Ear Assessments Flashcards
parts of the external ear
- external auditory canal
- cartilage
- mastoid process
- tympanic membrane
parts of the middle ear
- malleus, incus, stapes
- round window
- Eustachian tube
What are the three functions of the middle ear?
- it conducts sound vibrations from the outer ear to the central hearing apparatus in the inner ear
- it protects the inner ear by reducing the amplitude of loud sounds
- its Eustachian tube allows equalization of air pressure on each side of the tympanic membrane so that the membrane does not rupture
parts of the inner ear
- vestibule
- semicircular canals
- cochlea
- cranial nerve VIII
Describe the two pathways of hearing
- AC- air conduction- most efficient
- BC- bone conduction- bones of the skull vibrate, these vibrations transmit directly to the inner ear and to cranial nerve VIII
Conductive hearing loss
occurs when sound wave transmission through the external or middle ear is disrupted
examples:
- fluid build up
- cerumen impaction
Sensorineural hearing loss
results from a problem somewhere beyond the middle ear, from inner ear to auditory cortex
Examples:
- presbycusis - gradual nerve deterioration occurs with age
- ototoxic drugs- affect the hair cells in the cochlea
mixed hearing loss
both conductive and sensorineural
the ear and equilibrium
the labyrinth in the inner ear constantly feeds information to your brain about your body’s position in space
What happens if the labyrinth becomes inflamed?
it feeds your brain wrong information creating a staggering gait and a strong, spinning, whirling sensation called vertigo
what is the difference between vertigo and dizziness?
vertigo-the room is spinning
dizziness- you yourself are spinning
what is the difference between Eustachian tubes in adults and children?
children- horizontal
adults- slanted
Tinnitus
- commonly thought to be normal sounds of the body but it is not
- ringing of the ear
- very common
cerumen
ear wax
the TMJ is anterior to what part of the ear?
tragus
parts of the external ear are often used as…
landmarks
ex: helix, tragus
Infants and Children’s Ears
- infants Eustachian tubes are relatively shorter and wider and more horizontal
- greater risk for middle ear infections
- premature babies have high risk of hearing loss
- to assess hearing ask parents and assess their speech
adolescents’ ears
-concerned about loud music leading to hearing loss
Otosclerosis
a common cause of conductive hearing loss in young adults ages 20-40
-it is a gradual hardening that causes the footplate of the stapes to become fixed in the oval window, impeding the transmission of sound and causing progressive deafness
Ears of the Aging Adult
- cilia lining in the ear canal become coarse and stiff which may cause cerumen to accumulate and oxidize which greatly reduces hearing
- cerumen itself is drier b/c of atrophy of apocrine glands
- presbycusis
what is presbycusis?
- type of hearing loss that occurs with older people
- gradual Sensorineural loss caused by nerve degeneration
- first noticed by loss of high frequency hearing
what are some predisposing factors of Otitis Media?
- absence of breastfeeding in the first 3 months of age
- exposure to tobacco smoke
- daycare attendance
- male gender
- pacifier use
- seasonality (fall and winter)
- underlying disease
- feeding by bottle in the supine position
what is the most important side affect of acute otitis media?
- persistence of fluid in the middle ear after treatment, scar tissue
- middle ear effusion can impair hearing placing the child at risk for delayed cognitive development
dry cerumen
gray, flaky and frequently forms a thin mass in the ear cannal
-common in Asians and American indians
wet cerumen
honey brown to dark brown and moist
-occurs more often in Caucasians and African americans
which chromosome holds one gene trait determining the wet or dry cerumen phenotype?
chromosome 16
flaky dry cerumen can often be mistaken for what?
eczematous lesions
Pregnant women Ears
estrogen increase leads to ear pain and vertigo, affects middle ear
otitis externa
swimmers ear, sever painful movement of the pinna and tragus, redness and swelling of pinna and canal, scanty purulent discharge, scaling, itching, fever enlarged tender regional lymph nodes
-more common in hot humid weather
What medications can cause tinnitus?
-aspirin and vancomyecin(antibiotic)
Darwin’s tubercle
- a small, painless nodule at the helix
- congenital and not significant
when using an otoscope on an adult..
pull pinna up and back
-tilt the person’s head slightly away from you
when using an otoscope on a child..
pull pinna down
purulent otorrhea suggests what?
otitis externa or media
yellow-amber drum color suggests what?
otitis media with effusion (serous)
red color drum suggests?
acute otitis media
bulging drum suggests?
increased pressure from otitis media
retracted drum suggests?
vacuum in middle ear with obstructed Eustachian tube
what is the whispered voice test
- one ear at a time
- cover the tragus
- whisper 3 words
- shield lips from patient
- tests high frequency sound
What are the Weber and Rinne tuning fork tests?
-measures hearing by air conduction or by bone conduction
what is the Romberg test?
assesses the ability of the vestibular apparatus in the inner ear to help maintain standing balance
Atresia
absence or closure of the ear canal
testing hearing acuity in children
Newborns- startle (moro) reflex, acoustic blink reflex
3 to 4 months- acoustic blink reflex, infant stops movement and appears to “listen”, halts sucking, quiets if crying, cries if quiet
6 to 8 months - infant turns head to localized sound, responds to own name
preschool/school aged children - child must be screened with audiometry
What are some behavioral manifestations of hearing loss in children?
- inattentive in casual conversation
- reacts more to movement and facial expression than to sound
- facial expressions are strained or puzzled
- frequently asks to have statements repeated
- confuses words that sound alike
- speech problem
- appears shy and withdrawn
- frequently complains of earaches
- hears better at times when the environment is more conductive
Ears of the Aging Adult
- wrinkled pinna
- coarse, wiry hairs at opening of ear canal
- eardrum may be whiter in color and more opaque
- high tone frequency loss
Frostbite
reddish blue discoloration and swelling of the auricle after exposure to extreme cold, necrosis, pain, vesicles or bullae may develop
Cellulitis
inflammation of the loose, subcutaneous connective tissue
-shows as thickening and induration of auricle with distorted contours
Keloid
- overgrowth of scar tissue
- more common in dark skinned people
- most common on the lobule at the site of a peircing
carcinoma
ulcerated, crusted nodule with indurated base that fails to heal. bleeds intermittently. must refer for biopsy
excessive cerumen
produced or impacted because of narrow, tortuous canal or poor cleaning method, after swimming or showering cerumen expands and can cause sudden hearing loss
DONT USE QTIPS
exostosis
small bony, hard, rounded nodules of hypertrophic bone covered with normal epithelium. arise near ear drum
osteoma
single, stony hard, rounded nodule that obscures ear drum, non-tender, overlying skin appears normal
polyp
arises in canal from granulomatous or mucosal tissue, redder than surrounding skin and bleeds easily
- bathed in foul, purulent discharge
- indicates chronic ear disease
furuncle
exquisitely painful, reddened, infected hair follicle may appear on tragus or cartilaginous parts of the external ear
-regional lymphadenopathy often accompanies a furuncle
