A Pocket Guide to the Ear - A. Menner (Thieme, 2003) WW

2003·3.58 MB·English

Menner, A Pocket Guide to the Ear © 2003 Thieme
All rights reserved. Usage subject to terms and conditions of license.
Menner, A Pocket Guide to the Ear © 2003 Thieme
All rights reserved. Usage subject to terms and conditions of license.
A Pocket Guide
to the Ear
Albert L. Menner, M.D.
Otolaryngologist in Private Practice
Elmira, NY
USA
44 Illustrations
Thieme
Stuttgart · New York
Menner, A Pocket Guide to the Ear © 2003 Thieme
All rights reserved. Usage subject to terms and conditions of license.
IV
Library of Congress Cataloging-in-Publication ImportantNote:Medicineisanever-changing
Dataisavailablefromthepublisher. science undergoing continual development.
Researchandclinicalexperiencearecontinu-
allyexpandingour knowledge, inparticular
our knowledge of proper treatment and
Author’sNote drugtherapy.Insofarasthisbook mentions
Asincereefforthasbeenmadeforthistext- anydosageorapplication, readers mayrest
booktocontainup-to-date,acceptedguide- assuredthattheauthors,editors,andpublish-
linesfordiagnosingandtreatingearproblems. ershavemadeeveryefforttoensurethatsuch
However, medical knowledge is ever chan- referencesareinaccordancewiththestateof
ging, and treatment choices may also vary knowledgeatthetimeofproductionofthe
fromgeographicregiontoregion.Astuteprac- book.
titionersshouldbeawareofeventhemostre- Nevertheless,thisdoesnotinvolve,imply,
centchangesinmedicalinformation.Further- or express any guarantee or responsibility
more, the medical professional should on the part of the publishers in respect to
exercisegreatcareinperforminganyproce- anydosageinstructionsandformsofapplica-
dureorprescribinganymedication.Forexam- tion stated in the book. Every user is re-
ple, seemingly straightforward ear cleaning quested to examine carefully the manufac-
may bring about unexpected complications. turers’leafletsaccompanyingeachdrugand
Regardingtheprescriptionofdrugsandtheir tocheck,ifnecessaryinconsultationwitha
dosages, one should refer to the manufac- physician or specialist, whether the dosage
turer’sleafletaccompanyingtheproductand schedulesmentionedthereinorthecontrain-
beawareofthepatient’sknowndrugintoler- dicationsstatedbythe manufacturers differ
ancesandallergies. from the statements made in the present
Ifthereisanydoubtaboutacourseofaction, book.Suchexaminationisparticularlyimpor-
one should obtain appropriate consultation tantwithdrugsthatareeitherrarelyusedor
withanotherphysician.Eventhen,apatient have been newly released on the market.
may experience an adverse or unexpected Everydosagescheduleoreveryformofappli-
outcome.Ascaregivers,wemustalltakeper- cationusedisentirelyattheuser’sownrisk
sonalresponsibilityforouractions.Theauthor andresponsibility.Theauthorsandpublishers
andpublishercannotbeheldresponsiblefor requesteveryusertoreporttothepublishers
patient responses to procedures and treat- anydiscrepanciesorinaccuraciesnoticed.
mentsdescribedinthisbook. Some of the product names, patents, and
registered designs referred to in this book
areinfactregisteredtrademarksorproprie-
tary names even though specific reference
ª2003GeorgThiemeVerlag, to this fact is not always made in the text.
Ru¨digerstrasse14,D-70469Stuttgart, Therefore,theappearanceofanamewithout
Germany designationasproprietaryisnottobecon-
http://www.thieme.de strued as a representation by the publisher
ThiemeNewYork,333SeventhAvenue, thatitisinthepublicdomain.
