CH. 16 Jasmine Durham Case Study
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Rutgers University *
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121
Subject
Medicine
Date
Jan 9, 2024
Type
docx
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2
Uploaded by ProfCheetahMaster1983
Jasmine Durham
Chapter 16 Case Study Questions
December 4, 2023
Medical Terminology
Medical Record
Chronic Suppurative Otitis Media with Large Conductive Hearing Loss and Perforated
Tympanic Membrane
FINDINGS: This 14-year-old girl had a near-total tympanic membrane perforation. The small remnant of the tympanic
membrane superiorly had tympanosclerosis, so a total perforation was created.
MUCOSA: The middle ear mucosa was mildly inflamed. There was no active infection.
EUSTACHIAN TUBE: The eustachian tube was not visually obstructed. Furthermore, I was able to easily pass #00, #0,
and #1 lacrimal probes without difficulty. A #2 lacrimal probes had too much tension to pass easily.
OSSICLES: I was concerned about her ossicular chain since the amount of hearing loss is more than I would usually
anticipate with just a perforation alone. On close examination of the ossicular chain, the malleus was partially
immobilized, but this improved considerably with removal of the tympanosclerosis surrounding the neck of the malleus
and handle of the malleus. The incus long process was slightly eroded, but there was good continuity. The stapes was
intact and mobile.
OPERATIVE DESCRIPTION: The patient was placed in the supine position on the operating table. General endotracheal
anesthesia was administered. A small amount of hair was shaved from the postauricular region. The left ear was prepped
and draped in the usual fashion.
The skin of the left ear canal was carefully cleaned of dead skin, cerumen, and hardened purulent debris. Using an angled
and straight Beaver blade, a posterior canal flap was incised and elevated from the bone of the external auditory canal.
CANAOPLASTY: A peritympanic incision was made. The tympanic membrane remnant was reflected inferiorly off the
handle of the malleus. Diseased portions of the tympanic membrane (i.e., tympanosclerosis and mucosa) and fibrosis at
the perforation edge were resected using a microscissors. Following placement of saline-soaked gelfoam to support the
graft, the grafts were placed underneath the medial canal skin and tympanic membrane remnant. Polysporin ointment was
instilled into the ear canal. Weitlander retractors were removed. Hemostasis was obtained using an electrocautery. The
mastoid fascia was approximated using interrupted 3-0 Vicryl sutures. Wound care and dressings were carried out.
The patient was brought to the recovery room in stable condition. There were no intraoperative complications. Blood loss
was negligible.
FUTURE PLAN: The patient's conductive hearing loss will be reevaluated over the next 6 to 18 months to determine if
there is any significant residual conductive loss. She will have to be followed to determine if tympanosclerosis will re-fix
the ossicular chain.
Questions:
1 - How was the bleeding controlled?
The bleeding was controlled through the use of electrocautery the doctor was
able to control the bleeding.
2 - What is the definition of cerumen?
Cerumen is the medical term for ear wax.
3 - What is the definition of tympanosclerosis and what could be the effect of this?
Tympanosclerosis is a disorder in
which tissue in the eardrum and middle ear, particularly the tympanic membrane, becomes calcified. It may
compromise hearing if the damage is severe. It can result in hearing loss.
4 - What is the description and function of the Eustachian Tube?
The Eustachian tube is a canal that connects the
middle ear cavity with the nasopharynx. The tube has an extended form with a restricted portion near the
intersection of the osseous and pharyngeal zones known as the isthmus. It balances the air pressure in the middle
ear system with the atmospheric pressure outside the body and clears mucus from the middle ear. The tube is
usually closed and opens only during activities such as chewing, awning, and swallowing.
5 - Where was the incision made in the tympanic membrane?
Paratympanic (direct translation near tympanic)
membrane incision is a surgical cut made immediately next to tympanic membrane either the anteroinferior
quadrant or the posteroinferior quadrant of the tympanic membrane is carefully incised with a myringotomy
knife.
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