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PNP: Physical Assessment - BK > Ears > Flashcards

Ears Flashcards

1
Q

Cranial Nerves

A

I Olfactory

V Facial sensation

VII Facial movement, tears, taste, acoustic reflex

VIII Hearing and Equilibrium

IX Taste

X Taste

XI Taste, swallowing

XII Tongue movements

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2
Q

Conductive hearing loss

A

Refers to impairment of the outer and/or middle ear conductive mechanism only.

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3
Q

Sensory hearing loss

A

Refers to damage to the cochlea (outer hair cells or outer and inner hair cells).

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4
Q

Mixed hearing loss

A

Refers to the presence of both conductive and sensory impairment.

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5
Q

Neural hearing loss

A

Refers to damage to the auditory neurons (spiral ganglia) and/or the auditory branch of the eighth nerve.

Auditory Neuropathy and dysynchrony are examples of neural hearing loss.

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6
Q

Central hearing loss

A

Refers to damage to auditory structures in the brainstem, thalamo-cortex and/or cortex.

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7
Q

How Common is Hearing Loss

A
  • Profound
    • 1-2 hearing loss in 1000 infants
  • Significant hearing loss
    • 1-2 have hearing loss that will impact on their well being and education
    • 50% have no known risk
    • 12% of NICU graduates develop some form of sensorineural hearing loss
  • Newborn screening
    • Otoacoustic emission (like a tympanogram listens for action potential of the cochlea (ear talk) and that is what it picks up—picks up cochlea function
    • BAER more accurate (assesses wiring of auditory pathway—misses low and high frequency loss)
    • Brain stem evoked response is the diagnostic test
  • 33 babies are born every day with a hearing loss
  • Hearing is about 30 among congenital defects
  • 50% are contributed to genetic factors, likely to increase
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8
Q

Newborn Hearing Tests (2)

A

Otoacoustic Emission

Auditory Brainstem Response Training

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9
Q

Types of Hearing Loss

A

Conducive

Sensori-neural

Auditory Processing (Central)

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10
Q

Early Hearing Loss

A
  • First trimester structure of ear highly metabolic and therefore exposure to metabolic and highly susceptible to illness and exposure to medication in the mother
    • Maternal rubella
    • Cytomegalovirus
    • Genetic disorders leading to malformation of the cochlea
    • Sepsis with prolonged acidosis
    • Oxygen deprivation and hyperbilirubinemia
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11
Q

Universal hearing screening in the late 90’s

A

Mandated but not covered

Now linked to funding

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12
Q

Anatomic Early Hearing Loss

A
  • Genetic Studies
  • Meningitis
  • Congenital hypothyroidism
  • Medications—Lasix, aminoglycosides, vancomycin
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13
Q

Large Cochlear Aqueduct syndrome

A
  • Onset of hearing loss 6 to 7 months with progressive worsening
  • Balance is off, progressive loss
  • Tends to stabilize at 50 decibels
  • They need to not play football
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14
Q

Reasons for Hearing Loss

A
  • Wax
  • Foreign objects
  • Deafness due to hyperbilirubinemia, CMV
  • Cranial facial, tags
  • Medications
  • Deafness associated with aminoglycosides
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15
Q

Reasons for Hearing Loss

Genetic Syndromes

A
  • Genetic Syndromes
    • Deafness associated with white forelock and eye abnormalities
      • Waardenburg syndrome
    • Deafness associated with long QT syndrome
      • Jervell Syndrome
      • Lange Nielsen syndrome
    • Ion channelopathies
      • Progressive hearing loss
    • 3% carrier rate (same of CF). Mild to moderate hearing loss
    • Rest are autosomal dominant
    • 80% are recessive
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16
Q

History of Hearing Loss

A
  • History of hearing loss is critical
  • Looking at hearing loss early on
    • Wear a hearing aide if they are younger than 60 year
  • History of renal abnormalities (8 weeks in utero develop at the same time)
    • Alport’s syndrome
  • Genetic mediation for hearing loss in old age
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17
Q