NewYork,NY10001,U.S.A. Thisbook,includingallpartsthereof,isleg-
http://www.thieme.com allyprotectedbycopyright.Anyuse,exploita-
tion,orcommercializationoutsidethenarrow
Coverdesign:Cyclus,Stuttgart limitssetbycopyrightlegislation,withoutthe
TypesettingbyMitterweger&Partner publisher’sconsent,isillegalandliabletopro-
KommunikationsgesellschaftmbH,Plankstadt secution.Thisappliesinparticulartophoto-
PrintedinGermanybyAppl,Wemding stat reproduction, copying, mimeographing
or duplication of any kind, translating, pre-
ISBN3-13-131791-4(GTV) paration of microfilms, and electronic data
ISBN1-58890-139-4(TNY) 1 2 3 4 5 processingandstorage.
Menner, A Pocket Guide to the Ear © 2003 Thieme
All rights reserved. Usage subject to terms and conditions of license.
V
Foreword
AmajortrendinAmericanmedicineinrecentyearshasbeentopromote
primarycaremedicine.Well-trainedprimarycarephysiciansareessential
tomakinghigh-qualityhealthcareavailabletoall.Forasurgicalsubspeci-
altylikeotolaryngology–headandnecksurgery,avaluablecontributionto
thiseffortconsistsofmakingtheknowledgeandexperienceofthisfield
accessible to primary care practitioners. This is particularly helpful be-
cause diseases of the ear make up a large part of primarycare practice.
DoctorMenner’sbookisagoodexample ofsuchacontribution,making
thewisdomandinsightsofacareerinthisspecialtyavailableinashort,
concise,easy-to-readguidetodiseasesof theear.
DoctorMennergraduatedcumlaudefromJohnsHopkinsUniversity,re-
ceivedhisM.D.degreefromtheUniversityofVirginiaSchoolofMedicine
in 1970, and completed his residency in otolaryngology–head and neck
surgeryattheUniversityofMarylandin1975.Hehasbeeninprivateprac-
ticeinElmira,NewYorkformorethanaquartercentury.Hehasdistilled
hisknowledgeintothispracticalanduseful guidetootology.
Whetherthebookisreadcovertocoverorusedasareferenceasneeded,
itofferssoundadviceonthecommonandrareconditionsoftheearthat
willbeseenbyaprimarycarephysician.
WilliamC.Gray,M.D.
AssociateProfessor,DivisionofOtolaryngology
UniversityofMarylandSchoolofMedicine
Menner, A Pocket Guide to the Ear © 2003 Thieme
All rights reserved. Usage subject to terms and conditions of license.
VI
Acknowledgement
Writingthisbookhasbeenanentertainingtaskforthepastseveralyears.
Iamgratefultoanumberofindividualsfortheirhelp.Mydaughter,son,
andwifeweretheinitialcontributors.Stephanieencouragedmetostart
this project, Mike instructed me in the necessary computer skills, and
Donnahasbeenanongoingadvisorand lovingsupporter.
Numerous professional friends from my geographic area have helped.
Linda and Dr. Frank Gudas smoothed out an early manuscript. They also
directedmetoJoyPerry,anexcellentmedicaleditorwhogreatlyimproved
thetextandhelpedinsomanyotherways.Physiciansinvariousspecialties
readitandgaveadviceand/orencouragement,mostespeciallyfamilyprac-
titionerDr.TomMitchell.SincerethanksarealsoduetopathologistDr.Ter-
ryLenhardt,pediatricianDr.JonHomuth,psychologistDr.JoelGrace,der-
matologistDr.BillClack,pulmonologistDr.BillMcCauley,surgeonDr.Ben
Willwerth,otolaryngologistsDr.NilsPetersonandDr.JohnDooley,andmy
father-in-law,generalpractitionerDr.DonaldCoon.Muchhelpcamefrom
audiologists Sheila Giovannini and Mary Ann Bullett. Kathi Menner and
AnnRoseassistedwithgraphics,andScottMoore,withlegaladvice.
ThanksalsotoThiemeMedicalPublishersformakingthissuchanattrac-
tivebook.BrianScanlan,thepresidentofThieme,Dr.CliffBergman,and
Dr.LianePlatt-Rohloffweresogoodastobelieveinthistypeofpresenta-
tionandtoworkwithmetopolishittoitspresentform,especiallywiththe
excellentgraphics.
