1-Oto Ax Protocols

Question 1

Is the tympanic membrane generally considered part of the outer or middle ear?

Answer 1

Middle Ear

Question 2

Name as many landmarks of the pinna as you can.

Answer 2

• lobe
• tragus
• antitragus
• intratragic notch
• supratragic tubercle
• crus of helix
• triangular fossa
• crura of antihelix
• helix
• scaphoid fossa
• auricular tubercle
• antihelix
• concha
• external auditory meatus

Question 3

How is the outer third of the ear canal different from the inner two thirds?

Answer 3

• cartilaginous vs bone
• hair
• sebaceous (oil) and ceruminous (wax) glands

Question 4

Where in the ear are sebaceous glands found and what is their function?

Answer 4

In the concha and outer third of the ear canal.

Perform lubrication and antimicrobial functions, and keep canal free of debris.

Question 5

The TM is approximately ___ mm thick and consists of ___ layers.

Answer 5

0.07 mm
4 layers:
1 layer is continuous with the skin of the ear canal,
1 layer is continuous with the mucous membrane of the ME
1 of the inner fibrous layers consists of radial fibres and the other of concentric circular fibres

Question 6

Name as many of the landmarks of the TM that you can

Answer 6

• pars tensa
• pars flaccida (missing the 2 fibrous layers)
• umbo
• cone of light
• manubrium of malleus
• long process of incus
• annular ligament

Question 7

Name 3 red flags (CSHBC) for adults that may be noted during otoscopy.

Answer 7

• drainage or bleeding presently or in the preceding 90 days
• presence of a foreign object in the EAM, or excessive cerumen
• visible trauma or unexplained abnormality of the EAM, including previously uninvestigated congenital abnormality

Question 8

Name as many abnormalities of the pinna, EAM, and TM as you can that would be grounds for a referral, especially for a child.

Answer 8

• microtia
• atresia
• pits (possibly leaking) or tags
• stenosis (EAM)
• complete occlusion of EAM (cerumen)
• foreign body in EAM
• otitis externa (complete occlusion or suspected necrotizing)
• discharge (> 3 months, smelly, bloody, with spores, or with pain)
• nodules/ polyps/ cysts
• suspected hemotympanum (red)
• suspected cholesteatoma (white mass, retraction pockets)
• suspected gloms tympanum (bluish hue)
• suspected perforation (>3 months)

Question 9

Name three things involved in safe otoscopy.

Answer 9

• Use a clean/new otoscope tip.
• Change the tip if an infection is noted in one side before proceeding to the other side.
• Brace your hand against the patient to prevent injury with sudden movement.
• Receive informed consent.