Ear Pain

Question 1

Cone of light

Answer 1

. Btw 5 and 7 o’clock
. Usually ant. On tympanic membrane
. Lose cone of light or deviate it when something is in the ear

Question 2

Tympanic membrane

Answer 2

. Retracted: tympanic membrane more adhered to malleus process
. Pushed out: hide the malleus and deviate cone of light

Question 3

External ear anatomy

Answer 3

. Canal curves inward, approx. 24 mm long
. Cartilage encases outer 2/3
. Inner third of canal is surrounded by bone and lined by thin,. Hairless skin
. End of canal lites lat. tympanic membrane marking med. limit of inner ear

Question 4

Middle ear

Answer 4

. Air filled
. Ossicles
. Malleus, incus, stapes
. Transform sound vibrations into mechanical waves for inner ear
. Prox. End of Eustachian tube connects the middle ear to nasopharyngeal

Question 5

Inner ear

Answer 5

. Cochlea, semicircular canals, distal end auditory n.
. Movements of stapes vibrate perilymph in labyrinth of semicircular canals, heair cells and endolymph in ducts of cochlea producing electrical nerve impulses

Question 6

Otitis externa

Answer 6

. Will have pain on movement of auricle and Tragus
. Swimmer’s ear
. May be reddened
. Canal is swollen, narrowed, moist, pale, and tender

Question 7

Ear exam tips

Answer 7

. Move auricle up and down, press the tragus and press just behind ear if inflammation or pain is present

Question 8

Exam in infants

Answer 8

. Pull infant ear down and out, stabilize
. Light reflex will be diffuse
. Small, deformed, or lowest auricles may indicate associated congenital defects (renal disease)
. Small skin tab just forward of tragus is a first branchial cleft remnant (no significance), can sometimes be assoc. w/ familial hearing loss or renal disease
.

Question 9

Keloid

Answer 9

. Firm, modular, hypertrophic mass of scar tissue extending beyond the area of injury
. Common in shoulders and upper chest

Question 10

Tophi

Answer 10

. Deposit of uric acid crystals characteristic of chronic gout
. Hard nodules in helix or anti helix
. May discharge chalky white crystals through skin
. Appear near joints

Question 11

Cutaneous cyst

Answer 11

. Dome shaped lump in dermis forms benign closed firm sac attached to epidermis

Question 12

Chondrodermtitis

Answer 12

. Chronic inflammatory lesion
. Painful papule on helix/anti helix
. Biopsy needed to rule out carcinoma

Question 13

Basal cell carcinoma

Answer 13

. Common slow-growing malignancy that rarely metastasizes
. Raised nodule w/ lustrous surface and telangectatic vessels
. Growth and ulceration may occur
. More frequent in fair people exposed to sun

Question 14

Psoriasis

Answer 14

. Skin cell buildup and form scales and pruritic dry patches
. Immune system issue
. Triggers: infections, stress, cold, trauma

Question 15

Rheumatoid nodules

Answer 15

. Small lumps on helix/anti helix
. Can also occur in hands and distal ulna, knees, and heels
. Ulceration may occur as result from repeated injuries
. May antedate arthritis

Question 16

Ear exam process

Answer 16

. Inspect ear canal
. Inspect eardrum
. Identify handle of malleus and inspect the short process of malleus (if unusually short process and prominent handle suggests retracted drum)
. Look at pars flaccida sup. And margins of pars tense
. Look for perforations
. Evaluate mobility of eardrum w/ pneumatic otoscope

Question 17

Exotoses

Answer 17

. Nontender modular swellings covered by normal skin deep in ear canals
. Nonmalignant overgrowth, can obscure drum

Question 18

Perforation of eardrum

Answer 18

. Holes usually from purulent infections of middle ear

. Membrane covering perforation will be extra thin and transparent

Question 19

Tympanosclerosis

Answer 19

. Scarring process of middle ear from otitis media
. Involves deposition of hyaline and Ca and P crystals in eardrum and middle ear
. Can entrap ossicles and cause conductive hearing loss if severe
. Can see healed perforation and sign of a retracted drum

Question 20

Bulbous myringitis

Answer 20

. Painful hemorrhagic vesicles appear on the tympanic membrane, ear canal, or both
. Symptoms: earache, blood-tinged discharge from ear, conductive hearing loss
. Caused by mycoplasma, viral, and bacterial otitis media

Question 21

Acute otitis media

Answer 21

. Red bulging drum
. Can be accompanied by purulent effusion caused by S. pneumoniae or H. Influenzae
. Symptoms: earache, fever, hearing loss
. Eardrum is red, loses its landmarks, bulges lat. toward examiners eye
. Conductive hearing loss
. More common in kids

Question 22

Serous effusion

Answer 22

. Caused by viral URI or sudden atmosphere pressure change
. Eustachian tube can’t equalize air pressure in middle ear and outside air
. Air absorbed from middle ear into bloodstream and serous fluid accumulates in middle ear instead
. Symptoms: fullness, papping, mild conduction hearing loss, and sometimes pain

Question 23

Tympanometry

Answer 23

. Examin used to test condition of middle ear, mobility of tympanic membrane, and ossicles by creating air pressure variation in canal
. Makes tympanogram that represents relationship btw air pressure in canal and movement of TM
. Loos att compliance of flexibility of TM to changing air pressure

