Ear Assessment

Front 1

External Ear structures

Back 1

auditory canal
tympanic membrane, pars flaccida-top of TM, pars tensa-remainder of TM, annulus-outer thick rim of TM
auricle or pinna, tragus, helix, lobule

Front 2

Middle Ear

Back 2

malleus (umbo, manubrium (handle), & short process)
incus
stapes in oval window
opening of eustachian tube

Front 3

3 functions of middle ear

Back 3

1. conduct sound vibrations from outer to central hearing apparatus in inner ear
2. protect inner ear by reducing amplitude
3. e. tube allows air pressure equalization to keep TM from rupturing

Front 4

Inner Ear-Bony Labyrinth

Back 4

holds sensory organs for equilibrium & hearing
Vestibule & semicircular canals make up vestibular apparatus
cochlea-central hearing-looks like snail

Front 5

Infants and Children

Back 5

E. tube is shorter, wider, and more horizontal than adult's; more likely to become infected
lumen surrounded by lymphoid tissue, which increases during childhood and easily occluded

Front 6

Otosclerosis

Back 6

common cause of conductive hearing loss in young adults (20-40); gradual hardening that causes food plate of stapes to become fixed in oval window

Front 7

Aging Adult

Back 7

cilia become stiff-impedes sound waves, more cerumen build up
drier cerumen too
presbycusis-gradual sensorineural loss caused by nerve degeneration in inner ear or auditory canal

Front 8

Otitis media

Back 8

very common illness in kids; higher incidence in American Indians, Alaskans, Hispanics; also higher in premature infants, Down syndrom, and feeding babies in supine position
if 1st episode within 3 months old, increases risk of recurrent OMs

Front 9

otalgia

Back 9

earache due to ear disease or may be referred pain from teeth or oropharynx

Front 10

Otorrhea

Back 10

discharge suggests infected canal or perforated eardrum

Front 11

recruitment

Back 11

marked loss when sond is at low intensity but becomes painful when repeated in loud voice

Front 12

tinnitus

Back 12

ringing, crackling, buzzing in ears;
many meds have ototoxic sequelae (ASA, aminoglycosides, vancomycin)

Front 13

Vertigo

Back 13

objective-feels like room spins
subjective-person feels likes he/she spins
dysfunction of labyrinth

Front 14

inspect, palpate external ear

Back 14

bilaterally equal size
*microtia-ears smaller than 4 cm vert.
*macrotia-ears larger than 10 cm vert.
condition of skin-lumps, lesions, Darwin's tubercle-small painless nodule at helix
tenderness-move pinna and tragus
external auditory meatus-size of opening, presence of cerumen?

Front 15

Inspect with otoscope

Back 15

pull pinna back c adult, down c child
external canal-lesions, color, discharge
TM-color, characteristics-what do you see? position, integrity of membrane

Front 16

Whispered voice test

Back 16

plug one ear, whisper a word 1-2 ft from the person, repeat on other side
document presence of hearing loss but not able to measure degree of loss

Front 17

Tuning Fork
Weber Test

Back 17

use when pt reports better hearing in one ear; place vibrating fork on midline of person's skull; should be heard equally in both ears

Front 18

Rinne Test c Tuning Fork

Back 18

compares AC to BC sound
first place vibrating fork on mastoid process, have them tell you when sound goes away, then hold vibrating end near ear until sound disappears. BC should be at least 2X as long as AC time

Front 19

Romberg test

Back 19

used to assess ability of vestibular apparatus in inner ear to help maintain standing balance

Front 20

Infants & Children

Back 20

low set ears/deviation in alignment may indicate MR or GU malformation;
save otoscope exam until last;
no movement in response to pneumatic bulb puff of air indicates effusion or vacuum in mid. ear
Chronic TM releived by tympanostomy tubes

Front 21

Otitis Externa

Back 21

swimmer's ear, infection of outer ear, painful movement, red, swelling, risk for infection

Front 22

Branchial remnant

Back 22

ear deformity, usually appears as skin tag, most often in preauricular area in front of tragus

Front 23

Cerebrospinal Fluid Otorrhea

Back 23

skull fracture of temporal bone causes CSF to leak into canal

Front 24

sebaceous cyst

Back 24

usually behind lobule

Front 25

tophi

Back 25

small, white, hard noduels around helix area, contain uric acid crystals, sign of gout

Front 26

chondrodermatitis nodularis helicus

Back 26

painful on rim of helix, result of mechanical pressure or trauma

Front 27

keloid

Back 27

overgrowth of scar tissue which invades original site of trauma

Front 28

osteoma

Back 28

single, stony hard, rounded nodule obscures drum; nontender, benign, but usually removed

Front 29

exostosis

Back 29

small, bony hard rounded nodules of hypertrophic BONE

Front 30

polyp

Back 30

granulomatous or mucosal tissue, red, purulent, foul discharge, indicates chronic ear disease

Front 31

retracted drum

Back 31

light reflex absent/distorted; drum dull, lusterless, doesn't move; vacuum from obstructed e. tube and serous OM

Front 32

Otitis Media c Effusion (OME)

Back 32

serum in middle ear

Front 33

perforation

Back 33

ruptured TM from increased pressure

Front 34

cholesteatoma

Back 34

overgrowth of epidermal tissue in middle ear years after TM perforation

Front 35

Blue Drum

Back 35

hemoympanum-blood in middle ear, trauma resulting in skull fracture

Front 36

bullous myringitis

Back 36

small vesicle containing blood on drum, pneumonia or viral

Front 37

otomycosis

Back 37

fungal infection