Ear Quiz Flashcards
Examples of reported current or past symptoms that should always be correlated with the structural and functional physical findings of the ear
Earache Aural discharge Hearing loss Vertigo Tinnitus
Should be examined for inflammation, rashes, sebaceous cysts, cancerous lesions, tophi, and deformity
External ear
How long is the ear canal?
1-1.5 inches
What part of canal contains cartilage, cerumen glands, and hair?
Outer 1/3
How is the auricle displaced to allow better viewing of the auditory canal?
Posterior and superior (canal runs superior, then inferior toward the drum and runs a little posterior to anterior)
Typically present to some degree in the ear canal. Creates an acidic coat that probably prohibits bacterial and fungal growth
Earwax
Fresh earwax should be _____ colored and is pumped out of the ear by the ________
Honey colored
TMJ
Color of very old earwax
Dark/Black
How can earwax cause hearing problems?
If the wax becomes excessive or impacted against the ear drum (removal of wax restores hearing)
An abnormal, benign, boney growth of the temporal bone what may occasionally be seen protruding into the canal
Exostosis
A canal infection often due to swimming or canal damaging cleaning. (“Swimmers ear”)
Otitis externa
S/S of Otitis externa
- Earache
- Red and swollen ear canal
- Possible discharge
T/F Fungal overgrowth will most commonly cause otitis externa
FALSE.
MC is bacterial infections (fungal overgrowth = 10% of otitis externa)
Symptom that differentiates bacterial vs. fungal otitis externa
Fungal will producing pruritis (itching) rather than pain (bacteria)
Makes up the middle ear
- Eardrum (Tympanic membrane)
- Tympanic cavity
- Ossicles
Parts of the tympanic membrane
- Attic portion = pars flacida
- Lower 2/3 = pars tensa
T/F The tympanic cavity is convex shapped and tipped away from the examiner
FALSE.
It is concave shaped and tipped toward the examiner
What bone is the tympanic cavity located in?
The temporal bone
Ossicles of the middle ear
Malleus
Stapes
Incus
What makes the tympanic membrane landmarks?
Created by the malleus pressed up against the inside of the ear drum
Rounded part of the malleus at the interface of the pars flacida and pars tensa
Short process
The handle of the malleus which angles toward the posterior
Long process
The triangular reflection of light from the otoscope with its apex at the end of the long process and angling anterior at the margin of the tympanic membrane
Light reflex (Triangle of Light)
Collapse of the auditory tube due to pressure
Barotrauma
Collapse of the auditory tube due to swollen adenoids
Adenoidal hypertrophy
Occlusion of the lumen of the auditory tube secondary to an upper respiratory infection or allergy
Mucosal swelling and Excess mucus
How does the occlusion of the auditory tube cause pain?
Air trapped in the tube gets absorbed and creates a vacuum which retracts the eardrum, causing pain
4 fluids that can accumulate in the middle ear
1) Pus
2) Serrous
3) Mucus
4) Blood
A middle ear infection common to children between six months and 6 years old. Classic signs and symptoms include earache, fever, diminished or absent landmarks, and pus visible against the drum.
Suppurative Otitis Media
In children with otitis media but without fever and vomiting, antibiotic treatment has ___________
Little benefit and a poor outcome was unlikely
_______ is yellow therefore the eardrum may appear yellow. What else can accompany this?
Serous fluid
Air bubbles and fluid lines
______ is thick and viscid, therefore the ear drum may appear darker than normal.
Mucus (glue ear)
T/F With serous fluid or mucus in the ear, hearing is not diminished.
FALSE.
Hearing is diminished because the ossicles are unable to conduct sound as well
Causes of bloody effusions
- Temporal bone fractures
- Shearing force causing bleeding of the mucosa
Increases chances of developing middle ear effusions
- Crowded child care facilities
- Second hand smoke
- Bottle-fed infants
Conventional treatment for middle ear effusions as recommended by the CDC
WASP (Wait And See Prescription)
Recommended for children with 3 episodes of middle ear effusions in a six month period or persistent fluid (3 months with hearing loss and unresponsive to antibiotic therapy).
Tympanostomy tubes
White calcium patches on the drum resulting from old perforations, chronic inflammation, or previous tubes in the ear
Tympanosclerosis
Cystic masses composed of epithelial cells and cholesterol in the middle ear. May appear as a white nodule pressed against the inside of the drum.
Cholesteatomas
Cholesteatomas can result from _________, _______________, and perforations. The cyst erodes surrounding bones and ossciles and may cause________
Congenital defects
Complications of chronic otitis media
Hearing loss
Results from abnormal ossification of the ossicles especially fixation of the stapes to the oval window.
