ear Flashcards
place tuning fork in midline skull
do you hear anything? yes which ear?
both (midline)
if one ear (abnormal -lateralizes to L/R)
Weber test
conductive hearing loss: lateralizes to affected ear (louder in affected ear)
sensorinueral hearing loss: lateralizes to good ear (no sensation of sound in affected ear)
abnormal Weber test
plugged ear canal causes louder sound heard in affected ear with Weber test. example of:
conductive hearing loss
place tuning form on mastoid process
do you hear anything? yes
tell me when sound stops - then move it perpendicular to ear and ask if still here it.
normal: air conduction > bone conduction
conductive hearing loss: BC>AC (don’t hear it in front of hear)
Rinne test
bone conduction > air conduction (rinne test) is a feature of
conductive hearing loss
inflammation/infection of ear canal (superficial)
pain with manipulation of ear (pinna) or instrumentation of canal (otoscope)
acute otitis externa (swimmer’s ear)
ear infection caused by P. aeruginosa (most common) or S. aureus
acute otitis externa (swimmer’s ear - wet ear after gone swimming)
treatment of acute otitis externa (swimmer’s ear)
irrigation
topical antibiotics
infection of middle ear space - usually bacterial
acute otitis media (AOM)
diagnosis of acute otitis media
inspect tympanic membrane:
bulging
middle ear effusion (opaque, air-fluid level, pus)
erythema (nonspecific)
TM immobility under positive pressure with pnuematic otoscope
ear infection caused by P. pneumoniae (most common), nontypable H. influenzae (not type B), M. catarrhalis
acute otitis media
treatment of acute otitis media
antibiotics: amoxicillin, amoxicillin + clavulonic acid, cephalosporin tympanostomy tubes (recurrent infections, equalize pressure)
complication of acute otitis media
acute mastoiditis (AOM symptoms + post-auricular swelling, redness, mastoid tenderness)
connects middle ear to phayrnx
eustachian tube
difficulty maintaining equilibrium between middle ear pressure and atmospheric pressure
associated with allergic rhinitis
treat with intranasal steroids
eustachian tube dysfunction
overgrowth of desquamated keratin debris in middle ear space that may erode the ossicular chain (ossicles) and mastoid air cells → form cystic lesion lined by keratnizing squamous epithelium (can be metaplastic)
associated with chronic middle ear infections
cholesteatoma
“pearly” grayish-white lesion behind or involving TM or involving TM
conductive hearing loss
vertigo
cholesteatoma
treatment of cholesteatoma
surgical removal involving tymapnomastoidectomy and reconstruction of ossicular chain
negative ear pressure from eustachian tube dysfunction (pulls on TM and creates chronic retraction pocket) or direct growth of epithelium through a TM perforation, can cause:
cholesteatoma
displaced otoliths (stones) in SCC in vestibular apparatus diagnosed by dix-hallpike maneuver treated by epley maneuvar
benign paroxysmal positional vertigo (BPPV) - most common cause of vertigo
inflammation of vestibular nerve
vestibular neuritis
brainstem + cerebellar lesions damaging vestibular nuclei or posterior fossa tumor
central vertigo
imbalances of fluid + electrolyte composition of endolymph in vestibular apparatus causing this triad:
intermittent vertigo
tinnitis
hearing loss
Meniere disease (endolymphatic hydrops)
sensation of spinning, objects moving
vertigo
intermittent vertigo
tinnitis
hearing loss
Meinere disease
r/o schwannoma with MRI (usually no vertigo though)
