Assessments Chapter 15 Ears
History
-tinnitus -vertigo -otalgia -environmental exposure -recreational exposure -occupational exposure -hygiene practices
After reviewing the medical records of a patient, the nurse finds that the patient has hearing impairment caused by damage to the cranial nerve. Which cranial nerve is damaged? Cranial nerve II Cranial nerve VII Cranial nerve VIII Cranial nerve X
Cranial nerve VIII Cranial nerve VIII is the auditory, or vestibule-cochlear, nerve. This nerve transmits the impulses of sound to the brain and aids in hearing. Damage to this cranial nerve can cause hearing impairment and result in deafness. The optic nerve is the second cranial nerve, which aids in vision. The facial nerve is the seventh cranial nerve, which controls facial expressions. The vagus is the tenth cranial nerve; it controls the heartbeat. Therefore, damage to the second, seventh, or tenth cranial nerves will not result in deafness.
The nurse is caring for a patient with impaired hearing and impaired balance. Which part of the ear is affected in this patient? External ear Middle ear Inner ear Auricle
Inner ear The inner ear is responsible for hearing and balance. The organ of Corti, present in the inner ear, is the sensory organ of hearing. The numerous fibers along the basilar membrane of the organ of Corti are the receptor hair cells. These hair cells bend to mediate the sound vibrations into electric impulses that are carried to the brain. The labyrinth, in the inner ear, helps to maintain balance. Pinnae and the external auditory canal are the parts of the external ear, which carries sound waves to the middle ear. The ear ossicles, present in the middle ear, conduct sound vibrations into the inner ear. The auricle or the pinna, located externally, helps to perceive the direction of the source of sound.
Insertion of tympanostomy tubes
Polyethylene tubes are inserted surgically into the eardrum to relieve middle ear pressure and promote drainage of chronic or recurrent middle ear infections. Number of acute infections tends to decrease because of improved aeration. Tubes extrude spontaneously in 12 to 18 months.
bullous myringitis
Small vesicles containing blood are on the eardrum; it accompanies mycoplasma pneumonia and viral infections. Blood-tinged discharge and severe otalgia may be present.
What are the parts of the external ear?
Starts to develop in the 6th week of gestation External auditory canal Tympanic membrane Cerumen
The nurse documents observations about the light reflex seen on the tympanic membrane during an otoscopic examination. Which observation signifies that the ears are normal? The light reflection is at the 7 o'clock position in both the ears. The light reflection is distorted in both ears. The light reflection is amber yellow in color. The light reflection is at the 5 o'clock position on the right tympanic membrane, and the 7 o'clock position on the left.
The light reflection is at the 5 o'clock position on the right tympanic membrane, and the 7 o'clock position on the left. The nurse should systematically explore the landmarks of the tympanic membrane. The cone-shaped light reflex is prominent in the anteroinferior quadrant of the ear. In the right drum, it is at the 5 o'clock position, and in the left eardrum it is in the 7 o'clock position. This is the reflection of the otoscope light. Normally the reflection should be at the 7 o'clock position only in the left eardrum. Distortions in the cone of light can be a sign of increased inner ear pressure or otitis media. The light reflex of amber yellow color is seen in case of middle ear infection. p. 334
While assessing a patient, the nurse finds that the patient's ears are 3 cm in length and have a small, painless nodule at the helix. What does the nurse infer from these findings? The patient has microtia and swimmer's ear. The patient has macrotia and swimmer's ear. The patient has microtia and Darwin's tubercle. The patient has macrotia and Darwin's tubercle.
The patient has microtia and Darwin's tubercle.
After performing the otoscopic examination of a patient, the nurse concludes that the patient has an infection. Which findings enabled the nurse to reach this conclusion? The presence of pearl gray-colored tympanic membrane The presence of whiter and denser annulus at the periphery The presence of yellow/amber-colored tympanic membrane The presence of the malleus visible behind the tympanic membrane
The presence of yellow/amber-colored tympanic membrane The presence of yellow/amber-colored tympanic membrane indicates otitis media with effusion, which is a middle ear infection. The normal tympanic membrane is shiny, translucent, and pearl gray in color. Usually, the annulus appears white in color and denser at the periphery. Therefore, it does not indicate that the patient has an infection. In a healthy individual, the malleus is visible through the tympanic membrane.
