Assessments Ch 15 Ears

Stapes

"Stirrup" - inner of the 3 ossicles of the middle ear.

5. Describe the whispered voice test of the hearing acuity.

*Stand arm's length (2 ft.) behind the person *Test one ear at a time while masking hearing in the other ear to prevent sound transmission around the head: done by placing one finger on the tragus and pushing in and out of the auditory meatus. *Exhale fully and whisper slowly a set of 3 random numbers and letters (ex. "5,B,6") * The person repeats each number/letter correctly * If the response is not correct, repeat the whispered test using a different combination of 3 numbers/letters *A passing score is at least 3 correct out of 6 items whispered

Incus

"Anvil" - middle of the 3 ossicles of the middle ear

Tympanic membrane

"Eardrum" - thin, translucent, pearly gray, oval membrane that stretches across the ear canal and separates the outer ear from the middle ear. When viewed with an otoscope, it shows the light as a cone shaped reflection.

Malleus

"Hammer" - first of the 3 ossicles of the middle ear; The umbo, manubrium, and short process can be seen through the eardrum.

9. Describe the appearance of these nodules that could be present on the external ear:

-Darwin's tubercle - small painless nodule at helix. -sebaceous cyst - filled with sebaceous material and can be painful if infected. -tophi - small, whitish, yellow, hard, non-tender nodules in or near helix that contains greasy, chalky, material. -chondrodermatitis - painful nodules develope on rim of helix. --small, indurated, dull red, poorly defined and very painful. --result of repetitive mechanical pressure or environmental trauma. -keloid- overgrowth of scar tissue which invades original site of trauma. -carcinoma - ulcerated, crusted nodule with indurated base that fails to heal bleeds intermittently.

12a. Fill in the labels indicated in the following illustrations (outer ear).

-External auditory meatus -tragus -antitragus -lobule -location of mastoid process -antihelix -helix

12c. Fill in the labels indicated in the following illustrations (tempanic membrane).

-Posterior fold -incus -umbo -annulus -pars tensa -cone of light -manubrium of malleus -short process of malleus -anterior fold -pars flaccida

12b. Fill in the labels indicated in the following illustrations (inner ear).

-external auditory canal -mastoid process -tympanic membrane -round window -eustachian tube -inner ear -conchlea -cranial nerve VIII -vestibule -semicircular canals -stapes in oval window -incus -malleus -skull bone -cartilage

10. Describe the appearance of these conditions that could appear in the ear canal:

-osteoma - single, stoney hard, rounded nodule that obscures the drum: nontender, benign. -exostosis - small, boney hard, rounded nodules of hypertrophic bone, convered with normal epithelium; frequently in cold water swimmers; no treatment needed -furuncle - painful, reddened, infected hair follicle. -polyp - arises in canal from mucosal tissue; bleeds easily; indicates chronic ear disease; Benign.

11. List the disease state suggested by the following descriptions of the appearance of the eardrum.

-yellow-amber color tympanic membrane - otitis media with effusion. -pearly gray color tympanic membrane - normal tympanic membrane. -air-fluid level tympanic membrane - serous otitis media. -distorted light reflex tympanic membrane - acute otitis media. -red color tympanic membrane - actute purulent otois media. -dense white areas on tympanic membrane - sequelae of infections. -oval dark areas tympanic membrane - drum rupture. -black or white dots on drum - fungal functions. -blue drum - Trauma, skull fracture.

Vertigo

A spinning, twirling sensation. Objective- feels as if the room spins. Subjective-feels as if he or she spins

10. A common cause of a conductive hearing loss:

A. Impacted cerumen

2. Sensorineural hearing loss may be related to:

A. gradual nerve degeneration

Differentiate between air conduction and bone conduction.

Air Conduction, AC: the normal pathway of hearing; it is the most efficient. Bone Conduction, BC: Alternate route of hearing; bone of the skull vibrate; these vibrations are transmitted directly to the inner ear and to cranial nerve VIII.

11. You are assessing a patient's tympanic membrane and suspect an infection of acute purulent otitis media. Which of the following findings supports this?

B. absent light reflex, reddened drum, bulging drum

14. A patient with a head injury has clear, watery drainage from the ear. How should you proceed?

B. assess for the presence of glucose in the drainage

9. The sensation of vertigo may indicate:

B. pathology in the semicircular canals

4. During the otoscopic examination of a child younger than 3 years, the examiner:

B. pulls the pinna down

7. When assessing a patient's ear with an otoscope, the patient's head should be positioned:

B. tilted away from the examiner

Bone conduction, BC

Bones vibrate and transmit sound signals directly to the inner ear and CN8.

Mastoid

Bony prominence of the skull located just behind the ear

External auditory canal

Bridges the pinna to the eardrum.

