Tympanic membrane picture quiz

Question 1

how to tell if ear is left or right

Answer 1

The light reflex (cone of light) in the right eardrum is placed in the 4 o’clock to 5 o’clock direction.

The light reflex (cone of light) in the left eardrum is placed in the 7 o’clock to 8 o’clock direction.

Question 2

which ear?

Answer 2

Right ear
- cone of light is ar 4 to 5 o’clock position

Question 3

which ear?

Answer 3

left ear

Question 4

basic anatomy of the ear

Answer 4

Question 5

Innervation of the auricle

Answer 5

The auricle has several sources of sensory innervation:

• The superficial surface is supplied by the great auricular nerve and lesser occipital nerve, both of which are branches of the cervical plexus (C2 & C3), and the auriculotemporal branch of the mandibular nerve, which is a branch of the trigeminal nerve (cranial nerve V)
• The deep part of the auricle is supplied by the vagus nerve (cranial nerve X) and facial nerve (cranial nerve VII)

Question 6

Innervation of the external acoustic meatus

Answer 6

Like the auricle, the external acoustic meatus has several sources of sensory innervation, including:

• The auriculotemporal nerve, which is a branch of the mandibular nerve, which branches from the trigeminal nerve (cranial nerve V)
• The auricular nerve, which is a branch of the vagus nerve (cranial nerve X)

Question 7

Innervation of the tympanic membrane

Answer 7

• The medial surface of the tympanic membrane is supplied by the vagus (cranial nerve X) and glossopharyngeal nerve (IX).
• The lateral surface of the tympanic nerve is supplied by the auriculotemporal nerve (a branch of the mandibular division of trigeminal nerve) and facial nerve.

Question 8

Innervation of the inner ear

Answer 8

The inner ear is innervated by the vestibulocochlear nerve (cranial nerve VIII). This nerve originates from the lateral surface of the brainstem and travels through the temporal bone in the internal acoustic meatus to innervate the inner ear.

Once in the internal acoustic meatus, the nerve divides to form the:

• Vestibular nerve: this enlarges to form the vestibular ganglion before it divides into the superior and inferior vestibular nerve to innervate the three semi-circular ducts, the utricle and saccule.
• Cochlear nerve: this enters the base of the cochlea and passes through the modiolus to innervate the receptors of the Organ of Corti.

Question 9

describing tympanic membrane

Answer 9

Colour

• Healthy should appear pearly grey and translucent)
• Erythema suggests inflammation

Shape

• Healthy should appear relatively flat
• Bulging : increased middle ear pressure e.g. acute otittis media
• Retraction: reduced middle ear pressure (eustachian tube dysfunction) e.g. otitis media with effusion

Light reflex ‘Cone of light’
- right ear 4 to 5 o’clock
- left ear 7 to 8 o’clock
- abscence or distortion suggests bulging e.g. due to acute otitis media

Perforation

• Size and position
• presence of cholesteatoma (superior part of TM) - granulation tissue and discharge (smelly)

Scaring

• tympanoscelrosis can occur secondary to otitis media
• can cause conductive hearing loss

Question 10

Diagnose

Answer 10

Normal right ear
- Pearly colour
- Flat
- No sign of erythema
- Can see the handle of the malleus
- Light reflex present

Question 11

diagnose

Answer 11

normal ear drum

• anterior recess cnanot be seen as obscured by prominent ear canal wall

Question 12

diagnose

Answer 12

Ear wax- cerument
- combination of skin, sweat and oil form wax which protects the ear

Question 13

diagnose

Answer 13

Perforation of the the tympanic membrane sceondary to chronic fungal ear ifnection which has been incorrectly treated with antibiotic ear drop

Question 14

diagnose

Answer 14

otitis media with effusion

• tympanic membrane is dull
• retracted membrane
• sometimes light reflex is lost
• bubble seen behind TM

Question 15

diagnose

Answer 15

Tympanoscelrosis

Question 16

diagnose

Answer 16

otitis media with effusion
- retracted
- gas bubble prominent

Question 17

diagnose

Answer 17

Grommet

• ventilation tube
• classic psoition
• can move due to eptihtial migration and be ejected naturally

Question 18

diagnose

Answer 18

cholesteatoma due to chronic retraction of tympanic membrane
“beware of attic wax”

Question 19

diagnose

Answer 19

acute otitis media

• erythematous
• bulging
• distortion of light reflex

Question 20

diagnose

Answer 20

cholesteatoma

Question 21

diagnose

Answer 21

otitis externa

Question 22

diagnose

Answer 22

foreign body

Question 23

diagnose

Answer 23

chronic supportative otitis media -> perforation

Question 24

diagnose

Answer 24

haemotympanum
- usually secondary to trauma

Question 25

diagose

Answer 25

cholesteatoma

Question 26

diagnose

Answer 26

bleeding of the external auditory canal

Question 27

diagose

Answer 27

otitis media with effusion

Question 28

diagnose

Answer 28

Tympanic membrane calcification

Question 29

diagnose

Answer 29

normal left ear

Question 30

diagnose

Answer 30

impacted cerumen