Hearing Loss Progression

A
  • Can progress throughout childhood
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18
Q

Gene Mutations associated with hearing loss

A

Both high- and low-frequency progressive hearing loss represent a wide diversity of gene mutations that are observed in a large number of syndromic and non-syndromic diseases

Human KCNQ4 mutations known as DFNA2 cause non-syndromic, autosomaldominant, progressive high-frequency hearing loss in which the cellular and molecular basis is unclear

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19
Q

Newborn screening

A

Repeated on follow up center

Goal: Early intervention by age 6 months

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20
Q

Genetic Screening

Syndromic vs. Non-syndromic

A
  • Syndromic—1/3
  • Non syndromic 2/3—mitochondrial defect
    • Hereditary hearing loss may not be congenital
  • Is it stable or progressive?
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21
Q

Non Genetic

A

CMV infections, high bili etc, trauma, meningitis, noise induce hearing loss

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22
Q

Conductive Hearing Loss

4 examples

A
  • Eustachian tube dysfunction
  • Ear fluid
  • Hole in eardrum
  • Fixed middle ear bone
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23
Q

Sensorineural Hearing Loss

4 examples

A
  • Noise induced hearing loss
  • Presbycusis
  • Ménière’s Disease
  • Tumors of the auditory nerve
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24
Q

Noise Levels of Sound

A
  • Traffic - 80
  • Automobile (at 20 meters) - 70
  • Vacuum Cleaner - 65
  • Conversational Speech (at 1 meter) - 60
  • Quiet Business Office - 50
  • Residential Area at Night - 40
  • Whisper, Rustle of Leaves - 20
  • Rustle of Leaves - 10
  • Threshold of Audibility 0
25
Q

History Factors

A
  • Location
  • Duration
  • Severity
  • Drainage
  • Hearing loss
  • Associated symptoms: fever, pain, URI, ST,
  • Exposure to family illness
  • Aggravating or alleviating factor
  • Changes in behavior
26
Q

Assessment of the External Ear (3)

A

Pliability

Direction of Canal

Illuminate the surface of TM

27
Q

Assessment of external ear

Shape

A
  • Size
  • ***Large Ear found in Fragile X***
  • Symmetry
  • Variations from normal
  • Abnormalities
28
Q

Presence of dimples, tags, and nodules

A

Represents remnant of first brachial cleft

29
Q

Position of auricle

A
  • Should be along a straight plan with outer canthus of eye
  • Low set ears can be associated with kidney or chromosomal abnormalities
30
Q

External Ear assessments cont. (2)

A
  • Presence of swelling, drainage, erythema, trauma
  • Enlarged post auricular nodes and external otitis with cellulitis can make ear protrude
31
Q

Assessment of the Ear

Child friendly

A
  • Which ear should I check first?”
  • This simple question gives the child a sense of control and an understanding of what is going to happen next.
32
Q

Otoscope Basics

A
  • Make sure your light is getting full power otherwise drum will look yellow
  • Speculum should never enter the canal more than 10-15 mm
  • Examine the canal before you try to look at drum—look for furuncle or vesicle
  • Hold the otoscope firmly, rest the hand on child head or face
  • Place the speculum just inside the ear to gain child’s confidence
33
Q

Most common reason for redness when using an Otoscope

A
  • touching the ear canal with the tip of the speculum
    • Red reflex of the drum
    • Red drum with normal landmarks
34
Q

Otoscope size

A

Pick the right size

Bigger is better if you can

See through the hair

35
Q

Canal Direction

A
  • In newborns pull the auricle down and back
  • In older children, canal faces downward and forward
  • Pull the tip of auricle up and back
  • If painful indicates furuncle or external otitis media
  • Tell child that they must be quiet to ear the song. Then look in ear, ask if they heard the song
36
Q

A quick and easy way to get rid of lots of wax

A

Instill a few cc’s of Colace and let it sit for 10-15min, then irrigate the ear with water like usual.

