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Head And Neck > Ear Anatomy + Disorders > Flashcards

Ear Anatomy + Disorders Flashcards

1
Q

What are the 3 key regions of the ear

A

External ear
Middle ear/ tympanic cavity
Inner ear/ Labyrinth

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2
Q

What are the 4 parts of the Temporal Bone?

A
  • Petromastoid
  • Squamous
  • Tympanic plate
  • Styloid process
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3
Q

Which part of temporal bone contains the middle and inner ear?

A

Petrous

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4
Q

What opening is found on the inferior surface of the Petrous bone and what passes through?

A

Carotid canal, internal carotid passes through

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5
Q

What are the Mastoid air cells?

A

Small air filled spaces within the mastoid process

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6
Q

What do the Mastoid air cells communicate with and via what channel?

Why is clinically significant?

A
  • Communicate with Middle Ear cavity
  • Via the Mastoid Antrum (a bony channel)
  • Potential spread of infection from Middle ear to mastoid air cells-> Acute Mastoiditis

(Entry to Mastoid Antrum from Middle Ear is called the Aditus)

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7
Q

How is Acute Mastoiditis treated?

A

Surgery and IV Antibiotics

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8
Q

What are the 2 parts of the External ear?

A
  • Pinna/ auricle

- External Auditory/ Acoustic Meatus (EAM)

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9
Q

Describe the Pinna/ Auricle of the External ear

A
  • Cartilaginous And covered with skin
  • Fleshy, fatty lobule at inferior end (Earlobe)
  • Arranged into curved ridges, including a Helix and Tragus
  • The Tragus guards the EAM
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10
Q

Cauliflower ear results from what untreated condition?

A

Pinna Haematoma

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11
Q

What is a Pinna Haematoma?

How is it treated?

A

Blood accumulation between cartilage and its overlying periochondrium

Drainage
Prevent re-accumulation

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12
Q

Describe the EAM of the External ear

A
  • Starts as a cartilaginous tube laterally-> Continues as a bony canal medially, formed by Tympanic Plate
  • Lined with skin, which secretes Cerumen for protection (Not the inner bony part)
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13
Q

What are 2 components of Earwax?

A
  • Cerumen secreted from the EAM skin

- Discarded cells of the EAM skin

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14
Q

Common conditions involving the EAM are;

  • Wax
  • Foreign bodies
  • Otitis Externa

What is Otitis Externa?

A
  • Inflammation of the External Ear Canal/ EAM

- Also called ‘Swimmer’s Ear’

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15
Q

What is Malignant/ Necrotising Otitis Externa?

A

This is when the bacterial infection becomes more invasive and erodes through the bone of the ear

(Can affect facial nerve-> Palsy)

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16
Q

List 5 causes of Otitis Externa

A
  • Skin irritation from water/ shampoo/ soap
  • Damage to skin in ear canal
  • Increased build up of wax+H20-> Irritation + infection
  • Skin problems (Eczema, Psoriasis)
  • Hot humid weather
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17
Q

What are 5 symptoms of Otitis Externa?

A
  • Itching/ pain/ discomfort
  • Watery discharge
  • Dry flaky skin around outside of ear and along ear canal
  • Discomfort moving jaw (chewing/ speaking)
  • If severe, reduced hearing
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18
Q

What is Medial and Lateral to the Tympanic membrane

A

Lateral: EAM
Medial: Middle ear

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19
Q

Describe the Tympanic Membrane

A
  • Fibrous
  • Cone shaped, with apex pointing medially
  • Translucent
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20
Q

Describe 4 structural features of the Middle Ear

A
  • Air filled
  • Contains Ossicles
  • Connected to Nasopharynx via Pharyngotympanic/ Eustachian Tube
  • Lined with respiratory epithelium (ciliated pseudostratified columnar)
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21
Q

What do the Ossicles do?

Name them from Lateral to Medial

A

Transmit vibrations from Tympanic Membrane to Inner Ear structures

Malleus, Incus, Stapes

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22
Q

What is the purpose of Eustachian/ Pharyngotympanic Tube?

What is the clinical significance of the tube?

A
  • Allows equalisation of air pressure between atmosphere and middle ear
  • Necessary for efficient transfer of sound from middle to internal ear
  • Potential route for infection to spread into middle ear
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23
Q

What nerve carries general sensation from the middle ear?

A

Tympanic branch of Glossopharyngeal nerve (IX)

IX Also carries sensory info from Oropharynx

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24
Q

Middle ear infections can also spread through bone to to structures in the cranial cavity.