Otosclerosis
Normal range for the “finger rustle” test. Would this be more or less if someone had otosclerosis?
About 2 ft.
Would be less than 2 ft. if someone had otosclerosis
Test findings that indicate otosclerosis
- Finger rustle diminished on the affected side
- Weber’s test will lateralize to the affected site
- Air time will be less than bone time in Rinne’ test
Classic signs/symptoms of inner ear problems
-Vertigo (dizziness)
-Tinnitus (ringing ears)
-Sensory hearing loss
(nausea, vomiting, visual, and emotional problems are all usually secondary to vertigo)
Tuning forks can further differentiate __________ pathway problems from __________ and _________
Air-conduction pathway
Noise-induced hearing problems
Labyrinthitis
A vibrating fork is placed in the midline of the head and the patient is asked if they hear better in the right or left ear
Weber test
Normal finding for a Weber test
Patient hesitates to answer
What pathway does the Weber test evaluate?
Bone-conduction pathway
________ of the Weber test leaves the examiner with two possibilities 1) a significant ________ problem or 2) significant __________ problem
Lateralization
Air conduction
Sensorineural
Test to compare bone conduction to air conduction is Weber shows lateralization
Rinne’ test
Normal finding for the Rinne’ test
Should hear the tuning fork twice as long through the air then through bone
What would cause a person to hear the tuning fork longer through bone than air (Rinne’ negative)?
Significant canal or middle ear problem (obstruction, ossification, etc.)
What would cause a person to hear the tuning fork longer through air then bone, but not twice as long?
A significant sensorineural problem.
What does it imply if a person can’t hear the tuning fork by either bone or air conduction?
Total sensorineural loss
Number one reason for snsorineural hearing loss
Presbycusis (age related hearing loss)
Second most common cause of sensoineural hearing loss.
Noise induced hearing loss
Most common occupational and environmental hazard for hearing loss
Noise
Affects 10% of U.S. population. Originates from problems anywhere in the auditory pathway. Most cases result from the same conditions that cause conductive and sensorineural hearing loss
Tinnitus
What conditions are associated with Tinnitus, although the exact mechanism behind it is unclear?
- Skull fractures
- Closed head injury
- Whiplash injury
- TMJ disorders
Generally thought to be caused by a viral infection, symptoms include reduced or distorted hearing and vertigo.
Labyrinthitis
T/F Labyrinthitis is always painful
FALSE.
It is not painful
T/F Vertigo is exclusive to labyrinthitis
FALSE.
Any lesion in a part of the vestibular system can cause vertigo
Ear Red Flags
- Sudden or rapidly progessive hearing loss
- Vertigo
- Unilateral or pulsatile tinnitus
- Bleeding due to foreign object or pressure change injury
Common causes of otitis externa
- Excessive cleaning of the auditory canal
- Swimming
Physical findings of otitis externa
Red, swollen canal with canal debris or discharge
Eustachian tube blockage is often seen in children ______ who’ve had a history of ________
Physical findings of Eustachian tube blockage
Prominent landmarks due to drum retraction.
-no signs of inflammation
Suppurative otitis media is often seen in children ______ who’ve had a history of ________
Physical exam findings of Suppurative otitis media
Fever, diminished hearing, red and bulging ear drum
T/F Excessive ear wax is found most commonly in males who use Q-tips (may be also insidious)
True
Serrous or mucoid effusions are often seen in children ______ who’ve had a history of ________
Physical exam findings of Serrous or mucoid effusions
Normal, yellow, or dark tympanic membrane with possible air bubbles or fluid lines.
T/F Otosclerosis is seen in adolescents and is not genetic
FALSE.
Seen in adults with a family history of otosclerosis
T/F Otosclerosis produces no physical findings of the canal or eardrum
True
What freqeuncy sounds are lost first in someone with noise induced hearing loss?
High frequency sounds (3,000 to 6,000 Hz)
T/F Noise induced hearing loss will always produce a ruptured tympanic membrane on oticscope exam
FALSE.
Only if extremely severe. Most of the time, it produces no obvious signs in the canal or middle ear.
Typical patient profile for someone with Presbycusis
Elderly
Symptom characteristics of someone with Presbycusis
Complaints that others are mumbling or that they can’t understand what’s being said when there’s background noise (low frequency sounds and whispers are first to go)
Physical exam findings of Presbycusis
Rinne’ AC > BC, but less than 2:1 ratio
