GS - Auroscopy Flashcards
What is Auroscopy?
Auroscopy is a clinical examination that involves looking into the ears of a patient using an instrument called an auroscope. The physician is then able to examine under direct observation the pinna (outer part of the ear), external auditory canal (ear canal) and tympanic membrane (eardrum).
In practice auroscopic examination follows the general sequence of:
Inspection of the outer ear (pinna or auricle)
Examination of the external auditory canal
Examination of the tympanic membrane
What are the features of the external ear?
See image;
- Scaphoid fossa
- Helix
- Antihelix
- Concha
- Earlobe
- Tragus
- Antitragus
- Intertragiic incisure
- External auditory canal
- Cymba conchae
- Trangular fossa
- Crura of antihelix
What are the features of the inner ear?
See image;
- Malleus
- Light reflex
- Annulus
- Hint of promontory (through tympanic membrane)
- Pars tensa
- Pars flaccida
- Hint of include-stapedial joint (through tympanic membrane)
What are some External Ear conditions ?
External Ear conditions;
- Microtia /Anotia
- Aurcular skin tags
- Perichondritis
- Pinna Haematoma / Cauliflower ear
- Otitis externa
- Cerumen (wax) impaction
- Foreign bodies
What are some Middle Ear conditions ?
Middle Ear conditions;
- Acute Otitis Media
- Chronic (Suppurative) Otits Media
- Middle Ear Effusion ‘glue ear’ or grommet in-situ
- Tympanic membrane perforation
What are the signs, symptoms and management of Microtia / Anotia ?
Microtia / Anotia - External ear condition
Signs & Symptoms;
- Malformation of the pinna – detected at birth
- Rare condition
- (Microtia – ‘small ear’; anotia – complete absence of pinna and EAC)
Management;
- Minor abnormalities – hearing support as required
- Major abnormalities/malformation may require removal of pinna
- A CT scan may be done to assess the middle ear, ossicles and cochlea
May be associated with other middle/inner ear abnormalities and syndromes
What are the signs, symptoms and management of Auricular Skin Tags?
Auricular Skin Tags - External ear condition
Signs & Symptoms;
- Incidental finding – usually during neonatal checks
Management;
- Minor abnormality – does not usually require treatment
May be associated with other congenital conditions of the ear
What are the signs, symptoms and management of Perichondritis?
Perichondritis - External ear condition
Signs & Symptoms;
- Red, swollen tender ear
- Pus/Discharge
- Fever
Causes include:
Ear surgery, trauma, ear infections, piercings, burn
Management;
- May require incision and drainage of pus/fluid
- Swabs should be taken for culture (microbiology)
- Treat with antibiotics
Inflammation/infection of the skin and tissue surrounding the cartilage of the pinna
May cause permanent deformity (‘cauliflower ear’) – if cartilage becomes
What are the signs, symptoms and management of Pinna Haematoma and ‘Cauliflower Ear’?
Pinna Haematoma (left) and ‘Cauliflower Ear’ (right) - External ear condition
Signs & Symptoms;
- Note: may be associated with a head injury which may take precedence over the ear!
Management;
- Haematoma should be drained with an incision and compression dressing applied
- Review in a 4-7 days – as haematoma may re-collect
Haematoma of the pinna is often the result of direct trauma (most commonly after sport injury e.g. boxing or rugby)
If left untreated it may cause permanent deformity (‘cauliflower ear’) – because of deposition of fibrotic tissue
What are the signs, symptoms and management of Otitis Externa?
Otitis Externa - External ear condition
Signs & Symptoms;
- EAC may be swollen, exquisitely tender and filled with debris
Management;
- Usually treated with ear drops (steroid +/- antibiotic drops)
- Severe cases – may require insertion of a wick and microsuction to remove debris
- Ear swab should be taken for microbiology
Common inflammatory condition of EAC (may also be due to infection)
What are the signs, symptoms and management of Cerumen (Wax) Impaction?
Cerumen (Wax) Impaction - External ear condition
Signs & Symptoms;
- Otalgia
- Hearing loss
Management;
- Removal usually with micro-suction
- Syringing/Irrigation (becoming uncommon – and has contraindications)
What are the signs, symptoms and management of Foreign Bodies?
Foreign Bodies (left: cotton bud, right: insect) - External ear condition
Signs & Symptoms;
- Asymtomatic – may be found incidentally on auroscopy
- Otalgia
- Otorrhoea (unilateral)
- Hearing loss
- Bleeding
Management;
- Removal may be performed with micro- suction, instruments (forceps, hooks) or irrigation
- Insects in the EAC should be drowned first in olive oil
The patient’s history is usually ‘diagnostic’
Most patients are young children
Do NOT stick cotton buds in your ears!
What are the signs, symptoms and management of Acute Otitis Media?
Acute Otitis Media - Middle ear condition
Signs & Symptoms;
- Usually a preceding URTI
- Severe and progressive otalgia – followed by discharge (and resolution of the otalgia)
- +/- perforation of ear drum
Management;
- Treat with analgesia and antibiotics
A very common condition
What are the signs, symptoms and management of Chronic (Suppurative) Otitis Media?
Chronic (Suppurative) Otitis Media - Middle ear condition
Signs & Symptoms;
- Hearing loss
- Continuous recurrent
otorrhoea
- Perforation of the
tympanic membrane
Management;
- Antibiotic ear drops
- Regular ‘aural toilet’
- Grommet insertion
- Some cases may require mastoid surgery
What are the signs, symptoms and management of Middle Ear Effusion ‘Glue Ear’ and Grommet in-situ?
Middle Ear Effusion ‘Glue Ear’ (left) and Grommet in-situ (right) - Middle ear condition
Signs & Symptoms;
- Hearing loss
- Recurrent ear infections
- Poor/delayed speech
development
Management;
- Observe – 50% of cases resolve within 3 months
- Grommet insertion
Very common in children – caused by a combination of infection and eustachian tube dysfunction
What are the signs, symptoms and management of Tympanic Membrane Perforation?
Tympanic Membrane Perforation - Middle ear condition
Signs & Symptoms;
- Asymptomatic
- Hearing loss (variable)
Management;
- No specific treatment is required in most cases – most will heal spontaneously in a few weeks
- Persistent perforations (with hearing loss) may require surgical repair – tympanoplasty
May be caused traumatically or as a result of recurrent infection