The nurse is examining the tympanic membrane of a patient. Which landmarks should the nurse explore? Umbo Pars flaccida Vestibule Cochlea Short process of the malleus
Umbo Pars flaccida Short process of the malleus (umbrellas might look right, PTs paid for aardvarks) umbo, malleus (short process) malleus (manubrium), light reflex, pars tensa, pars flaccida, annulus The nurse should systematically explore the landmarks of the tympanic membrane during the examination. With the otoscope light, the nurse should be able to see the part of the malleus called the umbo. The short process of the malleus should also be visible. The nurse should also examine the pars flaccida, the superior section of the tympanic membrane. The vestibule is not a landmark of the tympanic membrane. It is a part of the inner ear, found within the bony labyrinth. The cochlea is also a part of the inner ear.
what is otosclerosis
a gradual bone formation that causes the footplate of the stapes to become fixed in the oval window, impeding the transmission of sound and causing progressive deafness
furuncle
a painful, reddened, and infected hair follicle, which is associated with lymphadenopathy, but not with hypomobile tymphanic membrane.
What allows for the drainage of effusion and aeration of the middle ear?
air bubbles of a functioning eustachian tube
keloid
an overgrowth of the scar tissue that is caused by trauma such as ear piercing.
How would you describe the canal?
cul-de-sac 2.5 to 3 cm long in adults -terminates at the eardrum (tympanic membrane) -lined with glands that secrete cerumen (a yellow, waxy, material -this waxy material lubricates and protects the ear -outer 1/3 is cartilage -inner 2/3 tunnels through the temporal bone and is covered in thin, sensitive skin -slight S-curve in adult
Opening of ear
external auditory canal -serves to funnel sound waves into its opening
What are the three functions of the middle ear?
1. conducts sound vibrations from outer eat to central hearing apparatus in inner ear 2. protects inner ear 3. equalization of air pressure
middle ear functions
1. conducts sound vibrations from the outer ear to the central hearing apparatus in the inner ear 2. protects the inner ear by reducing the amplitude of loud sounds 3. its eustachian tube allows equalization of air pressure on each side of the tympanic membrane so the membrane does not rupture (eg during pressure changes in an airplane
What is the biggest cause of ear infections?
1. environmental: children in high-risk groups have multiple pathogens and total bacterial load is high
What are some abnormal findings in the ear canal?
1. excessive cerumen 2. otitis externa 3. osteoma 4. foreign body 5. furuncle 6. polyp
What are the 3 parts of the ear?
1. external ear 2. middle ear 3. inner ear
What should you tell parents to protect their children from ear infection?
1. hold baby partly upright while feeding 2. do not prop bottle or let baby take a bottle to bed 3. encourage breastfeeding 4. prevent persistance of fluid in the middle ear after treatment
What are the 3 bones of the ear?
1. malleus 2. incus 3. stapes
Function of hearing involves the auditory system at what 3 levels?
1. peripheral, brainstem, and cerebral cortex
What are some abnormal lumps and lesions that could be found on the external ear?
1. sebaceous cyst 2. tophi 3. keloid 4. carcinoma
How many openings does the middle ear have?
4
Where should the light reflex be?
5 at right and 7 at left
The nurse is teaching the parents of a newborn infant about precautions to prevent middle ear infections. Which statement by the parent indicates a need for further teaching? "I should not give pacifiers to my baby." "I should avoid placing my baby in day care if possible." "I should breastfeed my baby for at least 3 months." "I should place my baby in the supine position while feeding with a bottle."