MyformerfellowENTresidentsfromtheUniversityofMarylandSchool
of Medicine made major contributions. Early on, Dr. Jack Biedlingmaier
advised me regarding teaching enhancements, and Dr. Hubert Le´veque
carefully helped with the factual content. More recently Dr. Bill Gray, a
knowledgeableanddedicatededucatorattheENTprogram,collaborated
tomakethiseditionasup-to-dateandaccurateaspossible;Ialsothank
himforwritingtheforeword.Finally,Iespeciallywishtohonorthemem-
ory of Dr. Cyrus L. Blanchard, the late Professor of Otolaryngology who
trained Jack, Hubert, Bill, myself, and countless other ENT residents for
the longest span of years of any ENT residency program in the United
States. Wemissyou,dearDr.B.
AlbertL.Menner,M.D.
Elmira,N.Y.
Menner, A Pocket Guide to the Ear © 2003 Thieme
All rights reserved. Usage subject to terms and conditions of license.
VII
Contents
1 HearingandBasicAudiometricConcepts.................... 1
PureToneAudiometry...................................... 1
SpeechAudiometry ........................................ 3
Conductivevs.SensorineuralHearingLoss...................... 4
2 EquipmentandEarExaminationMethods................... 7
BasicEquipment........................................... 7
AdvancedEquipment....................................... 10
3 UsefulAnatomyandFunction............................. 13
TheExternalEar ........................................... 13
TheMiddleEar ............................................ 15
TheInnerEar.............................................. 21
4 DisordersoftheExternalEar ............................. 26
TemporomandibularJointSyndrome........................... 26
NeuralgiasInvolvingtheEar.................................. 29
Hematomaof theAuricle.................................... 31
Perichondritisof theAuricle.................................. 32
CongenitalDisordersof theExternalEar........................ 33
NoncongenitalCystsandKeloidsof theAuricle.................. 35
SkinDisordersof theExternalMeatus.......................... 36
OtitisExterna.............................................. 38
OtherChronicExternalEarDisorders........................... 43
CerumenAccumulationsandKeratoses ........................ 44
TraumaandForeignBodies .................................. 45
Tumorsof theExternalEar................................... 48
5 DisordersoftheMiddleEar .............................. 51
TheEustachianTube........................................ 51
Myringitis................................................. 53
TympanicMembranePerforations............................. 54
ScarringandTympanosclerosis................................ 57
AcuteOtitisMedia ......................................... 59
Menner, A Pocket Guide to the Ear © 2003 Thieme
All rights reserved. Usage subject to terms and conditions of license.
VIII Contents
AcuteMastoiditis .......................................... 59
Retractionof theTympanicMembrane......................... 61
MiddleEarEffusions........................................ 62
EarEffusionsintheYoung—SpecialConsiderations ............... 65
AtelectasisandRetractionPockets............................. 67
AdhesiveOtitisMedia....................................... 68
Cholesteatoma ............................................ 70
UnusualEustachianTubeDisorders............................ 73
Otosclerosis............................................... 75
CongenitalOssicularAbnormalities............................ 76
MiddleEarTumors......................................... 77
SpontaneousPerilymphFistula ............................... 78
OverviewofMastoiditis ..................................... 79
6 DisordersoftheFacialNerve ............................. 81
Bell’sPalsy................................................ 82
Ramsay-HuntSyndrome..................................... 84
InfectionandFacialParalysis ................................. 85
TraumaandFacialParalysis .................................. 85
OtherCausesofFacialParalysis............................... 86
7 AuditoryDisordersoftheInnerEar........................ 88
Tinnitus.................................................. 89
Ototoxicity................................................ 92
Presbycusis ............................................... 93
Noise-InducedHearingLoss.................................. 95
NonorganicHearingLoss.................................... 97
CongenitalandHereditaryDisorders........................... 97
InfectiousCausesofSensorineuralLoss........................ 100
SuddenSensorineuralHearingLoss........................... 102
Me´niere’sDisease......................................... 103
AutoimmuneInnerEarDisease.............................. 107
CerebellopontineAngleTumors.............................. 108
ChapterSummary......................................... 109
8 VestibularDisordersoftheInnerEar...................... 111
Vertigo................................................... 111
Disequilibrium............................................ 112
NonvestibularDizziness .................................... 113
Menner, A Pocket Guide to the Ear © 2003 Thieme
All rights reserved. Usage subject to terms and conditions of license.
