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Ear Pain Flashcards

1
Q

Cone of light

A

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

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2
Q

Tympanic membrane

A

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

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3
Q

External ear anatomy

A

. 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

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4
Q

Middle ear

A

. 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

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5
Q

Inner ear

A

. 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

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6
Q

Otitis externa

A

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

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7
Q

Ear exam tips

A

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

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8
Q

Exam in infants

A

. 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
.

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9
Q

Keloid

A

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

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10
Q

Tophi

A

. 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

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11
Q

Cutaneous cyst

A

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

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12
Q

Chondrodermtitis

A

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

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13
Q

Basal cell carcinoma

A

. 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

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14
Q

Psoriasis

A

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

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15
Q

Rheumatoid nodules

A

. 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

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16
Q

Ear exam process

A

. 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

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17
Q

Exotoses

A

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

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18
Q

Perforation of eardrum

A

. Holes usually from purulent infections of middle ear

. Membrane covering perforation will be extra thin and transparent

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19
Q

Tympanosclerosis

A

. 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

20
Q

Bulbous myringitis

A

. 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

21
Q

Acute otitis media

A

. 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

22
Q

Serous effusion

A

. 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

23
Q

Tympanometry

A

. 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

24
Q

Tympanostomy

A

. 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

25
Hearing los screening
. Adults 50 yrs and older | . Give hearing handicap inventory for the elderly, handheld audiometer test, whisper or finger rub test
26
Presbycusis
. 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
27
Risk factors of hearing loss
``` . 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 ```
28
Hearing disorders of external and middle ear
. Conductive hearing loss . Impaction, infection, trauma, squamous cell carcinoma . Benign bony growths . Issues w/ tympanic membrane
29
Disorders of inner ear
``` . Sensorineural hearing loss . Congenital/hereditary hearing loss . Viral infections (rubella, cytomegalovirus) . Meniere’s disease . Noise exposure . Ototoxic drug exposure . Acoustic neuroma ```
30
Gold standard for hearing loss test
. Formal hearing test
31
Whisper voice test
. 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
32
Tuning fork used to test hearing loss
. 512 Hz
33
Conductive hearing loss
. 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
34
Sensorineural hearing loss
. 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
35
External ear pathology
``` . Congenital . Traumatic/laceration . Furuncle: infected hair follicle . Hematoma/cauliflower ear . Carmen impaction (wax) . Exostosis: bony outgrowth . Ramsey-Hunt syndrome (HSV-shingles) ```
36
Middle ear
. 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
37
Eustachian tube in childhood
Flaccid, shortened 10 degrees
38
Eustachian tube in adults
More rigid . Lengthened . 35 degrees
39
Eustachian tube pressure equalization
. Through transmission of air from nasopharynx to middle ear cleft w/ muscle contraction of pharynx
40
Pharynx
. Hollow tube that starts behind nose and goes down neck . Ends at top of trachea and esophagus . Components: nasopharynx, oropharynx, hypopharynx
41
Middle ear pathology
. 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
42
Acute otitis media
``` . Acute infection of ear . Less than 48 hours . Infection in middle ear . Red and bulging TM . Ca come w/ effusion ```
43
Chronic otitis media
. Effusion present for greater than 12 weeks . Same findings as otitis media w/ effusion w/ air bubbles . “Glue ear:: chronic suppurations OM
44
Membranous labyrinth of inner ear
. Cochlea . Semicircular canals: set of 3 bilaterally, fluid motion w/in canals causes hair cell motion to signal CNS . Utricle: respond to motion
45
Inner ear pathology
. 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
46
Audiogram
. Sound pressure level . Decibels . Frequency 20-20K Hz . Compares bone conduction to air conduction (external and middle ear amplified sound)
47
Tympanogram
. Adjunctive test . Pneumatic otoscopy: practitioner-patient dependent, unique speculum . Types: A (normal), B (flat), C (neg. middle ear pressure)

PSP (35 decks)

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