"I should place my baby in the supine position while feeding with a bottle." When an infant is fed in the supine position, some milk may flow into the ear and may increase the bacterial growth, which increases the risk of ear infection. Therefore, the nurse should advise the parents to avoid bottle-feeding the infant in the supine position and should suggest an inclined position instead while feeding. Pacifier use has also been linked to the risk of infection, so parents should not be encouraged to give pacifiers to their infants. Infants who are placed in daycare have an increased risk of infection because day care providers may not supervise bottle feeding as closely or devote as much attention to infection prevention. Breast milk provides antibodies and improves the immunity of the infant. Giving only breast milk to the infant for the first 3 months provides the best protection against ear infections.
cochlea
(latin for snail shell) -contains the central hearing apparatus
Scarred drum
- Dense white patches on the eardrum are sequelae of repeated ear infections. They do not necessarily affect hearing.
How long is the auditory canal?
-a cul-de-sac 2.5 to 3 cm long in adults that terminates at eardrum, or tympanic membrane -lined with glands that secrete cerumen
middle ear anatomy
-a tiny air-filled cavity inside the temporal bone -contains tiny ear bones, the malleus, incus, and stapes -has several openings
Cholesteatoma
-an overgrowth of the epidermal tissue in the middle ear or temporal bone -An overgrowth of epidermal tissue in the middle ear or temporal bone may result over the years after a marginal TM perforation. It has a pearly white, cheesy appearance. Growth of cholesteatoma can erode bone and produce hearing loss. Early signs include otorrhea, otalgia, unilateral conductive hearing loss, tinnitus.
inner ear anatomy
-embedded in bone -contains the bony labyrinth, which holds the sensory organs for equilibrium and hearing -within the bony labyrinth, the vestibule and the semicircular canals compose the vetibular apparatus and the cochlea -cannot directly examine ear, but you can assess its function
Family History
-family history -frequent ear infections -injury/trauma -surgery -recent problems with mouth, teeth, gums
Subjective Data Collection
-family history -personal history -medications -risk factors
lymphatic drainage in the ear
-flows to the parotid, mastoid, and superficial cervical nodes
Abnormal findings of the external ear
-frostebite -otitis externa, "swimmer's ear" -brachial remnant and ear deformity
Infants/children considerations
-in early development, the ear is posteriorly rotated and low set; later it ascends to its normal placement around eye level -Eustachian tube is relatively short and wider, and its position is more horizontal than in adults --these factors make an infant more susceptible to ear infections
What makes up the external ear?
-is called the auricle or the pinna -is made up of movable cartilage and skin
Who is most likely to get ear infections?
1. children 2. indigenous children of North (America, New Zealand, and Northern Europe)
Otitis Media with Effusion
An amber-yellow drum suggests serum in middle ear that transudes to relieve negative pressure from the blocked eustachian tube. You may note an air/fluid level with fine black dividing line or air bubbles visible behind drum. Symptoms are feeling of fullness, transient hearing loss, popping sound with swallowing. Also called serous otitis media, glue ear.
The nurse is preparing to perform otoscopy in a patient with an earache. The nurse finds that the patient's ear canal is filled with cerumen, along with discharge of yellow-colored fluid. What is an appropriate nursing action in this situation? Avoid irrigating the patient's ear Avoid instilling eardrops into the patient's ear Irrigate the patient's ear canal with warm water Clean the patient's ear with a cotton bud dipped in mineral oil
Avoid irrigating the patient's ear Otoscopic examination helps the nurse inspect the patient's external auditory canal and evaluate the tympanic membrane. During the examination, the nurse should check whether the patient's ear canal is filled with cerumen and should clean it in order to ensure a clear view of the tympanic membrane. However, if the patient has symptoms of infection (such as yellow discharge and earache) or a perforated tympanic membrane, the nurse should avoid irrigating the patient's ear canal, which could worsen the patient's symptoms. The nurse can instill the eardrops as prescribed by the primary health care provider to alleviate the symptoms of the infection. Irrigating the patient's ear canal with warm water can cause further damage and may cause perforations in the tympanic membrane. Cleaning the patient's ear with a cotton bud may push the ear discharge and cerumen deeper into the ear, so the nurse would apply gentle suction with a syringe to remove the fluids instead.
