Exam 4 (Ch.15&16) Flashcards
Used to lubricate and protect the ear
Cerumen
Function of Cerumen
helps keep foreign bodies from entering and reaching the TM
Gray and flaky, frequently forms a thin mass in the ear canal; more frequently in Asians and American Indians
Dry cerumen
Honey brown to dark brown and moist; more often in Caucasians and African Americans
Wet cerumen
What is the structure that connects the middle ear with the nasopharynx and allows for passage of air?
Eustachian Tube
When does the Eustachian tube usually open?
with swallowing or yawning
This part of the ear is responsible for protecting the inner ear by reducing the amplitude of loud sounds among other things.
The middle ear
Functions of middle ear
Conducts sound vibrations from the outer ear to central ear, protects inner ear by reducing the amplitude of loud sounds, and Eustachian tube allows equalization of pressure for TM
External portion of the ear is called:
Auricle or Pinna
A patients equilibrium is affected. Which part of the ear is responsible for this deficit?
Labyrinth (holds sensory organs for equilibrium and hearing
What is contained within the labyrinth?
Vestibule and the semicircular canals compose the vestibular apparatus, and the cochlea contains the central hearing apparatus.
If a patient has sensorineural or perceptive loss, what cranial nerve could be affected?
Cranial Nerve 8 (conducts impulses to brainstem)
Name the two types of tuning fork tests
Weber and Rinne tests (inaccurate and do not yield precise reliable data)
When performing the otoscopic exam on an adult, what do you do with the pinna?
Pull pinna up and back
When performing the otoscopic exam on a child, what do you do with the pinna?
Pull down
In aging adult, the eardrum may appear thicker or thinner?
Thicker (think harder to hear)
When performing the whisper test, how far away should the patient be from the examiner?
2 feet (arms length). Test one ear at a time while masking hearing in the other to prevent sound transmission around the head.
A person is experiencing ringing, crackling, and buzzing in their ears. What is wrong with them?
Tinnitus (phantom sound)(occurs when cerumen impaction, middle ear infection, or other ear disorders)
What is otitis media
Middle ear infection
How does OM occur?
obstruction of the Eustachian tube or passage of nasopharyngeal secretions in the middle ear.
What group of people are more likely to have OM?
children under the age of 2.
Normal findings when assessing the tympanic membrane.
Color: Pearly-gray
Prominent cone of light (5’o’clock in the right ear, 7’o’clock in the left ear)
Position should be flat and slightly pulled in at the center
Membrane should be intact
What are some predisposing factors for otitis media in children?
Absence of breastfeeding for the first 3 months Bottlefeeding in the supine position Exposure to tobacco smoke Daycare Male gender Pacifier use
Hearing loss that occurs with aging. Gradual onset over years, mostly high frequency loss, worse in noisy environments.
presbycusis
Another term of Otitis Externa is….
Swimmer’s Ear. (infection of the outer ear)
S/S Of Swimmer’s Ear
severe painful movement of the pinna and tragus, redness and swelling of the pinna and canal, scanty purulent d/c, scaling, itching, fever and enlarged tender regional lymph nodes. More common in hot, humid weather.
You can test the function of the inner ear by:
using the romberg test.
It assesses the ability of the vestibular apparatus in the inner ear to help maintain standing balance. also assesses the intactness of cerebellum and proprioception
These filter out the coarsest matter from inhaled air.
Nasal hair.
These filter out dust and bacteria
Mucosa blanket
What are the three levels of the auditory system?
Peripheral: transmits sound and converts into electrical impulses
Brainstem: permits locating the direction of sound in space and identifying the sound
Cerebral cortex: Interprets the meaning of the sound
Mechanical dysfunction of the external or middle ear.
(This is generally a partial loss of hearing). May be caused by impacted cerumen, foreign bodies, a perforated TM, pus or serum in middle ear and otosclerosis.
Conductive Hearing loss
Pathology of the inner ear, cranial nerve 8, or the auditory areas of the cerebral cortex. May be caused by presbycusis.
Sensorineural (perceptive) loss
the later wall of each nasal cavity contains three parallel bony projections. What are they called?
Superior, middle, and inferior TURBINATES
Numerous fibers along the basilar membrane are the receptor hair cells of the……
organ of Corti (sensory organ of hearing)
Incidence adn severity of OM have increased in indigenous children from….
North American, New Zealand, Australia, and Northern Europe
Common cause of conductive hearing loss in young adult’s b/w 20-40. Gradual bone formation causes the footplate of the stapes to become fixed in the oval window, impeding the transmission of sound and causing progressive deafness. Will first notice high-frequency tone loss.
Otosclerosis
Cause a staggering gait and strong spinning, whirling sensation
Vertigo
When should infants have a hearing screening
Before 1 month (complete eval by 3 months)
Dirty yellow/gray discharge, foul odor typically with perforation.
Cholesteatoma
A marked loss when speech is at a low intensity, but sound actually becomes painful when speaker repeats in a loud voice
Recruitment (happens when cerumen expands and becomes impacted after swimming or showering)
What medications may be the cause of tinnitus?
