Ear Flashcards
What is the gender bias associated with excessive ear wax?
Males
What is a Rinne negative finding?
Sound heard longer through bone than air (significant canal or middle ear problem)
What is the most common cause of otitis externa?
Bacterial infection
Are all middle ear fluids infected and/or painful?
NO
What is the Rinne test for presbycusis?
Air conduction is greater than bone conduction but less than the 2:1 ratio
What causes cholesteatomas?
Congenital defects, chronic otitis media and perforations
Suppurative otitis media is common among what age group?
Children 6 months to 6 years old
If one ear is affected by otosclerosis, what will be the findings of the “finger rustle”, Weber, and Rinne tests?
“finger rustle” - diminished on that side Weber - lateralization on that side Rinne - air will be less than bone
What is a Rinne positive finding?
Air is heard twice as long as bone
Why does sound lateralize to the ear with a significant canal or middle ear problem during the Weber test?
Sound cannot escape the ear therefore rebounding it back to the inner ear for a double dose of sound
What color is the eardrum?
Pearly gray
What is the shape of the tympanic membrane?
Concave
What is the most painful cause of otitis externa?
Bacterial infection
What is different with the main symptoms of otitis externa caused by bacteria compared to fungi?
Bacteria = pain Fungi = itching
What is usually the cause of a bloody effusion in the middle ear?
Temporal bone fractures or shearing force causing mucosal bleeding
What is the issue with cholesteatomas?
Erodes surrounding bone and ossicles therefore able to cause hearing loss
Blood vessels in what part of the tympanic membrane overlying the malleus are usually normal findings?
Pars flacida
What kinds of things can cause tinnitus?
1 skull fracture 2 closed head injury 3 whiplash injury 4 TMJ disorders
What is the supposed general cause of labyrinthitis?
Viral infection
What is the name for the triangular reflection of light from the otoscope seen on the tympanic membrane?
Light reflex
What ossicle creates the landmarks of the tympanic membrane?
Malleus
What will be the finding of the Rinne test if there is a total sensorineural loss of hearing?
Nothing will be heard by air nor bone
The auditory (Eustachian) tube joins what two structures?
Nasopharynx to middle ear
What are symptoms of inner ear problems?
Vertigo (nausea), tinnitus, sensory hearing loss
What is the condition where white calcium patches are present on the eardrum resulting from old eardrums perforations?
Tympanosclerosis
When must the Rinne test be performed?
If Weber test lateralizes
What fills the tympanic cavity?
Air
What is the color of fresh earwax? Of old and built up earwax?
Fresh = honey-colored Old = dark black
What does the Rinne test compare?
Air to bone conduction
Where is the tympanic cavity located?
Carved in the temporal bone
Where do we find the cerumen glands?
Outer 1/3 of the canal
What are the two divisions of the tympanic membrane?
Pars flacida (attic) Pars tensa (lower 2/3)
What happens to the patient when the eardrum perforates?
Discharge into canal and immediate end of earache
What are the two possibles problems if lateralization is found in the left ear during the Weber test?
1 sensorineural loss in the right ear 2 air conduction problem in left ear
What is another name for the tympanic membrane?
Eardrum
What is the clinical term for inflammation of the inner ear and its nerves?
Labyrinthitis
What tool can be used to assess for sensorineural problems or middle ear problems unable to be seen on the eardrum?
Tuning fork
If a patient hesitates to answer which ear they hear better in during the Weber test, what is to be expected?
Normal response (no issues)
What things can cause otitis externa?
1 bacteria 2 fungi 3 swimming 4 dermatitis/psoriasis may contribute
Which test involves a vibrating fork being places in the midline of the head and asking the patient which ear they hear the ringing better in?
Weber test
What is exostosis?
Abnormal, benign, boney growth of the temporal bone that protrudes into the canal
What is the number one reason for sensorineural hearing loss? Number two?
1 = age-related hearing loss (presbycusis) #2 = noise-induced hearing loss
What is the Rinne finding with noise-induced hearing loss?
Air conduction is greater than bone conduction but less than the 2:1 ratio
What is otosclerosis?
Abnormal ossification of the ossicles
How does fresh earwax naturally get pumped out of the ear?
TMJ
What is the clinical term for “swimmer’s ear”?
Otitis externa
What three tests check for cranial nerve VIII?
1 “finger rustle” 2 Weber test 3 Rinne test
If during the Rinne test, air conduction is greater than bone conduction but not by 2X, what is the problem?
Inner ear (sensorineural loss)
What is the treatment for eardrum perforations?
