Ears Asessment Flashcards
The middle ear acts as a?
Volume dampener to protect the inner ear
External Ear
Auricle or pinna
Made up of flexible cartilage and skin
Design is to guide sound waves into meatus of external auditory canal
Eustachian tube
Conduit that connects the middle ear to the nasopharynx and allows for pressure regulation of the middle ear
Inner ear is responsible for?
Translation of sound to cranial nerve VII which transmit it to the brain stem
Only section responsible for vestibular function
Organ of corti
Transfers the signal into electrical impulses for the auditory nerve
Sound is perceived in two ways
Air conduction and bone conduction, compromise in either causes hearing loss
Conductive hearing loss
Occurs when sound wave transmission through the external or middle ear is disrupted
Sensorimotor hearing loss
Results from a problem somewhere beyond the middle ear Sites of dysfunction: Cochlea Organ or corti Auditory nerve Auditory cortex
Presbycusis
Results from gradual degeneration of of nerves and sensory hair cells of the organ of corti
Can be from aging or ototoxic drugs
Tinnitus
Perception of buzzing or ringing in one or both ears that does not correspond with external sound
Illness in the labyrinth can cause
Loss of equilibrium and sense of vertigo
Menier’s disease
Vertigo, sever nausea and vomiting, exacerbation so that can last up to 24 hours
Vertigo is pregnant women can result from?
Increased vascularity and edema
Infants and children are susceptible to?
Otitis media,
Infants and children’s Eustachian tube is different how?
Shorter, wider and more horizontal
In children, Enlarged adenoids related to nasal allergies often obstruct?
Outlets for the eustachian tube to drain
Otis media can cause?
Severe discomfort, difficulty feeding, sleeping, and general fussiness and rarely causes hearing loss
Normal for fluid to remain in ears for three months
Repeated infections or persistent middle ear effusion causes?
Temporary conductive earring loss which can delay onset or advancement of speech
Otosclerosis
Common conductive hearing loss in older adults resulting from slow fusion of any combination of the ossicles in the middle ear
Presbycusis
Loss of higher pitch sounds, garbled or mumbled speech
Immediate attention for ear problems
Button battery in ear canal, foul smelling drainage, ear trauma, sudden hearing loss
Cholesteatoma
Abnormal accumulation of squamous epithelium within the middle ear
Common ear symptoms
Hearing loss
Vertigo
Tinnitus
Otalgia
Whisper test
Evaluates for loss of high frequency sounds. Have patient cover opposite ear. Whisper a simple sentence from 18” back, have pt repeat sentence
Weber’s test
Helps to differentiate the cause of unilateral hearing loss
Placement of external ear on the skull in infants
Superior portion of the pinna should be congruent with the outer canthus of the eye
Weber’s test
Helps to differentiate the cause of unilateral hearing loss
place tuning fork on midline of parietal bone
Macrotia
Excessive enlargement of the auricle; usually congenital
Microtia
Small or deformed auricle that may be associated with a blind or absent auditory canal
Edematous ears
External ear canal that is swollen with inflammation or infection
Cartilage staphylococcus
Painful reddened ear usually surrounds incisions, piercings, area of traumatic injury
Carcinoma on auricle
Common site of carcinoma
Related to sun exposure
Either basal cell or squamous cell rumors
Cyst
Sac or pouch with membranous lining filled with fluid or solid material
Tophi
Uric acid crystals associated with gout, may appear as hard nodules on ear
External Otis
Inflammatory and infectious discharge in external ear canal
TM rupture
To rupture a non intact TM Clear, purulent or bloody discharge Hearing loss Buzzing Ear pain
Acute Otis media
Acute infection in middle ear
Sudden onset
Fever and pain
Fluid may be in middle ear
Can be viral or bacterial
Tympanostomy tube
Indicated for chronic Otis media and it’s complications
Most common hearing test in primary care offices and schools are done with a device called?
audiometer: headphone and box that delivers tones in different frequencies
Special considerations for older adults?
cartilage and skin around the external ear may be less pliable
stiff hairs in the ear canal
TM may seem more opaque and less mobile
Abnormal findings for infants and children
Lack of moro reflex
inability to locate sound
lack of understandable language by 24 months
If a child has a tympanostomy tubes placed, the tube should be in the?
Inferior portion of the TM with the lumen of the tube patent
Failure of Romberg’s test may indicate dysfunction in the?
vestibular portion of the ear, semicircular canals, and vestibule
The most accurate way to evaluate hearing is by?
Audiogram
Signs of external otis
redness, swelling of external auditory canal, and discharge
Conductive hearing loss on one side may indicate?
external or middle ear disease
Patients with conductive hearing loss should have an assessment of?
auricle and external auditory canal to look for blockage
TM is assessed to ensure?
no middle ear abnormality or TM perforation
pain with auricle movement or tragus palpitation indicates?
otitis externa or furunucle
Otalgia usually indicates?
ear dysfunction, most commonly otitis media or otitis externa
Severe pain followed by drainage indicates?
ruptured TM
pain in the ear can be referred to?
pharynx
Children who frequently have otitis media are at risk for?
TM rupture, scarring and hearing loss
Risk factors
age, gender, hereditary, family history, lifestyle choices, environmental
Nonverbal cues for hearing loss
leaning forward, positioning head for “good ear”, concentrating on lip movement instead of eye contact, mumbling answers, giving answers not congruent with questions, asking to repeat questions frequently, responding with loud voice, monotone conversational voice
Patients with ear trauma also need evaluation for injury to surrounding structures, which include?
brain injury, basilar skull fracture, neck injury
hemotympanum, otorrhea or TM rupture may indicate?
barotrauma from pressure changes or basilar skull fracture
cholesteatoma
abnormal accumulation of squamous epithelium in the middle ear-growth can erode auditory ossicles and cause damage to patient’s hearing
Patients with foul smelling ear drainage, try to wick the fluid from the external ear with?
cotton wick or wisp of cotton
Grey to white cerumen is often mistaked as?
eczema
The middle ear acts as a perfect reservoir because?
it is dark, warm and moist
Semicircular canals and vestibules provide the body with?
equilibrium and proprioception, contains specialized cells for sensing position
symptoms of Menier’s disease
vertigo with severe nausea and vomiting
People with hearing loss are at risk for?
depression, decreased satisfaction with life, reduced functional health, withdrawal from social activities
four openings to the middle ear
TM
Cochlear window
oval window
eustachian tube