Question 24

Tympanostomy

Answer 24

. PE tubes
. Functions like Eustachian tubes
. Equalizes pressure in middle ear w/ external atmospheric pressure in addition to providing drainage of secretions from middle ear mucosa

Question 25

Hearing los screening

Answer 25

. Adults 50 yrs and older

. Give hearing handicap inventory for the elderly, handheld audiometer test, whisper or finger rub test

Question 26

Presbycusis

Answer 26

. Most common age-related cause of hearing loss
. Degenerating hair cells in ear cause gradual hearing loss, esp. high frequency sounds
. More likely to miss consonant sounds

Question 27

Risk factors of hearing loss

Answer 27

. Congenital or familial hearing loss 
. Syphilis
. Rubella
. Meningitis
. DM
. Recurring inner ear infections 
. Exposure to ototoxic agents 
. Frequent headphone use 
. Hazardous noise levels at work, leisure, or on battlefield

Question 28

Hearing disorders of external and middle ear

Answer 28

. Conductive hearing loss
. Impaction, infection, trauma, squamous cell carcinoma
. Benign bony growths
. Issues w/ tympanic membrane

Question 29

Disorders of inner ear

Answer 29

. Sensorineural hearing loss 
. Congenital/hereditary hearing loss 
. Viral infections (rubella, cytomegalovirus)
. Meniere’s disease
. Noise exposure 
. Ototoxic drug exposure 
. Acoustic neuroma

Question 30

Gold standard for hearing loss test

Answer 30

. Formal hearing test

Question 31

Whisper voice test

Answer 31

. Stan 2 ft behind seated patient
. Occlude nontest ear w/ finger and gently rub tragus in circular motion to prevent transfer of sound to nontest ear
. Exhale breath before whispering to ensure quiet voice
. Whisper combo of 3 numbers and letters and use different combo for other ear
. Normal if they can say sequence, or when sequence is done w/ different numbers again they get 3/6
. Abrnomal if 4/6 letters or numbers are wrong after 2 tries

Question 32

Tuning fork used to test hearing loss

Answer 32

. 512 Hz

Question 33

Conductive hearing loss

Answer 33

. External or middle ear issue impairs sound conduction to inner ear
. Age: child to 40 y/o
. Effects: little effect on sound, hearing improves in noise environments

Question 34

Sensorineural hearing loss

Answer 34

. Inner ear is sure involving cochlear n. And impulse transmission to brain
. Age: middle to later years
. Effect: high register loss, sound distorted, hearing worsens in noisy environments, patient voice loud because hearing is difficult

Question 35

External ear pathology

Answer 35

. Congenital 
. Traumatic/laceration 
. Furuncle: infected hair follicle 
. Hematoma/cauliflower ear 
. Carmen impaction (wax) 
. Exostosis: bony outgrowth 
. Ramsey-Hunt syndrome (HSV-shingles)

Question 36

Middle ear

Answer 36

. Facilitates amplification and transmission of sound
. Mucosal lined single cuboidal epithelium and respiratory epithelium that becomes pseudostratified near. Eustachian tube
. Muscles: stapedius, tensor tympani, tympanic reflex

Question 37

Eustachian tube in childhood

Answer 37

Flaccid, shortened 10 degrees

Question 38

Eustachian tube in adults

Answer 38

More rigid
. Lengthened
. 35 degrees

Question 39

Eustachian tube pressure equalization

Answer 39

. Through transmission of air from nasopharynx to middle ear cleft w/ muscle contraction of pharynx

Question 40

Pharynx

Answer 40

. Hollow tube that starts behind nose and goes down neck
. Ends at top of trachea and esophagus
. Components: nasopharynx, oropharynx, hypopharynx

Question 41

Middle ear pathology

Answer 41

. Myringitis: inflamed TM
. Conductive hearing loss
. TM perforation
. Otorrhea: ear discharge
. Otosclerosis: abnormal bone growth that results in fixation of ossicles and conductive hearing loss
. Polyp/granulation: inflammatory tissue
. Glomus: paragangliomas, benign but locally destructive vascular and CT

Question 42

Acute otitis media

Answer 42

. Acute infection of ear 
. Less than 48 hours 
. Infection in middle ear 
. Red and bulging TM 
. Ca come w/ effusion

Question 43

Chronic otitis media

Answer 43

. Effusion present for greater than 12 weeks
. Same findings as otitis media w/ effusion w/ air bubbles
. “Glue ear:: chronic suppurations OM

Question 44

Membranous labyrinth of inner ear

Answer 44

. Cochlea
. Semicircular canals: set of 3 bilaterally, fluid motion w/in canals causes hair cell motion to signal CNS
. Utricle: respond to motion

Question 45

Inner ear pathology

Answer 45

. Autoimmune disease: inflammatory damage to ear structures
. Labyrinthitis: viral inflammation, perpetual disequilibrium for days
. BPPV: debris from utricle
. Ménière’s disease: inc. endolympthatic pressure resulting in episodic fullness of ear, tinnitus, vertigo and hearing loss, usually just on ear
. Fistula: abnormal connection btw membranes

Question 46

Audiogram

Answer 46

. Sound pressure level
. Decibels
. Frequency 20-20K Hz
. Compares bone conduction to air conduction (external and middle ear amplified sound)

Question 47

Tympanogram

Answer 47

. Adjunctive test
. Pneumatic otoscopy: practitioner-patient dependent, unique speculum
. Types: A (normal), B (flat), C (neg. middle ear pressure)