Grand Rounds Archive - Otology/Neurotology

313 Pages·2005·1.02 MB·English

Grand Rounds Archive - Otology/Neurotology

Grand Rounds Archive

Otology/Neurotology
Acute Otitis Media:A Public Health Perspective [3/18/99]
Autoimmune Inner Ear Disease [4/8/93]
Barotrauma of the Middle and Inner Ear [3/23/95]
Bell's Palsy [7/20/95]
Unusual Cerebellopontine Angle Neoplasms [11/4/93]
Pediatric Cholesteatoma [10/7/93]
Chordomas of the Skull Base [10/1/92]
Congenital Aural Atresia [11/2/95]
Congenital Inner Ear Malformations [11/11/93]
Diving Medicine [01/13/00]
Eustachian Tube Function and Dysfunction [7/11/96]
Traumatic Injuries to the Facial Nerve [10/12/91]
Facial Reanimation of the Chronically Paralyzed Face [9/29/94]
Therapeutic Options for Treatment of Glomus Tumors [10/26/91]
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Grand Rounds Archive - Otology/Neurotology
Considerations in the Evaluation of the Hearing Impaired Child [3/11/93]
Update on Hearing Aids [6/3/93]
Herpes Zoster Oticus [8/21/97]
Neurotologic Manifestations Of HIV Infection [3/24/94]
Infectious Intracranial Complications of Suppurative Ear Disease [3/18/93]
Lateral Sinus Thrombosis [5/7/92]
Acute Mastoiditis [2/3/94]
Surgical Management Of Meniere's Syndrome [4/14/94]
Myringoplasty and Tympanoplasty [2/16/95]
Osteodystrophies of the Middle Ear and Temporal Bone [2/8/95]
Ototoxicity [8/20/92]
Ototoxicity [4/25/96]
Otitis Externa [10/12/95]
Pathology And Pathogenesis Of Otitis Media [4/21/94]
The Diagnosis and Management of Perilymphatic Fistulas [10/21/93]
Lesions of the Petrous Apex [8/4/94]
Complications of Stapedectomy [11/11/99]
Issues in Stapedectomy [2/6/92]
Sudden Sensorineural Hearing Loss [3/5/92]
Sudden Sensorineural Hearing Loss [11/18/93]
Temporal Bone Fractures [4/2/92]
Temporal Bone Gunshot Wounds: Evaluation and Management [8/5/93]
Subjective Tinnitus [03/12/98]
Tuberculous Otitis Media [11/22/92]
Tympanostomy Tubes [2/23/95]
Vestibular Adaptation and Rehabilitation [5/21/92]
Vestibular Neuritis [7/14/94]

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©2001, The Bobby R. Alford Department of Otorhinolaryngology and Communicative Sciences,
Baylor College of Medicine
One Baylor Plaza, NA102, Houston, TX 77030 [email protected]
URL: http://www.bcm.tmc.edu/oto (Modified: 12/12/01)
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From the Grand Rounds Archive at Baylor
Grand Rounds Archives

**** DISCLAIMER ****
The information contained within the Grand Rounds Archive is intended for use by
doctors and other health care professionals. These documents were prepared by
resident physicians for presentation and discussion at a conference held at The
Baylor College of Medicine in Houston, Texas. No guarantees are made with
respect to accuracy or timeliness of this material. This material should not be used
as a basis for treatment decisions, and is not a substitute for professional
consultation and/or peer-reviewed medical literature.
Acute Otitis Media: A Public Health Perspective
Derek Drummond, M.D.
March 18, 1999

Case Presentation
J.D., a previously healthy girl, presented to her pediatrician at 6
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From the Grand Rounds Archive at Baylor
months of age with a 3-day history of increasing irritability and
fevers. History revealed that she had upper respiratory tract
symptoms for 3 days that included nasal congestion, rhinorrhea,
dry cough, decreased appetite and low-grade fevers. The parents
became concerned the night before presentation when she
became very irritable, appeared to be in pain, and vomited once
after bottle-feeding. The girl was seen pulling on her ears and
was inconsolable prior to arrival at the pediatrician's office. She
had no previous medical problems and was not taking any
medication other than acetaminophen.
Physical exam demonstrated a 6-month old girl who was crying
in her mother's arms. She was alert but not cooperative. She had
a temperature of 101.5 F. Examination of the ears revealed a
right tympanic membrane that was bulging, erythematous, and
didn't move with pneumotoscopy. The nasal mucosa was
congested and the patient was mouth breathing. The remainder
of the physical exam was unremarkable. She was diagnosed with
acute otitis media and prescribed a 10-day course of amoxicillin
at 40mg/kg/day. Within 24 hours, her symptoms were improving
and she began to feed normally. Follow-up at 2 weeks revealed
bilateral middle-ear effusions in a happy, asymptomatic child.
The MEE would resolve spontaneously over the next 3 months.
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Acute Otitis Media

Slide 1 of 62
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Grand Rounds Archives

**** DISCLAIMER ****
The information contained within the Grand Rounds Archive is intended for use by doctors and other
health care professionals. These documents were prepared by resident physicians for presentation and
discussion at a conference held at The Baylor College of Medicine in Houston, Texas. No guarantees are
made with respect to accuracy or timeliness of this material. This material should not be used as a basis
for treatment decisions, and is not a substitute for professional consultation and/or peer-reviewed
medical literature.

AUTOIMMUNE INNER EAR DISEASE
Douglas D. Backous,, MD
April 8, 1993
The role of immunity in sensorineural hearing loss was first suggested in 1958 by Lenhart. Kikuchi, in
1959, wrote of "sympathetic otitis" whereby surgery on one ear affected hearing in the other. He
proposed an autoimmune phenomena as the etiology. In 1961 Beickert, and two years later, Terrayama
presented data supporting autoimmunity in experimental guinea pig cochleas. McCabe described 18
patients with bilateral asymmetric hearing loss progressing over weeks to months which responded to
steroid therapy. His 1979 paper asserted the importance of a high index of suspicion in these patients
since, if diagnosed early, they could be treated and their hearing preserved.
Humoral and cell mediated immunity, the lymphocyte-macrophage system, and the complement cascade
work in homeostatic harmony to provide immune protection to the host. B cells are produced in the bone
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