Ear Pain Flashcards
Cone of light
. Btw 5 and 7 o’clock
. Usually ant. On tympanic membrane
. Lose cone of light or deviate it when something is in the ear
Tympanic membrane
. Retracted: tympanic membrane more adhered to malleus process
. Pushed out: hide the malleus and deviate cone of light
External ear anatomy
. 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
Middle ear
. 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
Inner ear
. 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
Otitis externa
. Will have pain on movement of auricle and Tragus
. Swimmer’s ear
. May be reddened
. Canal is swollen, narrowed, moist, pale, and tender
Ear exam tips
. Move auricle up and down, press the tragus and press just behind ear if inflammation or pain is present
Exam in infants
. 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
.
Keloid
. Firm, modular, hypertrophic mass of scar tissue extending beyond the area of injury
. Common in shoulders and upper chest
Tophi
. 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
Cutaneous cyst
. Dome shaped lump in dermis forms benign closed firm sac attached to epidermis
Chondrodermtitis
. Chronic inflammatory lesion
. Painful papule on helix/anti helix
. Biopsy needed to rule out carcinoma
Basal cell carcinoma
. 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
Psoriasis
. Skin cell buildup and form scales and pruritic dry patches
. Immune system issue
. Triggers: infections, stress, cold, trauma
Rheumatoid nodules
. 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
Ear exam process
. 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
Exotoses
. Nontender modular swellings covered by normal skin deep in ear canals
. Nonmalignant overgrowth, can obscure drum
Perforation of eardrum
. Holes usually from purulent infections of middle ear
. Membrane covering perforation will be extra thin and transparent
Tympanosclerosis
. 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
Bulbous myringitis
. 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
Acute otitis media
. 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
Serous effusion
. 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
Tympanometry
. 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
Tympanostomy
. 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
Hearing los screening
. Adults 50 yrs and older
. Give hearing handicap inventory for the elderly, handheld audiometer test, whisper or finger rub test
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
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
Hearing disorders of external and middle ear
. Conductive hearing loss
. Impaction, infection, trauma, squamous cell carcinoma
. Benign bony growths
. Issues w/ tympanic membrane
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
Gold standard for hearing loss test
. Formal hearing test
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
Tuning fork used to test hearing loss
. 512 Hz
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
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
External ear pathology
. Congenital . Traumatic/laceration . Furuncle: infected hair follicle . Hematoma/cauliflower ear . Carmen impaction (wax) . Exostosis: bony outgrowth . Ramsey-Hunt syndrome (HSV-shingles)
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
Eustachian tube in childhood
Flaccid, shortened 10 degrees
Eustachian tube in adults
More rigid
. Lengthened
. 35 degrees
Eustachian tube pressure equalization
. Through transmission of air from nasopharynx to middle ear cleft w/ muscle contraction of pharynx
Pharynx
. Hollow tube that starts behind nose and goes down neck
. Ends at top of trachea and esophagus
. Components: nasopharynx, oropharynx, hypopharynx
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
Acute otitis media
. Acute infection of ear . Less than 48 hours . Infection in middle ear . Red and bulging TM . Ca come w/ effusion
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
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
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
Audiogram
. Sound pressure level
. Decibels
. Frequency 20-20K Hz
. Compares bone conduction to air conduction (external and middle ear amplified sound)
Tympanogram
. Adjunctive test
. Pneumatic otoscopy: practitioner-patient dependent, unique speculum
. Types: A (normal), B (flat), C (neg. middle ear pressure)
