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AHNNA > 7. Anatomy Of The Ear > Flashcards

7. Anatomy Of The Ear Flashcards

1
Q

What are some of the signs and symptoms of ear disease?

A 
Otalgia (ear pain)
Discharge
Hearing loss
Tinnitus
Vertigo
Facial nerve palsy
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2
Q

What does the external ear contain?

A

Pinna
External auditory meatus
Skin-lined

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3
Q

What does the middle ear contain?

A

Air filled cavity
Ossicles
Lined with respiratory epithelium
Pharyngotympanic tube connects it to nasopharynx

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4
Q

Where is the tympanic membrane?

A

Between external ear and inner ear

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5
Q

What does the inner ear contain?

A

Cochlea
Semicircular canals
Fluid filled

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6
Q

Which nerves carry general sensation from ear and can therefore cause referred pain?

A

Branches of:

  • cervical spinal nerves (C2/3)
  • vagus
  • trigeminal
  • glossopharyngeal
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7
Q

What should otalgia with a normal ear examination lead you to suspect?

A

An alternative site of pathology

E.g. TMJ dysfunction (CNVc), diseases of oropharynx (CNIX), disease of larynx and pharynx including cancers (CNIX, X)

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8
Q

What is the role of the external ear?

A

Collects, transmits and focuses sound waves onto the tympanic membrane

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9
Q

What are some abnormalities or conditions of the pinna?

A

Ramsay-hunt syndrome
Perichondritis
Pinna haematoma

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10
Q

What is a pinna haematoma?

A

Accumulation of blood between cartilage and its overlying perichondrium from blunt injury

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11
Q

What is the consequence of subperichondrial haematoma?

A

Deprives cartilage of blood supply and pressure necrosis of tissue

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12
Q

How do you treat pinna haematoma?

A

Drainage and prevent re-accumulation/re-apposition of 2 layers

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13
Q

What can happen if a pinna haematoma is not treated?

A

Fibrosis, new asymmetrical cartilage development, leads to cauliflower deformity

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14
Q

Roughly how long is the external acoustic meatus?

A

2.5cm

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15
Q

What is the external acoustic meatus made up of?

A

Cartilaginous (outer 1/3) and bony (inner 2/3) - sigmoid shape

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16
Q

What is inside the external acoustic meatus?

A

Hair, sebaceous and ceremonious glands line cartilage part, barrier to foreign objects

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17
Q

What does the bony part of the external acoustic meatus lack?

A

Glands and hairs

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18
Q

What do the ceremonious glands produce?

A

Ear wax

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19
Q

What is otitis externa and what are the symptoms?

A

Inflammation of external ear (external acoustic meatus)

Itchiness, pain, discharge, possible hearing loss

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20
Q

What are the most common bacterial causes of otitis externa?

A

Pseudomonas aeruginosa

Staphylococcus species

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21
Q

What is a serious complication of otitis externa?

A

Malignant otitis externa - potentially life-threatening, bacteria erodes through bone

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22
Q

How is at particular risk of developing malignant otitis externa?

A

Immunocompromised including diabetes

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23
Q

What are the common abnormalities of tympanic membrane?

A

Tympanosclerosis (scarring)
Bulging secondary to bacterial acute otitis media
Retracted and evidence of fluid within middle ear cavity (otitis media with effusion) - glue ear

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24
Q

What is a cholesteatoma?

A

Retraction of pars flaccida (TM) forms a sac/pocket, trapping stratified squamous epithelium and keratin
Proliferates forming cholesteatoma

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25
Q

What is cholesteatoma usually secondary to?

A

Chronic Eustachian tube dysfunction - negative pressures pull the pocket into the middle ear

26
Q

What are the symptoms of cholesteatoma?

A

Painless, often smelly otorrhea (discharge), hearing loss

27
Q

What are the possible consequences of cholesteatoma?

A

Not malignant but slowly grows and expands
Potentially mor serious consequences due to enzymatic bony destruction e.g. erode ossicles, mastoid/petrous bone, cochlea

28
Q

What are the ossicles in the middle ear?

A

Malleus
Incus
Stapes

29
Q

What is the role of the ossicles?

A

Amplify and relay vibrations from the TM to the oval window of the cochlea

30
Q

What tampers the ossicles movement?

A

Muscles tensor tympani and stapedius

31
Q

What is otosclerosis?

A

Acquired hearing loss

32
Q

What happnes in otosclerosis?

A

Ossicles fused at articulations due to abnormal bone growth particularly between base plate of stapes and oval window
Sound vibrations cannot be transmitted effectively to cochlea

33
Q

What do patients with otosclerosis present with?

