Chapter 13 - Eye and Ear Exams and Procedures

Cerumen

A buildup of excess earwax

Titmus Vision Tester

A compact electric testing device that uses computerized-designed optics to screen visual acuity

Pomeroy Syringe

A metal syringe that is filled with irrigating solution; the tip of the syringe is placed in the ear canal and the plunger is depressed to push the fluid into the ear

Tympanometry

A procedure used to measure whether or not the middle ear is transmitting sound waves; useful in diagnosing middle ear infections that commonly cause hearing loss in children

Tympanostomy

A procedure where a "surgically created" new opening in the tympanic membrane is created to allow fluid to drain from the middle ear

Audiologist

A professional trained to identify and treat hearing or balance problems

Oval Window (Cochlea)

A small snail shaped structure of the inner ear, that vibrations are converted into nerve impulses and transmitted via the auditory nerve to the brain, where they are processed as sound

Weber Test

A tuning fork is held against the crown if the patients head to determine which ear can hear sound the best

Rinne Test

A tuning fork is placed on the mastoid bone or inches from the patients ear to determine bone conduction of sound

Astigmatism

Abnormal curvature of the cornea, which causes blurry vision

AOM

Acute Otitis Media

Otorhinolaryngologist

An MD who specializes in disorders of the ear; ear, nose and throat (ENT) doctor

Fovea Centralis

An area in the posterior retina where incoming light, color and shapes are formed into nerve impulses.

Corneal Abrasion

An injury, such as a scratch or irritation, to the outer layers of the cornea

Otoscope

An instrument used to examine the ears, during physical examination

Audiometer

An instrument used to measure hearing

Conjunctivitis (Pink Eye)

Any infection or inflammation of the conjunctiva;

What temperature should ear irrigation solution be?

Body temperature whenever possible; 99 F to 100 F

Ossicles

Bones in the middle ear that carry sound vibrations

AU

Both ears

OU

Both eyes

Profound (deafness)

Both speech and language deteriorate

Jaegar Chart

Commonly used for near vision assessment; consists of a series of readings with the type ranging in size from newspaper headline print to the small print commonly found in telephone directories

Tumbling E Chart

Consist of the letter E arranged in different directions and in decreasing sizes; patient is asked to describe the direction the open end of the E is facing; children often point to the direction

Elephant Ear Wash

Convenient and easy to use; consists of a spray bottle with tubing attached to a nozzle; the bottle is filled with warm water and as the medical assistant pumps the trigger, it sprays the water into the ear with enough pressure to clean the ear but it doesn't cause discomfort or damage

Moderate-Severe Hearing Loss

Difficulty with speech; does not hearing most conversational speech

DVA

Distance visual acuity

Combination Antibiotic - Corticosteroid

Drugs that are both an antibiotic and corticosteroid combined into one medication (ex: TobraDex, Ciproflaxin-hydrocortisone, acetic acid - hydrocortisone)

ENT

Ear, Nose, Throat

Tympanic Membrane (TM)

Eardrum; drum-like structure that receives sound collected in the external auditory canal and amplifies it through the middle ear

Presbyopia

Farsightedness due to aging

Hyperopia

Farsightedness; the ability to see only objects that are far away

Ear Irrigation

Flushing of the ear canal with water or saline to dislodge foreign bodies or impacted cerumen (earwax)

Lens

Focuses light onto retina

Neurosensory Hearing Loss

Hearing loss associated with auditory nerve damage.

Retina

Inner most layer; Contains sensory receptors that process visual information and sends it to the brain

Opthalmoscope

Instrument used to examine the internal structures of the eye

Opthamolic

Intended for eye use only

Lactated Ringer's Solution is highly recommended because ______:

Its PH is closer to the PH of tears

Common solutions used to irrigate the eye include:

Lactated ringers solution, saline and water

Cataracts

Leading cause of blindness; cloudiness of lens

AS

Left ear

OS

Left eye

Opthalmologist

MD who specializes in the eyes; able to treat refractive disorders, prescribe medications, and perform various types of surgical procedures on the eye

Moderate Hearing Loss

May affect language development, articulation, interaction with peers and self-esteem; child may have difficulty hearing some conversational speech

Severe Hearing Loss

May affect voice quality

Mild Hearing Loss

May not hear soft speech; child may become fatigued after trying to listen for a long period of time