The nurse performs an otoscopic examination on the ear of a patient with mycoplasma pneumonia infection. During the exam the nurse sees that the patient has small vesicles on the eardrum that are filled with blood. Which condition does the nurse expect to find in the patient? Otomycosis Otitis externa Bullous myringitis Cholesteatoma
Bullous myringitis The presence of small blood-filled vesicles on the eardrum indicates that the patient has bullous myringitis, which is commonly associated with mycoplasma pneumonia and viral infections. It is characterized by the inflammation of the eardrum and severe pain in the ear. Otomycosis is a fungal infection, which is characterized by the presence of black or white dots on the eardrum or the ear canal. If the size of the patient's ear canal is reduced to one-fourth of its normal size due to severe swelling and inflammation, it indicates otitis externa. If the patient's tympanic membrane appears cheesy and pearly white due to the overgrowth of epidermal tissue in the middle ear or temporal bone, the patient has cholesteatoma.
fungal infection
Colony of black or white dots on drum or canal wall suggests a yeast or fungal infection
How does the normal tympanic membrane appear during an otoscopic examination? Straight and pink Convex and white Opaque and red Concave and pearl gray
Concave and pearl gray The tympanic membrane is concave with a pearly gray color. A prominent cone of light is seen in the anteroinferior quadrant, which is the reflection of the otoscope light. This structure is obliquely placed and is not straight. The tympanic membrane is not convex or opaque; it is concave and translucent. The normal tympanic membrane is pearly gray, and is not pink, white, or red in color.
What action should the nurse take during an otoscopic examination of an adult patient? Pull the auricle downward. Touch the speculum to the bony surface. Tilt the head of the patient towards left.
Pull the auricle downward. The nurse should pull the auricle up and back for an adult or an older child. This helps straighten the S-shape of the canal. In case of an infant or a child younger than 3 years of age, the nurse should pull the auricle downward. The nurse should insert the speculum slowly and carefully along the axis of the canal. The nurse should avoid touching the inner "bony" section of the canal wall. It is covered by a thin epithelial layer and is sensitive to pain. The nurse should also tilt the patient's head slightly away toward the opposite shoulder. This method brings the obliquely sloping eardrum into better view.
While performing the otoscopic examination of a patient, the nurse sees that the patient has a bright red-colored eardrum, distortion of light reflex, and drum hypomobility. Which treatment strategy would be most beneficial for this patient? Providing hearing aids for the patient Instilling 2% acetic acid solution into the ear Irrigating the ear canal with warm solution Inserting tympanostomy tubes into the ear surgically
Inserting tympanostomy tubes into the ear surgically The presence of a bright red eardrum and the absence or distortion of light reflex indicates that the patient has acute otitis media. It is commonly associated with infection and accumulation of fluid in the middle ear. This increases the pressure in the middle ear, resulting in bulging of the eardrum and a throbbing pain, and these symptoms can be alleviated by inserting tympanostomy tubes to drain the fluid from the ear and reduce the pressure. Hearing aids do not help drain the fluid present in the middle ear. Instillation of 2% acetic acid helps prevent otitis externa, but it does not reduce the pressure in the middle ear. Irrigating the ear canal with warm solution helps remove excess cerumen in the ear canal, but it does not help remove the excess fluids in the middle ear.
What is the function of the auricle? It helps to amplify sound in the inner ear. It helps to maintain the equilibrium of the body. It helps to protect the inner ear from loud sounds. It helps to funnel sound waves into the external auditory canal.
It helps to funnel sound waves into the external auditory canal. The external ear is called the auricle or pinna. It has a characteristic shape that helps to funnel sound waves into the external auditory canal for transmission to the middle ear. The semicircular canals of the inner ear help to maintain equilibrium. Sounds need not be amplified; rather, the middle ear helps to protect the inner ear by reducing the amplitude of the loud sounds.
What is the function of the inner ear? It promotes lubrication of the ear. It acts as a barrier against foreign bodies. It helps to maintain the balance of the body. It equalizes air pressure on both the sides of the eardrum.
