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Ent - Ear And Pharynx > Tympanometry And Stapedial Reflex > Flashcards

Tympanometry And Stapedial Reflex Flashcards

1
Q

What to do first when a patient comes with c/o of hard of hearing or hearing loss?

A

First examine the ear and try to localise the lesion whether it is in the external ear,middle ear,internal ear

DO NOT DO ANY TESTS BEFORE EXAMINING THE EAR

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2
Q

What to do in examination of a patient who c/o of hearing loss?

A

First examine the external ear ( pinna,eac,tympanic membrane ) . If external ear is normal then the lesion could be in middle ear or internal ear

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3
Q

How to find whether the lesion is in middle ear or internal ear ?

A

Perform TUNING FORK TESTS

This helps to identify the type of hearing loss ( CHL / SNHL)

CHL - middle ear pathology
SNHL - Inner ear pathology

FINALLY,confirm with AUDIOGRAM

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4
Q

What are the conditions of the Middle ear that causes conductive hearing loss despite tympanic membrane being normal?

A

Ossicular discontinuity
ossicular fixation
Fluid collection in middle ear

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5
Q

What test is done to identify the exact pathology of middle ear ?

A

Impedance audiometry

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6
Q

Impedance audiometry consists of ?

A

Tympanometry
Stapedial reflex

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7
Q

With what instrument tympanometry Is done?

A

A probe that has 3 openings

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8
Q

What does the probe do in the tympanometry?

A

First opening - produces sound of frequency 220-226hz

Second opening - collects the sound that is reflected back from the tympanic membrane

Third opening - changes the pressure of external auditory canal

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9
Q

What is the significance of collection of reflected sound ?

A

The main function of the middle ear is to transmit maximum sound via it

Normal middle ear - maximum transmission of sound and less sound is reflected back

Middle ear pathology - transmission is reduced and reflection is more

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10
Q

What is significance of changing pressure of the external auditory canal by the third opening of the probe ?

A

With the change in the pressure of EAC from -400 to
+ 200 we check the compliance (movement) of tympanic membrane

The pressure at which sound transmission is more is noted and is considered to be the pressure of middle ear

For proper transmission of sound , we require equal pressure on both the sides of tympanic membrane ( i.e eac and middle ear cavity )

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11
Q

When is the mobility / compliance of tympanic membrane is increased ?

A

In ossicular discontinuity

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12
Q

When does the mobility / compliance of tympanic membrane decrease?

A

Due to fixation of ossicles ( Eustachian tube normal ) and fluid in middle ear (Eustachian tube abnormal)

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13
Q

What is the function of Eustachian tube ?

A

Ventilates and maintains the pressure of the middle ear

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14
Q

What is indication of tympanometry?

A

To find the pathology of middle ear with an intact tympanic membrane

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15
Q

What type of test is tympanometry ?

A

Objective test ( patient’s cooperation not needed )

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16
Q

What is the graph produced by tympanometry ?

A

Tympanogram

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17
Q

What is the normal compliance ?

A

0.35 ml - 1.45 ml

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18
Q

What is the normal middle ear pressure ?

A

In adults = -50 to +50 mm of h2o
In children = -150 to +50 mm of h20

19
Q

What the normal tympanogram curve ?

A

A type ( more or less the peak is in the centre of the graph)

20
Q

What is Ad type of curve in tympanogram ?

A

In this type of curve , compliance is increased and middle ear pressure is normal

Seen in ossicular discontinuity

21
Q

What is As type of curve in tympanogram?

A

In this type , compliance is reduced but middle ear pressure is normal

Seen in otosclerosis /tympanosclerosis

22
Q

What is B type of curve in tympanogram?

A

Here , the compliance is reduced and pressure becomes negative

Seen in serous otitis media

23
Q

What does c type of curve indicate ?

A

Early stage of Eustachian tube obstruction with normal compliance ( since fluid is not yet started to get collected ) and negative pressure

24
Q

When is flat line seen in tympanogram?

A

🌟In no compliance of tympanic membrane due to excess fluid

🌟In perforation of tympanic membrane since there will be no pressure change

25
Q

B type is also known as what ?

A

Dome shaped curve

26
Q

Main aim of doing tympanometry is

A

To find the compliance of tympanic membrane
To find the pressure of middle ear
Middle ear pressure also indicates the status of Eustachian tube

27
Q

What is Valsalva manoeuvre?

A

Exhalation with closed nostrils and mouth causes air to pass through Eustachian tube and causes the tympanic membrane to pop out

This popping out can be felt and as well as seen via otoscope

28
Q

What is the purpose of Valsalva manoeuvre?

A

To check the patency of condition of eustachian tube

29
Q

Contraindication of Valsalva manoeuvre

A

Infection of Eustachian tube / infection of throat

30
Q

What is politzer test ?

A

Patient is asked to close one nostril and mouth

Thorough the other nostril pressure is increased via the politzer bag and causes popping out of tympanic membrane since Eustachian tube is the only passage of air and pressure

31
Q

What is Toynbee manoeuvre?

A

Retraction of tympanic membrane occurs when sip of water is taken due to retraction of tympanic membrane due to creation of negative intratympanic membrane

32
Q

What is Eustachian tube catheterisation?

A

Eustachian tube catheter is passed through the floor of nasal cavity into the nasopharynx

Refer marrow notes

33
Q

What is frenzel manoeuvre?

A

Mouth and nostrils are closed and posterior part of tongue is raised by saying Ka,ka,ka

Increased pressure of air is transmitted through Eustachian tube into the middle ear

Divers use this manoeuvre to equalise middle ear pressure with the external ear

34
Q

What is the best test for estimating Eustachian tube function?

A

Tympanometry

35
Q

Other test for checking the Eustachian tube function

A

Valsalva manoeuvre
Politzer test
Eustachian tube catheterisation
Toynbee manoeuvre
Frenzel manoeuvre

36
Q

What is stapedial reflex ?

A

It is a protective reflex that protects the inner ear from loud noise (70-90db)trauma

37
Q

What is the centre for stapedial reflex ?

A

Superior olivary complex

38
Q

From the superior olivary complex where does the efferent signals go?

A

It goes to facial nerve of both the sides and causes contraction of stapedius muscles of both the sides ultimately causing pulling back of stapes

39
Q

What is the afferent and efferent of stapedial reflex ?

A

Afferent - 8th nerve
Efferent - 7th nerve

40
Q

If stimulus of loud sound if given to say the right ear doesn’t the other ear also receive loud sound and the 8th nerve of the other side is also stimulated ?

A

No the other side will not get stimulated

This is because when travelling to the opposite ear around 40 db is lost in air conduction and it is not received as a loud sound in the opposite ear

But facial nerve of both the sides are stimulated since the reflex is bilateral

41
Q

Stapedial reflex in middle ear defect

A

Not elicited

42
Q

Stapedial reflex in inner ear pathology

A

Threshold for the reflex is decreased

43
Q

Stapedial reflex in auditory pathway pathology

A

Initially present but later absent , this is called as STAPEDIAL DECAY

44
Q

Best test for malingering

A

BERA

Ent - Ear And Pharynx (14 decks)

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