The Ishihara Method

Method used to for screening color vision by detecting color vision deficiency and red-green deficiency

Choroid Layer

Middle layer of the eye; helps supply retina with blood; dark, pigmented area that reduces reflection in the eye

NVA

Near visual acuity

Myopia

Nearsightedness; the ability to see only objects that are close up

Optician

Not an MD and cannot diagnose, prescribe, or treat eye disorders, but is able to fill prescriptions for eyeglasses and contact lenses

Optometrist

Not and MD, but a Doctor of Optometry (O.D). Cannot perform surgery, but can diagnose, prescribe, and treat eye disorders as well as refractive disorders

Macular Degeneration

Occurs when damage to the macula of the retina causes blurriness, darkness, or a loss of vision in the center of the visual field

Conductive Hearing Loss

Occurs when sound waves cannot reach the middle ear due to impacted cerumen, obstruction of the ear canal due to the presence of foreign bodies, polyps, or swelling due to otitis media

OE

Otitis Externa

OI

Otitis Interna

OM

Otitis Media

Eye Irrigation

Performed to flush the eye and may be ordered to relieve inflammation, remove foreign particles , cleanse and remove secretions due to infection, and flush out harmful substances such as chemicals

Contrast Sensitivity Testing

Provides screening test for visual for earlier diagnosis and treatment of particular eye diseases

AD

Right ear

OD

Right eye

Cones

Sensitive to bright light and help differentiate colors

Rods

Sensitive to dim light

Electronic Ear Irrigator

Several on the market; come equipped with pressure controls and suction equipment to remove debris that are dislodged; designed so the stream of solution is directed to the wall of the ear canal to prevent damage to the eardrum

Visual Acuity Test

Standard eye examination to determine the smallest letters a person can read on a Snellen chart, or E chart, at a distance of 20 feet

Medications dispensed in the eye come in:

Sterile drops or sterile ointment

Speech and Word Recognition Test

Testing done by audiologists to determine if an individual has difficult clearly interpreting speech with varying levels of background noise

Waterpik System

The oral irrigator can be converted into an ear irrigator by using the proper tip for ears

Auricle

The outer ear; serves as a mini satellite dish to catch sound waves then pass through the auditory canal until it reaches the eardrum.

What will happen to the patient if ear irrigation solution is to hot or to cold?

The patient can experience dizziness and/or nausea; and extremely hot solutions can cause damage to the eardrum

Irrigation

The process of using liquid to flush out a substance (cerumen)

Gross Hearing Screening

The provider stands 1 to 2 feet away from the patient and whispers a series of words or numbers; the patient is then asked to repeat them

Conjunctiva

Thin mucous membrane that lines the eyelids and outer surface of the eyeball

TM

Tympanic Membrane

Snellen Chart

Used to test distance visual acuity; this chart is used for adults and school aged children and consists of different letters in the English alphabet, displayed in decreasing sizes

Antibiotic

Used to treat bacterial infections in the form of ear Commonly used for external infections of the ear. ( (ex: Bacitracin, Bleph-10, Cortisporin)

Corticosteroids

Used to treat ear inflammation, reduce swelling, irritation, and discharge (ex: Dexamethasone, Flucinone)

Antifungal

Used to treat fungal causes of ear infection (ex: Acetic Acid)

Alpha-Agonists

Used to treat glaucoma (ex: Apraclonidine, Brimonidine)

Carbonic Anhydrase Inhibitors (CAI)

Used to treat glaucoma (ex: Brinzolamide)

Cholinergic

Used to treat glaucoma (ex: Pilocarpine)

B-Beta Blockers

Used to treat glaucoma (ex: Timolol)

Vitamin/Nutritional Supplement

Used to treat macular degeneration (ex: Antioxidants, saffrron, Ginko)

Monoclonal Antibodies

Used to treat macular degeneration (ex: Eylea, Lucentis, Macugen, saffron supplements, and Visudyne used with photodynamic therapy (PDT)

Antivirals

Used to treat viral infections (ex: Vitrasert, Zirgan, Viroptic, Herplex, Vira-A)

The two common methods used to test for hearing acuity by the provider are the :

Weber test and Rinne test

Cornea

Where light enters the eye

Sclera

White part of the eye; outermost lining