TM blocked by cerumen – OTC products for removal

37
Q

Foreign Bodies

A

Solid objects such as stone, beads, paper, dead roaches are commonly found

Should be removed as soon as possible

38
Q

External Otitis Media

A

Pain on movement of the auricle

Canal may be red, friable, and full of pus

Inspect the entire TM looking at landmarks, color, contour and perforations.

39
Q

Infections of the External Ear Canal

A
  • Related to changes in the pH of ear canal
  • Any organism— fungal, viral, bacteria, yeast Pseudomonas is common***
40
Q

TIPS for Ears

A
  • Tenderness to palpation of the tragus is indicative of otitis externa
  • Always look at the mastoid bone for redness and evaluate for tenderness
  • Not everyone reads the book so if you cannot see the drum pull opposite than you normally would for that age
  • Children are unique. Some children love having you look at their ears – find something cute inside.
41
Q

Otorrhea

Otitis externa

A
  • Alteration in acidic PH increase susceptibility to microbial invasion
  • Severe pain
  • Sense of fullness in the ear
42
Q

Etiology of Otorrhea

A
  • Excessive moisture, excessive cleaning disrupts the surface epithelium
  • Bacterial, viral (HSV, Varicella), Fungal (candida, aspergillus niger)
43
Q

Treatment of Otorrhea

A
  • Debridement of ear canal
  • Topical antibiotics (concentration are 100-1000 times greater than with systemic therapy
  • Expandable methylcellulose Oto-Wick or sponge (ear wick)
    • Change wick every 2 days
  • Fungal infection: Acetic drops or antifungal drops
44
Q

Pathophysiology of Otitis Media

A
  • Middle ear cavity filled with air and is sterile under normal circumstances
  • Air enters the middle ear when you swallow through the eustachian tube (ET)
  • When the ET does not function, middle ear cavity does not ventilate normally
  • Negative air pressure results as the air is absorbed ¡ Fluid effused in the middle ear
  • Bacteria comes from nasopharynx into the middle ear cavity leading to AOM
45
Q

Pathophysiology of Otitis Media under 3

A
  • Eustachian tube is different
    • Shorter
    • Wider
    • Straighter
  • Makes it easier for the infection to travel up the Eustachian tube
  • Assess the movement of the tympanic membrane to determine if a patient has otitis media
  • Changes in the appearance of the tympanic membrane suggestive of acute infection
  • Bulging or purulent material visualized behind the tympanic membrane
46
Q

Tympanic Membrane

A
  • Color
  • Note the landmarks
    • Malleus
    • Borders of TM
    • Light reflex
  • Presence of perforation and of tympanostomy tubes
  • Presence of fluid
47
Q

Tympanic Membrane (5)

A

Color

Texture

Landmarks

Light reflex

Mobility

48
Q

TM Color and Significance

Amber

A

Serous fluid

49
Q

TM Color and Significance

Blue or deep red

A

Blood in the middle ear

50
Q

TM Color and Significance

Chalky white

A

Thick TM indicative of recurrent infection

51
Q

TM Color and Significance

Red

A

Infection

52
Q

Mastoiditis

A
  • Infection of the mastoid air cells
  • Accumulation of the purulent exudate in middle ear does not drain through ET or perforated TM but spread to mastoid bone
  • Air cells are destroyed and progresses to coalescent phase
  • ENT referral
53
Q

Acute Otitis Media

Bacterial

A

S. pneumoniae

H. Influenzae

Moraxella catarrhalis

Group A streptococcus

Enteric gram negative

54
Q

Acute Otitis Media

Viral

A

RSV

Influenza

Mycoplasma pneumoniae

Fungal

55
Q

Ear Trauma

A
  • Can damage middle ear and/or inner ear.
  • Results from fall or fight.
  • Bleeding into the auricular cartilage may require drainage
    • Hematomas need referral to ENT for evacuation
56
Q

Dullness of TM

A

fibrosis

57
Q

White areas of TM

A

Healed perforations or inflammation

58
Q

Air bubbles

A

Middle ear fluid

PNP: Physical Assessment - BK (13 decks)

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