Ear exam

Question 1

What is the auricle

Answer 1

First part of the hearing apparatus

made of cartilage (poorly perfused)

Question 1

Things to consider when changes in balance are noted

Answer 1

1. vertigo (room spinning or them spinning) vs lightheadedness (had to sit down) BPPV
2. related to changes in position?
3. associated symptoms (nausea and vomiting)

Question 2

Auriculotemporal nerve

Answer 2

branch of trigeminal nerve that innervates the auricle

Question 3

What is the function of the auricle?

Answer 3

Channels sound to the hearing apparatus (mechanical energy)

Question 4

Exterior auditory canal (EAC)

Answer 4

two segments, padded and bony, channels waves through to middle ear

Question 5

What nerve innervates the EAC?

Answer 5

Facial nerve

Question 6

Why is the back part of the EAC more sensitive?

Answer 6

It is skin over bone (no padding)

Question 7

Tympanic membrane

Answer 7

Ear drum

Question 8

What are the landmarks of the tympanic membrane?

Answer 8

Cone of light (where light reflects off drum)-absent when fluid is behing it

Bony annulus (where ear drum attaches to the bone)

Question 9

Layers of TM

Answer 9

ectoderm (outer cutaneous)

middle CT

endoderm (innermost mucosum)

Question 10

Pars tensa

Answer 10

where TM is tightly attached to bone

most common area where it may become perforated

along bottom arc of ear drum

Question 11

pars flaccida

Answer 11

along superior arc of ear drum (attic)

where chronic disease tends to occur

Question 12

What is the function of the TM?

Answer 12

transfer mechanical energy into ossicular chain

Question 13

What is the function of the cochlea?

Answer 13

transfers mechanical membrane into electrical energy

Question 14

What is the function of the Eustachian tube?

Answer 14

regularize pressure between the middle ear and the EAC

Question 15

TMJ

Answer 15

can be diagnosed by touching the muscles inside the mouth

typically caused by muscles, not a jaw dysfunction

often presents with ear pain, but can be ruled in when no ear pathology is present

Question 16

Things to consider when changes in hearing are noted

Answer 16

1. timing of loss
2. ability to understand (neurological)
3. tinnitus (abnormal noise perception in the ear)-ringing, chirping, low buzz

Question 17

Menieres disease

Answer 17

presents with fluctuating hearing loss

and vertigo

Question 18

speech discrimination

Answer 18

have a hard time with volume AND understanding what’s being said

Question 19

steps of the physical exam

Answer 19

inspect (auricle, external meatus)-common spot for actinic keratosis, look for skin changes, look for discharge or excess ear wax

palpate (auricle)-look for tenderness, lumps or bumps

visualize (canal and TM)-look for blockage, foreign bodies

Question 20

external meatus

Answer 20

opening of EAC

Question 21

tug test

Answer 21

tug gently

if pain is noted, it may indicate cnal pathology

Question 22

why would you hold the otoscope to the side?

Answer 22

makes patient feel more comfortable

if pt moves, you can move with them

Question 23

Exostosis

Answer 23

bony outcroppings present in the EAC

not pathological

typically seen in pts who sleep in cold water

Question 24

acute otitis externa

Answer 24

"swimmer's ear" bacterial infection of the EAC positive tug test treatment includes reacidification of the ear canal

Question 25

perforation of TM

Answer 25

a hole in the TM can be from infection or traumatic

Question 26

bullous myringitis

Answer 26

infection of the ear drum itself (usually combined with infection of the middle ear) extremely painful atypical bacteria

Question 27

acute otitis media

Answer 27

bulged out ear drum hyperemic (highly vascularized) cone light present but not in the right spot

Question 28

glomus tumor

Answer 28

zebras (not very common) vascular tumor may be in front of or behind the TM pulsatile tinnitus

Question 29

hemotymanum

Answer 29

blood in the middle ear space posterior nose bleeds caused by basalar skull fracture

Question 30

serous otitis media

Answer 30

serous fluid in the middle ear (does not indicate infection) give it time to go down

Question 31

conductive hearing loss

Answer 31

disruption of sound energy through outer and middle ear

Question 32

sensorineural

Answer 32

hearing loss caused by problems with the end organ

Question 33

Weber tuning fork test

Answer 33

not used all that often tests for lateralization of hearing loss

Question 34

unilateral conductive loss

Answer 34

"i can hear it in the "bad" ear" indicates a conductive loss in the bad ear

Question 35

unilateral s/n loss

Answer 35

"i hear it in the good ear" indicates that the bad ear is experiences sensorineural loss

Question 36

Rinne tuning fork test

Answer 36

used to test air conduction vs. bone conduction (which is louder one or two)

Question 37

normal Rinne test results

Answer 37

air conduction \> bone conduction

Question 38

Rinne results that indicate conductive loss are

Answer 38

bone conduction \> air conduction