Ears, (terminology)

Incus

"anvil," middle of the three ossicles of the middle ear

Tympanic membrane

"eardrum," thin, translucent, oval membrane that stretches across the ear canal and separates the middle ear from the outer ear

Malleus

"hammer," first of the three ossicles of the middle ear

Stapes

"stirrup," inner of the three ossicles of the middle ear

Inspect and palpate external ear. what to look at

- size and shape - Skin condition - Tenderness - External auditory meatus

Retracted eardrum

-Landmarks look more prominent and well defined. -Malleus handle looks shorter and more horizontal than normal -Many more** -caused by obstruction of eustachian tube and serous otitis media.

Carcinoma

-Ulcerated crusted nodule with indurated base that fails to heal. - May occur also in ear canal and exude chronic discharge that is either serosanguineous or bloody.

Testing hearing acuity

-Whisper voice test, -Tuning Fork tests (Webber and Rinnie)

Otitis media with effusion

-amber-yellow eardrum suggest serum in middle ear -air/fluid level may be present with fine black dividing line or air bubbles visible behind eardrum. -symptoms: sensation of fullness, transient hearing loss, popping sound with swallowing

Excessive cerumen****

-even when ear canal is 90-95% blocked, hearing stays normal -when cerumen expands after swimming or showering, sensation of ear fullness and sudden hearing loss.

Acute otitis media

-middle ear fluid is infected. -redness and bulging (superior part of eardrum) -earache and fever. -deep throbbing pain -transient hearing loss occur.

Otitis externa

-severe swelling of canal, inflammation, tenderness.

Osteoma

-single, stony hard, rounded nodule that obscures the eardrum; nontender; overlying skin appears normal -attached to inner third of canal -benign but should be referred for removal.

Exostosi

-small, hard, rounded nodules of hypertrophic bone, covered with normal epithelium -arise near eardrum but do not usually block it. -may cause accumulation of cerumen, which blocks the canal.

Branchial Remnant and Ear deformity

A facial remnant or leftover of the embryological branchial arch usually appears as a skin tag.

Cholesteatoma

An overgrowth of epidermal tissue in the middle ear or temporal bone may result over the yers after a marginal tympanic membrane perforation. It has a pearly white, cheesy appearance. Growth of the cholesteatoma can erode bone and produce hearing loss. Early signs include otorrhea, unilateral conductive hearing loss, tinnitus.

Health history questions (Look in Jarvis for more detailed history questions)

Any earache or ear pain? Any ear infections? Any discharge from ears? Any hearing loss? Any loud noises at home or job (environmental hazards) Any ringing or buzzing in ears? Ever felt vertigo (spinning)? How do you clean your ears? Medications? Any surgeries?

Polyp

Arises in canal from granulomatous or mucosal tissue; redder than surrounding skin and bleeds easily; bathed in foul purulent discharges; indicates chronic ear disease. Benign, but should be referred for excision.

Fungal infection (otomycosis)

Colony of black or white dots on eardrum or canal wall suggests a yeast or fungal infection

Atresia

Congenital absence of closure of ear canal

Scarred eardrum

Dense white patches on the eardrum are sequelae of repeated ear infections. They do not necessarily affect hearing.

Cellulitis ***

Inflammation of loose, subcutaneous connective tissue. It manifests as thickening and induration of pinna with distorted contours.

Cochlea

Inner ear structure containing the central hearing apparatus

Umbo

Knob of the malleus that shows through the tympanic membrane

Sebaceous cyst

Location is commonly behind lobule, in the postauricular fold, -painful and often are multiple.

Inspect with the otoscope.

Look at external canal, Look at the tympanic membrane - colour and characteristics - position - integrity of membrane

Annulus

Outer fibrous rim encircling the eardrum

Keloid

Overgrowth of scar tissue, which invades original site of trauma. -most common at the lobule at the sight of the ear piercing.

Chondrodermatitis Nodularis Helicis

Painful nodules that develop on the rim of the helix as a result of repetitive mechanical pressure or environmental trauma -small, indurated, dull red, poorly defined, and very painfull.

Insertion of Tympanostomy tubes

Polyethylene tubes are inserted surgically into the eardrum to relieve middles ear pressure and promote drainage of fluid from chronic or recurrent middle ear infections. Number of acute infections tends to decrease because of improved aeration. Tubes are extruded spontaneously in 12-18 months.

Frostbite

Reddish, blue discoloration and swelling of pinna after exposure to extreme cold.

Cerebrospinal Fluid Otorrhea

Skull fracture of temporal bone causes cerebrospinal fluid to leak from ear canal and pool in concha when the patient is supine.

Bullous myringitis

Small vesicles containing blood on the eardrum accompany Mycoplasma pleumoniae, and virus infections. Affected patients may have blood tinged discharge and severe otalgia.

Pars flaccida

Small, slack, superior section of tympanic membrane

Tophi

Small, whitish yellow, hard, nontender nodules in or near helix or antihelix; contains greasy, chalky material of uric acid crystals and are a sign of gout.

Cerumen

Yellow waxy material that lubricates and protects the ear canal

Vertigo

a spinning, twirling sensation

Perforation

appears as round or ovel darkened area on the eardrum.

Pinna

auricle, or outer ear

Mastoid

bony prominence of the skull located just behind the ear

Foreign body in the ear ***

common objects are beans, corn, breakfast cereal, jewellery beads, small stones, sponge rubber.

Eustachian tube

connects the middle ear with the nasopharynx and allows passage of air

Otorrhea

discharge from the ear

Furuncle

exquisitely painful, reddened, infected hair follicle. Regional lymphadenopathy often accompanies a furuncle.

Presbycusis

gradual sensorineural hearing loss, caused by nerve degeneration in the inner ear or auditory nerve, that occurs with aging

Conductive hearing loss

hearing loss caused by fixation of the stapes (bones of the inner ear)

Otitis externa (swimmer's ear)

infection of outer ear, sever pain on movement of the pinna and tragus, redness and swelling, discharge, scaling, itching, fever, enlarged tender regional lymph nodes. -hearing is normal or slightly diminished.

Otitis media

inflammation of the middle ear and tympanic membrane

Otitis externa

inflammation of the outer ear and ear canal

Otalgia

pain in the ear

Tinnitus

ringing in the ears

Organ of Corti

sensory organ of hearing

Helix

superior, posterior free rim of the pinna

Pars tensa

thick, taut, central/inferior section of tympanic membrane

Blue eardrum (hemotympanum)

this indicates the presence of blood in the middle ear, as occurs when trauma results in skull fracture