What is the auricle
First part of the hearing apparatus
made of cartilage (poorly perfused)
Things to consider when changes in balance are noted
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)
branch of trigeminal nerve that innervates the auricle
What is the function of the auricle?
Channels sound to the hearing apparatus (mechanical energy)
Exterior auditory canal (EAC)
two segments, padded and bony, channels waves through to middle ear
What nerve innervates the EAC?
Why is the back part of the EAC more sensitive?
It is skin over bone (no padding)
What are the landmarks of the tympanic membrane?
Cone of light (where light reflects off drum)-absent when fluid is behing it
Bony annulus (where ear drum attaches to the bone)
Layers of TM
ectoderm (outer cutaneous)
endoderm (innermost mucosum)
where TM is tightly attached to bone
most common area where it may become perforated
along bottom arc of ear drum
along superior arc of ear drum (attic)
where chronic disease tends to occur
What is the function of the TM?
transfer mechanical energy into ossicular chain
What is the function of the cochlea?
transfers mechanical membrane into electrical energy
What is the function of the Eustachian tube?
regularize pressure between the middle ear and the EAC
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
Things to consider when changes in hearing are noted
1. timing of loss
2. ability to understand (neurological)
3. tinnitus (abnormal noise perception in the ear)-ringing, chirping, low buzz
presents with fluctuating hearing loss
have a hard time with volume AND understanding what's being said
steps of the physical exam
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
opening of EAC
if pain is noted, it may indicate cnal pathology
why would you hold the otoscope to the side?
makes patient feel more comfortable
if pt moves, you can move with them
bony outcroppings present in the EAC
typically seen in pts who sleep in cold water
acute otitis externa
"swimmer's ear" bacterial infection of the EAC
positive tug test
treatment includes reacidification of the ear canal
perforation of TM
a hole in the TM
can be from infection or traumatic
infection of the ear drum itself (usually combined with infection of the middle ear)
acute otitis media
bulged out ear drum
hyperemic (highly vascularized)
cone light present but not in the right spot
zebras (not very common)
may be in front of or behind the TM
blood in the middle ear space
posterior nose bleeds
caused by basalar skull fracture
serous otitis media
serous fluid in the middle ear (does not indicate infection)
give it time to go down
conductive hearing loss
disruption of sound energy through outer and middle ear
hearing loss caused by problems with the end organ
Weber tuning fork test
not used all that often
tests for lateralization of hearing loss
unilateral conductive loss
"i can hear it in the "bad" ear"
indicates a conductive loss in the bad ear
unilateral s/n loss
"i hear it in the good ear"
indicates that the bad ear is experiences sensorineural loss
Rinne tuning fork test
used to test air conduction vs. bone conduction
(which is louder one or two)
normal Rinne test results
air conduction > bone conduction
Rinne results that indicate conductive loss are
bone conduction > air conduction