Otoscopy and Middle Ear Test Battery Flashcards
1
Q
visual inspection of the pinna
A
check for abnormalities and/or drainage
2
Q
abnormalities of the pinna
A
- occur when we were in development
- indicator of another syndrome or anomaly
- pre-auricular pit- indicator of hearing loss
3
Q
otoscope information
A
- rechargeable
- specula
4
Q
specula
A
- tips at the end
- disposable/non-disposable
- smaller opening designed for children
5
Q
only pick the smaller specula if you’re working with…
A
a younger child or someone with a smaller ear canal
6
Q
otoscopy procedure
A
- first thing to look for is the cone of light
- pulling back the pinna will help straighten the ear canal
7
Q
otoscopy: ear infection
A
redness or dull cone of light
8
Q
otoscopy: ear tubs in kids
A
- different types of ear tubes
- some work there way out
- airplane tubes are very temporary
- permanent ear tubes
9
Q
otoscopy: perforation in the eardrum
A
can be from tubes or quetips
10
Q
otoscopy: common abnormal findings
A
- dark ear wax
- ear canal occlusion
- middle ear pathology
11
Q
dark ear wax
A
the darker the ear wax, the harder it is
12
Q
ear canal occlusion
A
cerumen, foreign object
13
Q
middle ear pathology
A
if drainage is present, you are done
14
Q
tympanometer
A
- an objective, physiological measure of acoustic admittance of the middle ear by use of air pressure
- screening and diagnostic
- varying pressure from positive to negative and comparing it to the atmospheric pressure
15
Q
what does the tympanometer test for?
A
test of the middle ear function
16
Q
tympanogram
A
graph representing middle ear functioning
17
Q
vertical line of a tympanogram
A
static compliance (ml)
18
Q
horizontal line of a tympanogram
A
pressure (daPa)
19
Q
tympanometry is also known as…
A
acoustic impedance, acoustic immittance
20
Q
tympanometry: probe stimulus
A
- 220-226 Hz
- varying levels of pressure
21
Q
varying pressure above and below atmospheric pressure causes…
A
tympanic membrane and ossicular chain to stiffen
22
Q
characteristics of a tympanogram
A
- ear canal volume
- mobility
- pressure
- shape
23
Q
ear canal volume (ECV)
A
- not a part of the mountain, just a part of the test
- measuring the length of the auditory canal from the opening of the ear canal to the end point which is typically the TM
24
Q
ECV tells us…
A
- obstruction
- perforation
- clinician error
25
ECV normative data: adults
- 0.61-1.5 cc (up to 2.0)
- males tend to be larger
26
ECV normative data: children
0.4-1.0 cc
27
if ECV is abnormally large (greater than 2.0)...
- opening of the ear canal to the middle ear space
- perforation
28
if ECV is abnormally small (less than 0.3)...
- obstruction or clinician error
- opening of the ear canal to the obstruction (cerumen, foreign object, ear canal wall)
29
static compliance (mobility)
the movement of the tympanic membrane back and forth due to pressure
30
static compliance is the most efficient operate point in terms of...
ear canal pressure is observed as a peak in the tympanogram
31
static admittance
- peak height or amount of acoustic energy that flows into the middle ear system at its greatest
- recorded as "peak height"
32
normative values of static compliance: children
0.3-0.9
33
normative values of static compliance: adults
0.3-1.6
34
if static compliance is 0.2 or below...
low mobility (stiff)
35
if static compliance is 1.6 or higher...
high mobility (flaccid) hyper-mobile
36
what may cause a tympanic membrane to move stiffly?
- tumor
- tympanosclerosis
37
tympanosclerosis
scar tissue
38
what may cause a tympanic membrane to be hyper-mobile?
- ossicular discontinuity
- can also just have a hyper-mobile eardrum (normal hearing)
39
ossicular discontinuity
break in the ossicle chain
40
peak pressure
- +200 - -200 daPa varying pressure delivered to ear canal
- peak should occur at or near atmospheric pressure '0'
41
normative values of peak pressure: children and adults
+/- 100 mm
42
if a peak is occurring beyond -100...
- negative pressure
- eustachian tube blocked
- ear infection
43
if a peak is occurring beyond +100...
- positive pressure
- not very common
44
if there is no peak...
- tympanic membrane is not moving at all
- fluid
- tumor
45
shape of a tympanogram
a way to reference the results of a tympanogram
46
type A tympanogram
- normal
- static compliance = WNL
- pressure = WNL
- ECV = WNL
47
type B tympanogram
- flat
- static compliance = none
- pressure = none
- ECV = WNL
48
cause of type B
fluid/otitis media
49
type B: ECV is abnormally low, then...
obstruction (cerumen/clinician error)
50
type B: ECV is abnormally high, then...
perforation/ear tube
51
type C tympanogram
- negative pressure (behind eardrum)
- static compliance = WNL
- pressure = negative
- ECV = WNL
52
cause of type C
blocked eustachian tube/ME infection/allergies
53
type A (d) tympanogram
- hyper-mobile
- static compliance = high
- pressure = WNL
- ECV = WNL
54
cause of type A (d)
ossicular discontinuity/flaccid TM
55
type A (s) tympanogram
- shallow or stiff
- static compliance = low
- pressure = WNL
- ECV = WNL
56
cause of type A (s)
tympanosclerosis/tumor
57
acoustic reflex
tensor tympani and stapedius muscles in your middle ear retract in response to an intense sound
58
acoustic reflex is not a test of hearing but a...
physiologic test of middle ear function
59
reflex to an intense sound is...
bilateral
60
bilateral reflex to an intense sound: ipsilateral
reflex occurs in the same ear that the stimulus is presented
61
bilateral reflex to an intense sound: contralateral
reflex occurs in the ear opposite to where stimulus is presented
62
purpose of acoustic reflex testing
- to cross check behavioral testing
- help with site of lesion
63
methodology of acoustic reflex testing
- probe tip is inserted into both ear canals and a very intense, but brief tone is presented (up to 120 dB)
- the audiologist looks for a response on the equipment
- the patient does nothing to participate
64
acoustic reflex testing: frequencies tested
500, 1000, 2000, 4000 Hz
65
acoustic reflex decay
- when stapedius muscle cannot sustain the contraction
- presentation tone is 10 dB above AR threshold
- presentation time is 10 seconds
66
acoustic reflex decay confirms or rules out...
retrocochlear pathology such as acoustic neuromas
67
eustachian tube function (ET)
- equalizes the pressure of the middle ear space with the atmospheric pressure
- it is a derivative of the tympanometry test
- probe tip used for tympanometry is in place and patient is asked to swallow a drink of water after positive pressure is presented, then again after negative pressure is presented
- there should be a notable change in pressure after each swallow due to the ET opening
