely by sneezing. This procedure is typically reserved for perforations of less than 10%.

    Activity
    Many surgeons postpone swimming until the ear is completely healed, or up to 6 months. In addition, some surgeons recommend water precautions during bathing for several weeks.

    Medication Summary
    Controlled studies of effective antibiotics in various countries demonstrate 80-90% efficacy. See also Otitis Media.

    Myringitis is quite painful, and patients frequently request analgesics. Ortophenum, or acetaminophen with codeine (Tylenol #3), is commonly prescribed. See also Otitis Media; External Ear Infections; External Ear, Malignant External Otitis; and External Ear, Inflammatory Diseases.

    Good results occur with use of acidifying agents such as acetic acid solution. See External Ear Infections; External Ear, Malignant External Otitis; and External Ear, Inflammatory Diseases.
    Normal Tympanic Membrane Pictures attachment.php?s=7796c1b003b2576fde8b79cedb4437f2&attachmentid=2035&d=1441658049

    Consequences of Overdiagnosis
    The consequences of overdiagnosis, however, must be considered. A prescription for antibiotics almost always follows the diagnosis. A patient who does not actually have acute otitis media is unnecessarily placed at risk for the occasional adverse consequences of antibiotic therapy. More importantly, if the patient is declared not to have responded satisfactorily to the medication, use of broader spectrum antibiotics is advocated at a follow-up examination. Repeated episodes of acute otitis media, particularly episodes that appear not to have responded to antibiotics, often lead to referral for tympanostomy tube surgery, sometimes with adenoidectomy.

    Overdiagnosis of acute otitis media can have an impact in clinical research trials because it results in an overestimation of efficacy for all treatments and a blurring of any actual differences in efficacy between treatments. Standardized and stringent criteria for the clinical diagnosis of acute otitis media and a characterization of improvement or cure are lacking. A literature review of 26 clinical trials revealed 19 sets of criteria for making the diagnosis of acute otitis media.4 Some of the children in these studies did not actually have acute otitis media but had otitis media with effusion or no disease at all. After enrollment in an antibiotic study, “ear infection” in such children probably would be classified as cured or improved following a course of antibiotic treatment, even though they did not have acute otitis media in the first place.

    The classic findings of acute otitis media, such as fever and earache, are sometimes absent even in cases confirmed by tympanocentesis. A bulging, red, immobile tympanic membrane is highly associated with acute otitis media. However, many physicians rely on redness of the eardrum as the main diagnostic clue. Crying (and most young children cry when their ears are examined), removal of cerumen with associated irritation of the auditory canal and fever can all cause redness of the eardrum in the absence of middle ear infection. Most of all, when a parent brings a child to the physician because of irritability, rhinorrhea and fever, the temptation is great to see at least a little bit of redness or fluid behind the eardrum as justification for an antibiotic prescription.
    Normal Tympanic Membrane Pictures attachment.php?s=7796c1b003b2576fde8b79cedb4437f2&attachmentid=2036&d=1441658058

    Definitions of Acute Otitis Media and Otitis Media with Effusion
    Distinguishing episodes of otitis media as acute suppurative otitis media or otitis media with effusion is important for clinical decision making.5 Acute otitis media is defined by the presence of symptoms of acute illness and signs (full or bulging) of a tympanic membrane under positive pressure. Otitis media with effusion is defined by the absence of symptoms and signs of acute infection (other than reduced hearing) and the presence of signs (retracted or neutral position) of a tympanic membrane under negative pressure or no pressure and fluid in the middle ear space. Antibiotics are traditionally indicated for acute otitis media but may often be appropriately deferred if otitis media with effusion is present, in agreement with recommendations by the U.S. Agency for Healthcare Research and Quality (formerly called the Agency for Health Care Policy and Research).

    References:
    Acute Otitis Media: Part 1. Improving Diagnostic Accuracy - American Family Physician
    http://emedicine.medscape.com/article/858558-overview











    Last edited by Medical Photos; 09-07-2015 at 08:34 PM.

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