It helps to maintain the balance of the body. The inner ear contains the bony labyrinth, which comprises the parts that aid in hearing and maintaining body balance. The external auditory canal is part of the external ear and consists of wax glands that secrete cerumen to promote the lubrication of the ear. Cerumen acts as a sticky barrier that traps foreign bodies and prevents them from reaching the tympanic membrane. The eustachian tube is part of the middle ear and it equalizes air pressure on both the sides of the eardrum.
Retracted Drum
Landmarks look more prominent and well defined. Malleus handle looks shorter and more horizontal than normal. Short process is very prominent. Light reflex is absent or distorted. The drum is dull and lusterless and does not move. These signs indicate negative pressure and middle ear vacuum from obstructed eustachian tube and serous otitis media.
The nurse is caring for a patient who is scheduled for a root canal surgery. The patient complains of having ear pain. Which condition does the nurse expect to find in the patient? Otalgia Osteoma Otorrhea Cholesteatoma
Otalgia Otalgia is characterized by earache and can be caused by an ear, dental, or oropharynx disorder. This patient who is scheduled for a root canal surgery may also complain of having ear painm which indicates that it is a referred pain, so the nurse could conclude that the patient has otalgia. Osteoma is characterized by the presence of stony hard and rounded nodules in the ear drum. Otorrhea is associated with ear canal infection that results in accumulation of fluid in the middle ear. Cholesteatoma is characterized by the presence of yellow- or gray-colored discharge with a foul odor.
A patient feels pain when the nurse pulls the pinna during assessment. What might be the reason for this pain? Frostbite Keloid Otitis externa Branchial remnant
Otitis externa Otitis externa, also called swimmer's ear, is an infection of the outer ear, with severe pain upon movement of the pinna and the tragus. Redness and swelling of the pinna may also occur. Although frostbite can cause ear pain for the patient, this condition is marked by reddish-blue discoloration and swelling of the auricle, which cause vesicles or bullae. A keloid is an overgrowth of scar tissue, most commonly at the lobule of the pierced ear. The branchial remnant is the leftover embryologic branchial arch, occurring most often in the preauricular area, in front of the tragus.
Which condition may cause conductive hearing loss in a patient? Presbycusis Otosclerosis Inflammation of the labyrinth Eighth cranial nerve damage
Otosclerosis Conductive hearing loss is caused by the mechanical dysfunction of the external and middle ear. Otosclerosis is associated with a decrease in the mobility of ossicles present in the middle ear and may result in dysfunction of the middle ear; therefore otosclerosis is associated with conductive hearing loss. Presbycusis is caused by degeneration of the nerve located in the inner ear, which may damage the cochlear hair cells and result in sensorineural hearing loss. Inflammation of the labyrinth may cause inner ear dysfunction and may result in sensorineural hearing loss, but not conductive hearing loss. Damage to the eighth cranial nerve may result in sensorineural hearing loss. p. 327
adult considerations
Otosclerosis -common cause of conductive hearing loss in young adults between the ages of 20 and 40 years
A patient reports having impaired balance and a tendency to fall down while walking. Which test would the nurse perform in the patient in order to identify the cause of these symptoms? Rinne test Weber test Romberg test Otoacoustic emission (OAE) test
Romberg test The vestibular apparatus present in the inner ear is responsible for maintaining body balance. If a patient is unable to maintain body balance and falls down frequently, the nurse may suspect that the patient's vestibular apparatus is not functioning correctly. The Romberg test helps to assess the ability of the vestibular apparatus in maintaining standing balance. Rinne and Weber tests are the tuning fork tests that are used to measure hearing loss. In tuning fork tests, the hearing is measured by air or bone conduction. The otoacoustic emission (OAE) test is used to screen hearing ability in the newborn. Rinne, Weber, and OAE tests are used to evaluate hearing impairment.
