Ear Examination

Question 1

Which part of the external auditory canal if formed from cartilage?

Answer 1

The outer third is made of cartilage and the inner 2/3 formed from bone

Question 2

What is the proper name for wax?

Answer 2

Cerumen

Question 3

What is the role of cerumen/wax?

Answer 3

It has antibacterial properties and is normally slightly acidic

Question 4

Where should you look when inspecting the pinna?

Answer 4

Look at the pinna itself and BE SURE TO LOOK BEHIND IT

Question 5

What should be palpated when examining the ear?

Answer 5

Palpate the mastoid for any tenderness which could be a sign of mastoiditis
Palpate the cartilaginous structures of the pinna

Question 6

What might a post-auricular scar indicate?

Answer 6

Previous mastoid surgery

Question 7

How does otitis externa present?

Answer 7

Ear pain
Swelling and erythema of the external auditory canal
Pain on movements of the outer ear
Tragal sensitivity

Question 8

What is an auricular haematoma?

Answer 8

Accumulation of blood between the perichondrium and cartilage, often occurs after blunt trauma.

Question 9

What is a complication of an auricular haematoma?

Answer 9

If not incised and removed it can cause fibrous organisation leading to cauliflower ear

This surgery should be done within seven days of presentation

Question 10

What is chondrodermatitis nodularis helicis?

Answer 10

A very painful and tender lesion that develops on the pinna- on the helix or antihelix of the pinna. Tend to be unilateral but may be bilateral. Thought to be due to pressure on the ear, e.g. from pillows

Question 11

What is auditory exostosis?

Answer 11

Abnormal bone growth that occurs within the ear canal. Triggered by exposure to cold water and wind.

Question 12

What is a complication of auditory exostosis?

Answer 12

Can obstruct the ear canal- conductive deafness

Reduce clearance of wax increasing risk of infection- otitis externa

Question 13

How might someone with auditory exostosis present?

Answer 13

Recurrent episodes of otitis externa
Conductive deafness
Exposure to cold water

Question 14

How can auditory exostosis be prevented?

Answer 14

Use ear plugs

Question 15

What might be done to treat auditory exostosis?

Answer 15

Surgery can be carried out to relieve the obstruction if causing recurrent issues

Question 16

When should irrigation (syringing) be avoided for excessive ear wax?

Answer 16

Avoid if the drum is perforated
Gromets within last 1.5 years
Cleft palate
Mastoid surgery

Micro-suction is better so refer to ENT

Question 17

What is the most common skin cancer to arise on the ear?

Answer 17

Squamous cell carcinoma. Bowen’s carcinoma in situ is the premalignant lesion. Tend to ulcerate and may be painful. Occur on the ears due to sun exposure

Question 18

What is the normal colour of the tympanic membrane?

Answer 18

Greyish

Redness indicates inflammtion

Question 19

What is a cholesteatoma?

Answer 19

Destructive and expanding growth consisting of keratinised squamous epithelium. It produces a foul smelling discharge. Erosive process can cause them to erode the ossicles or the base of the skull. Prone to occur where there are retraction pockets, can be due to recurrent middle ear infection creating negative pressures or eustachian tube dysfunction.

Question 20

What can cause bulging of the tympanic membrane?

Answer 20

Otitis media

Question 21

What is the name for scarring of the tympanic membrane?

Answer 21

Tympanosclerosis- can occur after inflammation or trauma.