Suggest 3

A
  • Meninges
  • Temporal Lobe
  • Sigmoid Sinus
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25
Q

What kind of joints are the articulation between the Ossicles?

Describe the articulation between Stapes and the Inner Ear

A

Synovial joints

Stapes articulates with the Inner Ear at the Oval Window of the Cochlea

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26
Q

How does Osteosclerosis present?

A
  • Gradual
  • Unilateral or bilateral
  • Conductive hearing loss
27
Q

Describe the function of the Ossicles

A
  • Transmit vibrations from an air medium to a fluid medium within the Cochlea
  • Amplifying and Concentrating sound
28
Q

Why can Osteosclerosis lead to hearing loss?

A
  • Causes mature bone to be replaced with woven bone-> Footlate of Stapes FUSES to Oval Window
  • Vibrations can’t be transmitted to inner ear-> Hearing loss

(Fusion can also be between Ossicles)

29
Q

The Eustachian tube is usually closed.

When is it intermittently opened?

A

By the pull of attached palate muscles when swallowing or yawning

30
Q

What does the Stapedius muscle do?

What other muscle has same overall effect?

A

Dampens excessive vibration of the Stapes footplate at the Oval Window

Tensor tympani

31
Q

What branch of the facial nerve runs over the inner surface of the Tympanic Membrane?

A

Chorda Tympani

32
Q

Describe how a Cholesteatoma comes about

A
  • Chronic negative pressure in middle ear-> Retraction of Pars Flaccida forms a Sac/ Pocket
  • Trapping of Strat. Squamous epithelia+ keratin-> Proliferation into a Cholsteatoma
33
Q

How does a Cholesteatoma present?

A
  • Painless
  • Smelly otorrhea
  • May have hearing loss
34
Q

What is the usual cause of a Cholesteatoma?

A

Chronic Eustachian Tube dysfunction-> Negative pressure in middle ear

35
Q

A Cholesteatoma is not malignant but it slowly grows and expands.

Suggest a complication

A

Enzymatic destruction of bone (Ossicles/ petrous/ mastoid)

36
Q

Describe the self cleaning function of the EAM

A

Epithelial Migration:

- Epithelia moves laterally outwards from Tympanic Membrane

37
Q

Suggest 3 non-otological causes of Otalgia

A
  • TMJ dysfunction (Vc)
  • Oropharynx diseases (IX)
  • Larynx and pharynx diseases (IX and X)
38
Q

Compare the appearance of the Tympnic Membrane in;

  • Acute Otitis Media
  • OM with Effusion
A

Acute OM;
- Outwards/ Lateral Bulging (due to raised pressure)

OM with Effusion;

  • Retracted (pulled in medially)
  • Evidence of fluid in middle ear
39
Q

Describe Otitis Media with effusion

What is the usual cause?
How is treated?

A
  • AKA ‘Glue Ear’, NOT an infection
  • Fluid buildup and negative pressure in middle ear
  • Eustachian tube dysfunction
  • Most resolve spontaneously in 2 to 3 months
40
Q

Why does OM with effusion cause hearing loss?

This condition is usually in children, how can it be managed temporarily?(resolves on its own in 2-3 months)

A

Fluid decreases mobility of TM and ossicles-> Hearing loss

Using Grommets, which act to equilibrate pressures between atmospheric pressure and middle ear

41
Q

What is Acute Otitis Media?

What are 4 symptoms?

A
  • An acute middle ear infection, more common in children/ infants
  • Otalgia (Infants may pull/ tug at ear)
  • Nonspecific infection symptoms (fever)
  • Red TM, may be bulging
42
Q

Describe the Aetiology of Acute Otitis Media

A
  • Mostly viral

Occasionally bacterial;

  • Strep pneumoniae
  • Haemophilus influenzae
43
Q

Why are children more susceptible to middle ear pathology than adults?

A

Eustachian tube is shorter + more horizontal so;

  • Easier passage for infection to spread
  • Tube can block more easily-> Impaired ventilation and drainage of middle ear
44
Q

List 4 complications of Acute OM

A
  • TM perforation
  • CN VII involvement
  • Mastoiditis
  • Intracranial complications (Meningitis, sigmoid sinus thrombosis, brain abscesses)
45
Q

What are the 4 parts of the Inner Ear/ Labyrinth?

A
  • Cochlea

Vestibular apparatus;

  • Utricle
  • Saccule
  • 3 Semicircular ducts and canals
46
Q

What are 3 Semicircular canals/ ducts? (One for each possible plane of head rotation)

A
  • Anterior
  • Posterior
  • Lateral
47
Q

What do you call the fluid that fills the structures of the inner ear?

