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Anatomy
Head and Neck
An 8 year old girl is brought to ED with a fever and a painful ear, which developed a few days after a sore throat. On examination you note that the patient has a red inflamed throat and a bulging tympanic membrane. You diagnose otitis media. Which of the following structures provided a route of infection for the throat infection to spread to the middle ear:
Answer:
The eustachian tube (pharyngotympanic tube, auditory tube) connects the nasopharynx and the middle ear and is the conduit for spreading infections.Middle Ear
Anatomy / Head and Neck / Ear
Last Updated: 13th October 2023
The middle ear is an air-filled cavity in the petrous temporal bone between the tympanic membrane laterally and the lateral wall of the internal ear medially.
![By OpenStax [CC BY 4.0], via Wikimedia Commons](https://mrcemsuccess.com/wp-content/uploads/2016/07/ear.png)
Structure of the Ear. (Image by OpenStax [CC BY 4.0], via Wikimedia Commons)
Ossicles
Its basic function is to transmit vibrations of the tympanic membrane across the cavity of the middle ear to the internal ear which it does through three interconnected bones:
- the malleus (connected to the tympanic membrane)
- the incus (connected to the malleus)
- the stapes (connected to the incus and attached to the lateral wall of the internal ear at the oval window)
Relations
The middle ear communicates with the mastoid area posteriorly and the nasopharynx (via the eustachian tube) anteriorly. The eustachian tube (pharyngotympanic tube, auditory tube) equalises pressure on both sides of the tympanic membrane.
The mucous membrane lining the mastoid air cells is continuous with the mucous membranes throughout the middle ear. Therefore infections in the middle ear can easily spread into the mastoid area (and from here to the middle cranial fossa).
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- Biochemistry
- Blood Gases
- Haematology
| Biochemistry | Normal Value |
|---|---|
| Sodium | 135 – 145 mmol/l |
| Potassium | 3.0 – 4.5 mmol/l |
| Urea | 2.5 – 7.5 mmol/l |
| Glucose | 3.5 – 5.0 mmol/l |
| Creatinine | 35 – 135 μmol/l |
| Alanine Aminotransferase (ALT) | 5 – 35 U/l |
| Gamma-glutamyl Transferase (GGT) | < 65 U/l |
| Alkaline Phosphatase (ALP) | 30 – 135 U/l |
| Aspartate Aminotransferase (AST) | < 40 U/l |
| Total Protein | 60 – 80 g/l |
| Albumin | 35 – 50 g/l |
| Globulin | 2.4 – 3.5 g/dl |
| Amylase | < 70 U/l |
| Total Bilirubin | 3 – 17 μmol/l |
| Calcium | 2.1 – 2.5 mmol/l |
| Chloride | 95 – 105 mmol/l |
| Phosphate | 0.8 – 1.4 mmol/l |
| Haematology | Normal Value |
|---|---|
| Haemoglobin | 11.5 – 16.6 g/dl |
| White Blood Cells | 4.0 – 11.0 x 109/l |
| Platelets | 150 – 450 x 109/l |
| MCV | 80 – 96 fl |
| MCHC | 32 – 36 g/dl |
| Neutrophils | 2.0 – 7.5 x 109/l |
| Lymphocytes | 1.5 – 4.0 x 109/l |
| Monocytes | 0.3 – 1.0 x 109/l |
| Eosinophils | 0.1 – 0.5 x 109/l |
| Basophils | < 0.2 x 109/l |
| Reticulocytes | < 2% |
| Haematocrit | 0.35 – 0.49 |
| Red Cell Distribution Width | 11 – 15% |
| Blood Gases | Normal Value |
|---|---|
| pH | 7.35 – 7.45 |
| pO2 | 11 – 14 kPa |
| pCO2 | 4.5 – 6.0 kPa |
| Base Excess | -2 – +2 mmol/l |
| Bicarbonate | 24 – 30 mmol/l |
| Lactate | < 2 mmol/l |
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