7.1.1 Signs and Symptoms of Ear Disease

Question 1

What symptoms and signs can a patient with ear disease present with?

Answer 1

• Otalgia
• Discharge
• Hearing loss (conductive vs sensorineural)
• Tinnitus
• Vertigo- feel the room is spinning (different from feeling dizzy)
• Facial nerve palsy (both CNVIII and CNVII enter petrous bone via internal acoustic meatus)

Question 2

Label the image

Answer 2

(Pinna is the entire thing)

Question 3

What are the 3 different parts of the ear?

Answer 3

External
Middle
Inner

Question 4

What makes up the external ear?

Answer 4

• Pinna
• External auditory meatus
  Up to the point of the lateral tympanic membrane
  Skin-lined (keratinised squamous epithelium)

Question 5

What separates the external ear from the middle ear?

Answer 5

Tympanic membrane, lateral part is external and medial is middle ear

Question 6

What makes up the middle ear?

Answer 6

• Air-filled cavity
• Ossicles (malleus,incus and stapes)
• Lined with respiratory epithelium (psuedostratified ciliated columnar, has goblet cells too)
• Connected to nasopharynx via eustachian tube (fibrocartilaginous tube)

Question 7

What makes up the inner ear?

Answer 7

• Cochlea
• Semicircular canals (has anterior,lateral and posterior)
• Fluid-filled

Question 8

Why can you get referred pain at the ear from several different locations?

Answer 8

Branches of the following carry general sensation, therefore pathology affecting these nerves causes referred pain:
- C2/3 spinal nerves
- CNX
- Trigemnial, auriculotemporal branch
- CNIX
- CNVII

Question 9

What is the function of CNVIII (vestibulocochlear)?

Answer 9

Special sensory, hearing and balance

Question 10

If there is a normal ear examination with otalgia what sites should you suspect pathology?

Answer 10

• TMJ dysfunction (CNVc)
• Diseases of oropharynx (CNIX)
• Disease of larynx and pharynx (including cancers, CNIX & X)

Question 11

What is the function of the external ear?

Answer 11

Collects, transmits and focuses sound waves onto the tympanic membrane

Question 12

What are some causes of pinna abnormalities?

Answer 12

• Congenital
• Inflammatory (Ramsay-hunt syndrome, vesicles on the ear also, facial palsy)
• Infective- perichondritis (infection of the perichondrium of the ear will need antibiotics to treat this usually)
• Traumatic- Pinna haematoma and cauliflower ears

Question 13

What is a pinna haematoma?

Answer 13

Blood accumulation between cartilage and overlying perichondrium from blunt injury

Question 14

How does a pinna haematoma occur?

Answer 14

1.Trauma
2.Subperichondrial haematoma forms, deprives cartilage of blood supply
3.Leads to pressure necrosis

Common in contact sports

Question 15

How do you treat a pinna haematoma?

Answer 15

Drainage and prevent re-accumulation between the two layers by using pressure either side of the ear

Question 16

What happens if a pinna haematoma is left untreated?

Answer 16

Fibrosis occurs, new asymmetrical cartilage develops

Cauliflower ears

Question 17

Describe the outer external acoustic meatus

Answer 17

• 2.5cm long skin-lined cul-de-sac
• Lined with keratinising stratified squamous epithelium (skin basically)
• Cartilaginous outer 1/3
• Bony inner 2/3
• Sigmoidal shape

Question 18

What can you find in the cartilaginous outer 1/3 of the EAM?

Answer 18

• Hair
• Sebaceous glands and ceruminous glands (forms a barrier to foreign objects)

Question 19

What do ceruminous glands do?

Answer 19

Production of ear wax

Question 20

Describe the self-cleaning function of the EAM

Answer 20

Desquamation and skin migration laterally off tympanic membrane out of canal

Epithelial migration