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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
History Factors
* Location * Duration * Severity * Drainage * Hearing loss * Associated symptoms: fever, pain, URI, ST, * Exposure to family illness * Aggravating or alleviating factor * Changes in behavior
26
Assessment of the External Ear (3)
Pliability Direction of Canal Illuminate the surface of TM
27
Assessment of external ear Shape
* Size * \*\*\*Large Ear found in Fragile X\*\*\* * Symmetry * Variations from normal * Abnormalities
28
Presence of dimples, tags, and nodules
Represents remnant of first brachial cleft
29
Position of auricle
* Should be along a straight plan with outer canthus of eye * Low set ears can be associated with kidney or chromosomal abnormalities
30
External Ear assessments cont. (2)
* Presence of swelling, drainage, erythema, trauma * Enlarged post auricular nodes and external otitis with cellulitis can make ear protrude
31
Assessment of the Ear Child friendly
* 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
Otoscope Basics
* 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
Most common reason for redness when using an Otoscope
* touching the ear canal with the tip of the speculum * Red reflex of the drum * Red drum with normal landmarks
34
Otoscope size
Pick the right size Bigger is better if you can See through the hair
35
Canal Direction
* 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
A quick and easy way to get rid of lots of wax
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
Foreign Bodies
Solid objects such as stone, beads, paper, dead roaches are commonly found Should be removed as soon as possible
38
External Otitis Media
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
Infections of the External Ear Canal
* Related to changes in the pH of ear canal * Any organism— fungal, viral, bacteria, yeast Pseudomonas is common\*\*\*
40
TIPS for Ears
* 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
Otorrhea Otitis externa
* Alteration in acidic PH increase susceptibility to microbial invasion * Severe pain * Sense of fullness in the ear
42
Etiology of Otorrhea
* Excessive moisture, excessive cleaning disrupts the surface epithelium * Bacterial, viral (HSV, Varicella), Fungal (candida, aspergillus niger)
43
Treatment of Otorrhea
* 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
Pathophysiology of Otitis Media
* 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
Pathophysiology of Otitis Media under 3
* 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
Tympanic Membrane
* Color * Note the landmarks * Malleus * Borders of TM * Light reflex * Presence of perforation and of tympanostomy tubes * Presence of fluid
47
Tympanic Membrane (5)
Color Texture Landmarks Light reflex Mobility
48
TM Color and Significance Amber
Serous fluid
49
TM Color and Significance Blue or deep red
Blood in the middle ear
50
TM Color and Significance Chalky white
Thick TM indicative of recurrent infection
51
TM Color and Significance Red
Infection
52
Mastoiditis
* 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
Acute Otitis Media Bacterial
S. pneumoniae H. Influenzae Moraxella catarrhalis Group A streptococcus Enteric gram negative
54
Acute Otitis Media Viral
RSV Influenza Mycoplasma pneumoniae Fungal
55
Ear Trauma
* 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
Dullness of TM
fibrosis
57
White areas of TM
Healed perforations or inflammation
58
Air bubbles
Middle ear fluid

PNP: Physical Assessment - BK (13 decks)

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