Aspirin, furosemide (Lasix), and Vancomycin
A small, painless nodule at the helix of ear, is a congenital variation and is not significant
Darwin’s Tubercle
Enlarged, tender lymph nodes near ear indicate
inflammation of the pinna or mastoid process
What do you assess for when using an otoscope?
swelling, lesions, redness, and foreign bodies
Absence or closure of the ear canal
Atresia
What is the best indicator of a middle ear infection in a Newborn
Drum immobility
How many deciduous teeth are there in the average mouth?
20
Dense white patches on the eardrum are sequelae of repeated ear infections. Does not necessarily affect hearing.
Scarred Drum
Season rhinitis if caused by….
pollen (perennial if allergen is dust)
Nose picking, trauma, vigorous nose blowing, or a foreign body can cause……
Epistaxis (nosebleed)
What is the function of the turbinates?
increase surface area so more blood vessels and mucous membranes are available to warm, humidify, and filter the inhaled air
Sinuses drain into…….
middle meatus (tears from nasolacrimal duct go to inferior meatus)
Air filled pockets within the cranium. They communicate with the nasal cavity and are lined with the same type of ciliated mucous membrane. They lighten the weight of skull bones; serve as resonators of sound production and provide mucus.
Paranasal sinuses
What 2 sinuses are accessible during examination
frontal and maxiallary
When examining gums of the elderly patient, what might you notice?
gums receding, teeth look slightly yellow, and longer due to receding gums. Surfaces worn down and abraded.
Shows the uvula split either completely or partially and occurs in about 2% of the general population and up to 10% in some American Indian groups.
Bifid uvula
The highest incidence of cleft lip and palate occurs in this ethnic group.
Asians (intermediate: Caucasians; lowest in African Americans)
What is underlying each turbinate?
The meatus
The structure that divides the two nares and is continuous inside with the nasal septum? What is it?
Columnella
Why is the tongue smoother in geriatric patients?
papillary atrophy
A benign bony ridge running in the middle of the hard palate and occurs in 20-35% of the US population
Torus palatinus
A benign, milky, bluish-white opaque appearance of the buccal mucosa that occurs commonly in African Americans.
Leukodema
Small blue-white spots with irregular red halos located in the mouth scattered over the mucosa is better known as?
Koplik Spots (early sign and pathognomonic of measles)
Chalky white/ thick raised patch with well-defined borders. The lesion is firmly attached and does not scrape off. May occur on lateral edges of tongue.
Leukoplakia
How can Leukoplakia occur
heavy smoking and alcohol use.
A white cheesy, curdlike patch on the buccal mucosa on tongue. It scrapes off, leaving a raw, red surface that bleeds easily.
Candidiasis or monilial infection (termed thrush in newborns)
How do monilial infection occur?
use of antibiotics or coritcosteroids and in immunosuppressed people
May be caused directly by ear disease or may be referred pain from a problem in teeth or oropharynx
Otalgia
Pain with movement of tragus is a sign of…..
otitis and furuncle (boil)
Functions of the nose
warms, moistens and filters the inhaled air, and it is the sensory organ for smell
What is the most common site of nosebleeds, it is the anterior part of the septum holds rich vascular network.
Kiesselbach plexus
What cranial nerve transmits to the temporal lobe of the brain?
Cranial nerve 1
Function of saliva
lubricates the food bolus, starts digestion, and cleans and protects the mucosaCr
small, isolated white or yellow papules on the mucosa of cheek, tongue, and cheek
Fordyce granules
Makes uvula and soft palate rise in the midline
Cranial Nerve X
Used for sticking tongue out
Cranial nerve VII
Traumatic areas or ulcers on the posterior hard palate on either side of midline. Result from abrasions while sucking.
Bednar aphthae
Most important side effect of acute OM is…….
The persistence of fluid in the middle ear after treatment
Mouth and lip turns in due to lack of teeth
Edentuious
Cherry red lips occurs from (3’
Carbon monoxide
Acidosis
Ketoacidosis
Beefy red swollen tongue with smooth glossy areas
B12 deficiency
If tooth loss occurs the remaining teeth drift
Maloclusion
Normal: sound is equally loud in the both ears
Conductive loss: sound lateralize to poorer ear from background room noise, which masks hearing in normal ear.
Seniorineuro: sound lateralizes to better ear or unaffected ear. Poor ear unable to lateralize sound
Weber Test
Normal: sound is heard twice as long by AC as by BC.
Conductive loss: person hears equally long by BC and AC or even longer.
Sensorineural: normal ratio of AC>BC is intact but is reduced overall
Rinne Test
Amber-yellow drum suggests serum in middle ear; feeling of fullness, transient hearing loss, popping sound with swallowing
Serous otitis with effusion
Severe tinnitus can cause….
Depression
If the labyrinth is inflamed what can happen
Wrong info is sent to brain and can cause unsteady gait (vertigo)