On reviewing the medication history of a patient, the nurse finds that the patient is on long-term gentamicin (Garamycin) therapy. Which risk does the nurse expect the patient to have? Acute otitis media Conductive hearing loss Sensorineural hearing loss Chondrodermatitis nodularis helicis
Sensorineural hearing loss Sensorineural hearing loss is caused by gradual degeneration of the nerves with aging or because of ototoxic drugs such as gentamicin (Garamycin). This medication may affect the hair cells in the cochlea, resulting in sensorineural hearing loss. Gentamicin (Garamycin) is an aminoglycoside antibiotic used to treat bacterial infection, but it does not cause middle ear infections such as acute otitis media. Conductive hearing loss is caused by external and middle ear disorders; it is a partial loss of hearing. Gentamicin (Garamycin) would not cause mechanical dysfunction of the middle ear and would not cause conductive hearing loss. Chondrodermatitis nodularis helicis is caused by increased pressure and trauma in the middle ear, but not by gentamicin (Garamycin).
Which parameters would the nurse assess in an elderly patient by performing the Romberg test? Standing balance Air conduction Bone conduction Proprioception Intactness of the cerebellum
Standing balance Proprioception Intactness of the cerebellum The Romberg test assesses the functional ability of the vestibular apparatus in the inner ear, which helps maintain standing balance. The Romberg test can also assess proprioception, which is the ability to sense the stimuli that arise within the body, such as position and motion. Deep tone reflex indicates the intactness of the cerebellum, which can be assessed with the Romberg test. Unlike the tuning fork test, the Romberg test does not measure the ability of hearing by determining air and bone conduction.
While performing an otoscopic examination in a two-week-old newborn, the nurse finds that the newborn has hypomobile tympanic membrane. What does the nurse suspect from this finding? The newborn has a keloid. The newborn has a furuncle. The newborn has cholesteatoma. The newborn has serous otitis media.
The newborn has serous otitis media. While retracting the ear drum pressure in the ear canal decreases, which creates a vacuum in the middle ear and decreases the motility of the drum. The retraction of the eardrum and the drum hypomobility occur due to serous otitis media, which is a middle ear infection. Keloid, furuncle, and cholesteatoma do not create a high vacuum and do not result in drum hypomobility.
During the otoscopic examination of a patient, the nurse sees that the superior part of the patient's eardrum is bright red and bulging. What does the nurse infer from this finding? The patient has skull fracture. The patient has acute otitis media. The patient has chronic otitis media. The patient has a fungal ear infection.
The patient has acute otitis media. Acute otitis media is an acute inflammation of the middle ear, which may result in vasodilatation and accumulation of fluid. This may cause a bright red and bulging eardrum. Skull fracture may result in bleeding from the inner ear and may cause a bluish or dark red discoloration of the eardrum. Chronic otitis media is characterized by the presence of a thick, yellow amber-colored eardrum due to severe inflammation and the formation of pus. Fungal ear infections are characterized by the presence of black or white spots on the eardrum.
While examining a patient with a middle ear infection, the nurse avoids performing middle ear insufflations. What is the rationale behind this intervention? The patient has an ophthalmic infection. The patient has a gastrointestinal infection. The patient has a urinary tract infection. The patient has an upper respiratory tract infection.
The patient has an upper respiratory tract infection. The patient with a middle ear infection may have drum hypermobility or hypomobility. To evaluate drum mobility in the patient, the nurse would ask the patient to perform insufflation by holding the breath. The patient with an upper respiratory tract infection may have difficulty in breathing, so the nurse should avoid performing this intervention in the patient with an upper respiratory tract infection to prevent breathlessness. In patients with ophthalmic, gastrointestinal, and urinary tract infections, the nurse can insufflate the middle ear, because it will not propel infectious matter into the middle ear.
While assessing a patient, the nurse finds that the patient's ears are 3 cm in length and have a small, painless nodule at the helix. What does the nurse infer from these findings? The patient has microtia and swimmer's ear. The patient has macrotia and swimmer's ear. The patient has microtia and Darwin's tubercle. The patient has macrotia and Darwin's tubercle.