Contents IX
NystagmusandElectronystagmography....................... 114
BenignParoxysmalPositionalVertigo ......................... 117
VestibularNeuronitis....................................... 119
Me´niere’sDisease,Revisited................................. 120
CervicalVertigo........................................... 120
VascularDisorders......................................... 121
CircumscribedLabyrinthitis.................................. 121
MotionSickness .......................................... 122
Epilogue ................................................ 124
“TopTen”ClinicalMisjudgmentsinEarDisorders................ 125
Glossary................................................. 128
AcronymsandAbbreviations ............................... 137
Index................................................... 139
Menner, A Pocket Guide to the Ear © 2003 Thieme
All rights reserved. Usage subject to terms and conditions of license.
X
Introduction
AsanENTspecialistwhohasbeeninprivatepracticeforyears,Iobviously
seemanynewpatientswithearproblems.Often,apatientwillgiveahis-
torysimilartothefollowingoneofapatientwhomwewillrefertoasPat.
Hercaseispresented hereas an example of thetypesofearcomplaints
thatcliniciansoftenencounterineverydaypractice.
“Doctor,IaskedforareferraltoyoubecauseI’mtiredoftheseearinfec-
tions.Therehasbeenpressure,onandoff,inmyrightearformonths.It
feelsfull andaches a littlebit, even downmy neck. Myown doctor saw
fluidinitonce,andtheantibioticsheprescribedclearedthingsupfora
while. However, the problem keeps coming back. Sometimes both ears
bother me, and I also getdizzy from timetotime. Ipersonallythink it’s
an inner ear infection. Nasal sprays and decongestant pills don’t help.
Forthe lastfewdays,Ifeel it morethaneverintherightearagain, and
I’mgladIgotintoseeyounow.Iprobablyneedanothercourseofanti-
biotics,butisthereanythingdifferentyoucandoforme?”
Atthispointintheinterview,Iinwardlymadeatentativeguessatthe
diagnosis.Therearecertainchronicailments,somerelatedtotensionand
stress,thatmightrefersomanysymptomstooneorbothears.Nonethe-
less, a more complete evaluationwas justified. Pat needed careful ques-
tioning,along withagoodENTandhearingassessment.
Thediagnosiswasunexpected.Itwasdeterminedwithabriefbutthor-
ough examination, one that a family practitioner could carry out in the
office.IwillreturntoPat’seartroubleslaterinthebook,intheEpilogue.
Thisshortvolumeisintendedtoprovideyouwithallthenecessaryknowl-
edgeandtoolstoevaluatepatientslikePatandtoreachthesamediagnosis
asmyself.
Intendedforallthosewhotreatearsandhearing,thisbookcanbeanaid
to nurse practitioners, physicians’ assistants, family practitioners, inter-
nists, ER physicians, pediatricians, audiologists, and even ENT residents.
ThemedicalstudentorresidentrotatingthroughENTwillfinditespecially
useful.Thoughthetextisintentionallyshort,itdealswithalmostevery-
thingthatcangowrongwithears,basedoncarefulstudyandobservation
duringabusyENTpracticeformorethan25years.Inoneway,itisabrief
clinical“encyclopedia”ofeardisease.Inanotherway,itisanentertaining
textthatcanprovidethereaderwithconsiderableexpertiseonearsafter
a fewhours’reading. The presentation cutsthrough to important truths
Menner, A Pocket Guide to the Ear © 2003 Thieme
All rights reserved. Usage subject to terms and conditions of license.