Small ones heal on their own Large ones might need to be patched up surgically
Tinnitus affects roughly what percentage of the U.S. population?
10%
What is probably the most common occupational and environmental hazard?
Noise
Disorders of what other areas besides the inner ear can also cause vertigo?
Vestibular nerve, brainstem, cerebellum
What does the middle ear consist of?
1 eardrum 2 tympanic cavity 3 ossicles
Which ossicle is most likely to be affected by otosclerosis?
Stapes (fixation to the oval window)
What is the appearance of mucus in the middle ear?
Thick, viscous, darker than normal
What are the three possible mechanisms for auditory tube blockage?
1 barotrauma 2 adenoidal hypertrophy 3 URTI or allergy causing lumen occlusion
When does otosclerosis most commonly occur?
Between ages 11-30
What specific sounds are lost first followed noise-induced hearing loss?
High frequency sounds (3000 to 6000 Hz)
What are the functions of earwax?
1 produce acidic coat that inhibits bacterial and fungal growth 2 prevents water from entering skin due to hydrophobic nature
Antibiotic treatment has been shown to have little benefit in which kind of earache cases?
Otitis media without fever
What are things that increase the chances of getting middle ear effusions?
1 crowded child care facilities (increased URTIs) 2 secondhand smoke 3 bottle-fed infants
What is the term for age-related hearing loss?
Presbycusis
What are cystic masses composed of epithelial cells and cholesterol found in the middle ear called?
Cholesteatomas
What is the conventional treatment for middle ear effusions from the CDC?
WASP prescription (wait and see for 24 hours)
What are the 3 ossicles?
Malleus, incus, and stapes
Is hearing impaired in cases of serous fluid or mucus buildup in the middle ear?
Yes because ossicles can’t conduct sound vibrations as well
How does tympanosclerosis affect the patient?
If just on the eardrum - no issues If on ossicles - diminished hearing
Patients with seborrhea or eczema are at risk for what kind of ear problem?
Otitis externa
Which form of conduction should be more efficient: air or bone?
Air
What is the name of the handle portion of the malleus which angles posteriorly?
Long process (manubrium)
What is the color of sterile serous fluid that can build up in the middle ear?
Yellow
What are the Weber and Rinne findings for suppurative otitis media?
Weber - lateralizes to affected side Rinne - negative on affected side
How long do tympanostomy tubes stay in the eardrum before they are dislodged into the canal?
6-12 months
The Weber test is an example of what kind of conduction pathway/
Bone (traveling through cranial bones, skipping canal and middle ear)
What is the name of the rounded part of the malleus at the interface of the pars flacida and tensa?
Short process
What is the gender bias for otosclerosis?
Females 2X (worse during pregnancies)
During Dr. Fallon’s study on patients with otitis media, which part of the body was found to almost always be sublimated on the side of the condition?
Occiput
Is labyrinthitis painful?
No, rarely
What actions can aggravate otitis externa?
Chewing, pressing on trague, wiggling auricle
How can foreign objects affect the ear?
1 inflammatory 2 decreased hearing
What motion of the auricle produces the best view with the otoscope due to the hilly nature of the canal?
Pull auricle up and backward
What is the normal range for the “finger rustle” test?
2 ft
When the auditory tube becomes occluded, what happens that causes the earache itself?
Trapped air gets resorbed which causes retraction of the eardrum
Which four fluids have the potential to accumulate in the middle air following an occlusion of the auditory tube?
1 pus 2 serous fluid 3 mucous 4 blood
What should be the findings of a normal Rinne test?
Air conduction should be 2X longer than bone conduction
Presbycusis usually affects what group of people?
Elderly
At what point are tympanostomy tubes recommended?
Recurrent infections (3 episodes in 6 months) Persistent fluid (3 months with hearing loss and unresponsive to antibiotics)
What signs may be present in the ear in someone with serous fluid buildup in the middle ear?
1 yellow eardrum 2 air bubbles 3 fluid lines
Which direction does the umbo face?
Backward
What anatomical issue causes middle ear problems?
Blockage of the auditory tube
If during the Rinne test, bone conduction is greater or equal to air conduction on the side of lateralization, what is the problem?
Canal or middle ear problem
What is the issue with excessive earwax?
Can become impacted against eardrum and lead to decreased hearing
What are the 4 major red flags of ear conditions?
1 sudden or rapid hearing loss
2 vertigo
3 unilateral tinnitus
4 bleeding due to foreign object or pressure change injury