A

Gradual unilateral or bilateral conductive hearing loss

34
Q

What does the pharyngotympanic tube do?

A

Equilibrates pressure of middle ear with atmospheric pressure

35
Q

How does the pharyngotympanic tube equilibrate pressure?

A

Mucous membrane of middle ear continuously reasons air in middle ear causing negative pressure
Pharyngotympanic tube allows equilibration of pressure within middle ear cavity with that of atmosphere
Allows for ventilation of and drainage of mucus from middle ear

36
Q

What is otitis media with effusion?

A

Glue ear
Fluid and negative pressure in middle ear - decreases mobility of TM and ossicles, affecting hearing
Due to Eustachian tube dysfunction

37
Q

How do you get rid of otitis media with effusion?

A

Most resolve spontaneously in 2-3 months

,at persist and/or impede speech and language development/school performance - requires grommets

38
Q

What is acute otitis media?

A

Acute middle ear infection

39
Q

What are the signs and symptoms of acute otitis media?

A

Otalgia
Other non-specific symptoms e.g. temperature
Red/bulging TM and loss of normal landmarks

40
Q

What are the bacterial (occasional) causes of acute otitis media?

A

Streptococcus pneumoniae

Haemophilus influenzae

41
Q

What usually causes acute otitis media?

A

Usually viral

42
Q

Why are children more susceptible to ear problems?

A

Pharyngotympanic tube is shorter and more horizontal in infants
Therefore, easier passage for infection from nasopharynx to middle ear
Tube can block more easily (adenoids), compromising ventilation and drainage of middle ear, increasing risk of infection/glue ear

43
Q

What are some complications of acute otitis media?

A

Tympanic membrane perforation
Facial nerve involvement (rare)
Rarer but potentially life-threatening: mastoiditis, intracranial complications (meningitis, sigmoid sinus thrombosis, brain abscess)

44
Q

What is mastoiditis?

A

Infection that affect mastoid bone

Swollen and red behind ear, possible ear pushed forward

45
Q

Why can mastoiditis occur?

A

Middle ear cavity communicates via mastoid antrum with mastoid air cells
Provides a potential route for middle ear infections to spread into the mastoid bone

46
Q

What does the inner ear consist of?

A

Vestibular apparatus and cochlea

47
Q

What is the inner ear involved in?

A

Hearing and position-sense/balance

48
Q

What happens in the cochlea?

A 
Fluid movement (generated by footplate of stapes)
Converted into action potentials (in CNVIII) -> perceived as sound
49
Q

What happens in the vestibular apparatus?

A 
Fluid movement (generated by position and rotation of head)
Converted into action potentials (in CNVIII) -> perceived as position sense and balance
50
Q

What do inner ear pathology present with?

A

Hearing loss (sensorineural)
Tinnitus
Disturbances of balance and vertigo

51
Q

What is the cochlea?

A

Fluid-filled tube with specialise hair cells that generate action potentials when moved

52
Q

What causes movement of fluid in cochlear duct?

A

Movements at the oval window

53
Q

What do the waves of fluid cause in the cochlea?

A

Movement of special sensory cells (stereocilia)

Which generate action potentials via CNVIII

54
Q

What is the vestibular apparatus?

A

Fluid-filled tubes with specialised hai cells that generate action potentials when moved

55
Q

What does the vestibular apparatus include?

A

Semicircular ducts
Saccule
Utricle

56
Q

How does the vestibular apparatus work?

A

Moving position or road action of head, moves fluid
Bends stereocilia
Generate actions potentials via CNVIII

57
Q

What is presbycusis?

A

Sensorineural hearing loss associated with old age
Bilateral and gradual
Affects cochlea or vestibular apparatus

58
Q

What is benign paroxysmal positional vertigo?

A

Vertigo only
Short lived episodes, triggered by movement of head
Affects vestibular apparatus

59
Q

What are the diagnostic tests/treatments for benign paroxysmal positional vertigo?

A

Dix-hallpike

Epley manoeuvres

60
Q

What is Ménière’s disease?

A

Vertigo, hearing loss and tinnitus
Affects both cochlea and vestibular apparatus
May describe aural fullness, nausea and vomiting
Symptoms longer lasting
Recovery in between
Hearing may deteriorate over time

61
Q

What is acute labrynthitis?

A

History of upper respiratory tract infection
Affects both cochlea and vestibular apparatus
Involvement of all inner ear structures, associated with hearing loss/tinnitus, vomiting and vertigo

62
Q

What is acute vestibular neuronitis?

A

History of upper respiratory tract infection
Affects both cochlea and vestibular apparatus
Usually no earring disturbance or tinnitus
Sudden onset of vomiting and severe vertigo

AHNNA (18 decks)

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