1. Using the otoscope, the tympanic membrane is visualized. The color of the membrane is:

C. pearly gray

5. In examining the ear of an adult, the canal is straightened by pulling the auricle:

C. up and back

13. When assessing hearing acuity in a 6-month-old, the examiner would:

C. watch for head turning when saying the child's name

Atresia

Congenital absence or closure of ear canal

Eustachian tub

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

6. Darwin's tubercle indicates:

D. A congenital, painless nodule at the helix.

8. The hearing receptors are located in which region?

D. Cochlea

12. You are teaching a parent of an infant the health promotion activities to reduce the risk for acute otitis media. Which would you include in the teaching plan?

D. Eliminating smoke in the house and car

3. Before examining a patients ear with the otoscope, you would palpate which for tenderness?

D. Pinna, tragus, and mastoid process

Otorrhea

Discharge from the ear

8. Contrast the motions used to straighten the ear canal when using the otoscope with an infant versus an adult.

For infants, the pinna is pulled down and back. For adults, the pinna is pulled up and back.

Eardrum: Blue or dark red color

Indicates blood behind the drum. Could be trauma or skull fracture.

Eardrum: Black or white dots on drum or canal

Indicates bulging of eardrum. Could be acute otitis media.

Eardrum: Black or white dots on drum or canal

Indicates colony of growth. Could be a fungal infection.

Eardrum: Bright red color

Indicates infection in middle ear. Could be acute otitis media.

Eardrum: Dark, round or oval areas

Indicates perforation. Could be drum rupture.

Eardrum: Prominent landmarks

Indicates retraction of drum. Could be a vacuum in the middle ear from an obstructed Eustachian tube.

Eardrum: White dense areas

Indicates scarring. Could be sequelae of infections.

Eardrum: Air/fluid level or air bubbles

Indicates serous fluid. Could it be otitis media with effusion

Eardrum: Yellow-amber color

Indicates serum or pus. Could be: Otitis media with effusion or chronic otitis media.

Eardrum: Diminished or absent landmarks

Indicates thickened eardrum. Could be chronic otitis media.

Otitis media

Inflammation of the middle ear and tympanic membrane; Common in babies and children. Higher rates associated with absence of breast-feeding, second-hand smoke, daycare attendance, male sex, pacifier use, fall and winter seasons, and bottlefeeding in supine position.

Otitis Externa

Inflammation of the outer ear and ear canal

Cochlea

Inner ear structure containing the central hearing apparatus

Conductive hearing loss

Involves and mechanical dysfunction of the external or middle ear: commonly caused by impacted earwax.

Umbo

Knob of the malleus that shows through the tympanic membrane

Annulus

Outer fibrous rim encircling the eardrum

Otalgia

Pain in the ear; Can be referred pain coming from teeth or oralpharynx.

Tinnitus

Ringing in the ears

Organ or Corti

Sensory organ of hearing

Sensorineural hearing loss

Signifies pathology of the inner ear, CN8 or the auditory areas of the cerebral cortex: impacted earwax, foreign bodies, stabbed eardrum, middle ear puss, otoclerosis.

Pars flaccida

Small, slack, superior section of tympanic membrane

12. List the findings that may appear during the whispered voice test and audiometric screening.

Test on the ear while masking hearing in the other to prevent sound transmission around the head

4. Relate the anatomic differences that place the infant at greater risk of middle ear infections.

The low set Eustachian tube is angled upwards, shorted, wider and more horizontal than adults. This does not allow fluids to drain easily.

Air conduction, AC

The normal pathway of hearing; most efficient.

6. Explain the positioning of normal ear alignment in the child.

The top of the pinna should match an imaginary line extending from the corner of the eye to the occiput. The ear should also be positioned within 10 degrees of vertical.

Pars Tensa

Thick, taut, central-inferior section of tympanic membrane

Presbycusis

Type of hearing loss involving gradual sensorineural deficit caused by nerve degradation in the inner ear; starts in the in the 50s age group. Starts with the loss of high frequency sounds such as consonants in speech.

Cerumen

Yellow waxy material that lubricates and protects the ear canal: Often sticky and brown or honey colored in Caucasians and blacks; often dry, gray and flaky in American Indians and Asians.

Pinna

aka auricle, is the outer ear. Has flexible cartilage and skin in the shape of a funnel to guide sound waves into its opening.

Ototoxic drugs

aspirin, aminoglycosides: -gentamicin, -tobramycin -amikacin, ethacrynic acid, furosemide, Indomethacin, Naproxen, quinine, vancomycin.

3. Differentiate among the types of hearing loss and give examples.

otosclerosis - hardening causing foot plate of stapes to become fixed. prebycusis - gradual sensorineural loss caused by nerve degeneration in the inner ear.

7. Define otosclerosis and presbycusis.

otosclerosis- hardening causing foot plate of stapes to become fixed. prebycusis - gradual sensorineural loss caused by nerve degeneration in inner ear.