A

Endolymph

48
Q

The Cochlea is the part of the Inner Ear responsible for hearing.

Describe how this works

A
  • Stereocilia in the spiral Organ of Corti
  • Respond to fluid motion (generated by Stapes ‘tapping’ on Oval Window) and generate an AP
  • The AP moves down the Cochlear part of CN VIII to be perceived as sound
49
Q

The Vestibular Apparatus is responsible for balance and position.

Describe this

A
  • Stereocilia in Utricle and Saccule respond to Rotation Acceleration AND Pull of Gravity
  • Stereocilia in Semicircular ducts/ canals respond to Rotational Acceleration in 3 different planes
  • Head/body movement-> Fluid movement-> Bending of stereocilia-> Generating an AP
  • The AP travels down Vestibular part of CN VIII to be perceived as our sense of Position and Balance
50
Q

What are 3 general possible symptoms of inner ear pathology

A
  • Hearing loss
  • Tinnitus
  • Disturbances to balance and vertigo
51
Q

Compare Conductive and Sensorineural hearing loss

A

Conductive;
- Associated with Middle and External Ear

Sensorineural;
- Associated with Internal Ear

52
Q

Some conditions affect BOTH hearing and balance, some affect ONLY one of the two.

List;

  • 2 conditions that affect BOTH hearing and balance
  • 1 condition that affects ONLY HEARING
  • 1 condition that affects ONLY BALANCE
A

Affects Both;

  • Meniere’s Disease
  • Labyrinthitis

Affects only hearing;
- Presbycusis (Age related)

Affects only balance;
- Benign Positional Paroxysmal Vertigo (BPPV)

53
Q

Describe the most common cause of Sensorineural hearing loss

How can it be treated?

A

Presbycusis;

  • Associated with old age
  • Hearing loss prevents Gradually and Bilaterally
  • Initially affects ability to hear higher pitched sounds
  • Can be treated with hearing aids
54
Q

Describe the presentation of most common cause of Vertigo

Only affects balance

A

Benign Positional Paroxysmal Vertigo, BPPV;

  • Intermittent, short episodes of Vertigo (Seconds)
  • Triggered by head movement
55
Q

Name the test used to diagnose BPPV.

What’s the treatment?

A

Test: Dix-Hallpike

Treat: Epley manoeuvres

56
Q

What is the typical triad of symptoms of Ménière’s disease?

Name 3 other symptoms

A
  • Vertigo
  • Hearing loss
  • Tinnitus
  • Nystagmus
  • Aural fullness
  • Nausea and vomiting

(Hearing May deteriorate over time)

57
Q

Suggest 2 broad types of infection of inner ear

What is 1 similarity between them

A
  • Acute Labyrinthitis
  • Acute Vestibular Neuronitis
  • History of Upper Respiratory Tract infection
58
Q

What is the difference between Acute Labyrinthitis and Acute Vestibular Neuronitis

A

AL;
- ALL inner ear structures involved-> Vomiting, Vertigo and Hearing loss/ Tinnitus

AVN;

  • Usually NO hearing disturbance/ tinnitus
  • Sudden onset of Vomiting and severe vertigo (lasting days)
59
Q

What can Rinne’s and Weber’s tests be helpful with?

When may we use them?

(Weber-forehead, Rinne- sides)

A
  • Helpful to distinguish between Conductive and Sensorineural hearing loss
  • When no immediately obvious cause can be identified
60
Q

During an ear examination, examine both ears and avoid standing/ having to bend over.

How do we begin an ear examination?

A

Inspect and palpate the;

  • Skin around Pinna
  • Mastoid process
  • Pinna itself
61
Q

How is the EAM examined using an Otoscope?

A
  • In an adult, pull Pinna UP, OUT and BACK to straighten EAM

- In a child, pull Pinna DOWN and BACK

62
Q

Describe 3 visual features of a normal Tympanic Membrane when looking through and Otoscope

A
  • Translucent
  • Handle/ Manubrium of Malleus seen near the centre
  • TM is oblique so that Superior margin is closer to examiner’s eye
63
Q

What does a bulging Tympanic Membrane indicate?

What do you call white plaques on the Tympanic Membrane?

A

Fluid or pus in Middle Ear

Tympanosclerosis

64
Q

How would you differentiate between Meniere’s and Acute Labyrinthitis?

A

Meniere’s;

  • Episodic, typically lasting a few hours
  • Possible prior history of Aural Fullness

Acute Labyrinthitis;

  • Symptoms last longer (days to weeks)
  • Often sudden onset, possible prior history of URT Infection

Head And Neck (20 decks)

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