The patient has microtia and Darwin's tubercle. When a patient has smaller ears, the length of which is less than 4 cm vertically, it indicates that the patient has microtia. The presence of a small painless nodule at the helix is indicative of Darwin's tubercle. It is a congenital variation and is not significant. Therefore, the nurse concludes that the patient has microtia and Darwin's tubercle. If the patient's ears are more than 10 cm in length, then it indicates that the patient has macrotia. Swimmer's ear is also known as otitis externa; it is caused by accumulation of water in the ear. It causes inflammation, earache, and redness. Because the patient does not have symptoms of otitis externa, the nurse does not conclude that the patient has microtia and swimmer's ear. Because the patient's ears are not more than 10 cm long and do not have inflammation and pain, the nurse does not conclude that the patient has macrotia and swimmer's ear. A small painless nodule is present in the patient; thus, the patient has Darwin's tubercle. Because the patient's ears are not more than 10 cm long, the nurse does not conclude that the patient has macrotia.
While performing otoscopic examination in a patient with gout, the nurse finds that the patient has small, whitish-yellow nodules and uric acid crystals in the ear helix. What information will the nurse document in the patient's chart? The patient has tophi. The patient has a keloid. The patient has battle sign. The patient has a sebaceous cyst.
The patient has tophi. The presence of small, whitish-yellow, hard nodules in the helix indicates that the patient has tophi. These lumps are caused by deposition of uric acid crystals, which is common in patients with uric acid gout. A keloid is an outgrowth of scar tissue around the wound, and in the ear, keloids develop mostly at the ear lobule. Battle sign is characterized by the presence of blood in the tympanic membrane and discoloration of posterior side of the pinna and mastoid process. A sebaceous cyst is a black-colored nodule that blocks sebaceous glands. Keloids, battle signs, and sebaceous cysts are not signs of gout, so these would not be documented as such in the patient's chart.
blue drum
This indicates blood in the middle ear, as in trauma resulting in skull fracture.
Acute Otitis Media
This results when the middle ear fluid is infected. An absent light reflex from increasing middle ear pressure is an early sign. Redness and bulging are first noted in superior part of drum (pars flaccida), along with earache and fever. Then fiery red bulging of entire drum occurs along with deep throbbing pain. Accompanied by possible fever and transient hearing loss. Pneumatic otoscopy reveals drum hypomobility.
Presbycusis
caused by degeneration of the nerve located in the inner ear, which may damage the cochlear hair cells and result in sensorineural hearing loss.
mixed hearing loss
combo of conductive and mixed hearing loss
acute otitis media
gives the tympanic membrane a red, swollen appearance
secretory otitis
has deposited fluid in the upper middle ear -note the bubbles
amplitude
how loud a sound is
Perforation
if the acute otitis media is not treated, the drum may rupture from increased pressure. Perforations also occur from trauma (e.g., a slap on the ear). Usually the perforation appears as a round or oval darkened area on the drum. Central perforations occur in the pars tensa. Marginal perforations occur at the annulus. Marginal perforations are called attic perforations when they occur in the superior part of the drum, the pars flaccida.
conductive hearing loss
involves a mechanical dysfunction of the external or middle ear -it is a partial loss because the person is able to hear if the sound amplitude is increased enough to reach normal nerve elements in the inner ear
What happens id a maternal rubella infection occurs during the first trimester?
it can damage the organ of Corti and impair hearing
What will you see if the TM is perforated?
may allow for direct visualization into the middle ear
Inflammation of the labyrinth
may cause inner ear dysfunction and may result in sensorineural hearing loss, but not conductive hearing loss.
Damage to the eighth cranial nerve
may result in sensorineural hearing loss.
meatus
opening to the ear
What does swelling or budging of the TM indicate?
otitis media
What does a diffuse cone of light indicate?
otitis media with effusion
buildup of cerumen
partially occludes the external ear canal
malleus
parts include umbo, manubrium, and the short process
tympanic membrane
separates the external and middle ear -tilted obliquely to the ear canal -tranluscent with a pearly gray color and a prominent cone of light in the anterionferior quandrant -slightly concave, pulled at its center by the malleus
sensorineural (or perceptive) hearing loss
signifies a pathology of the inner ear, cranial nerve VIII, or the auditory areas of the cerebral cortex
frequency
the pitch, or number of cycles per minute
Who is more likely to have dry cerumen? Who is more likely to have wet cerumen?
wet: caucasian and African Americans dry: Asians and American Indians
