Chapter 15: ears

Recruitment

a marked loss when speech is at low intensity but sound actually becomes painful when speaker repeats in loud voice

Darwin's tubercle

a small, painless nodule at the helix

The person is unable to hear whispered items..

a whisper is a high frequency sound and is used to detect high tone loss

Atresia

absence or closure of the ear canal

3-4 months should respond?

acoustic blink reflex, infant stops movement and appears to "listen", halt sucking, quiets if crying, cries if quiet

ear pain and ear rubbing in children are associated with?

acute otitis media as are a cloudy, bulging eardrum and a distinctly red eardrum

inspection with otoscope

adult or older child- pull the pinna up and back to help straighten the S-shape of the canal -infant and child younger than 3 pull the pinna down -hold otoscope upside down

Vestibular apparatus: Romberg Test

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

Frank blood or clear watery drainage (cerebral spinal fluid) after trauma suggest?

basal skull fracture and warrants immediate referrals. CSF feels oily and is positive for glucose on TesTape

preschool and school aged child should respond?

child must be screened with audiometry

hearing loss shows with?

competition from background noise, as at a party

3. cholesteatoma

dirty yellow/gray discharge, foul odor

Otorrhea

discharge from the ear -suggest infected canal or perforated eardrum (3 types)

abnormal response to vibratility indicates?

drum hypomobilty indicates effusion or a high vacuum in the middle ear. -for the newborn's first 6 weeks, drum immobility is the best indicator for middle ear infection

Macrotia

ears larger than 10 cm

Microtia

ears smaller than 4cm vertically

With perforation, ear pain occurs

first..stops with a popping sensation, then drainage occurs

pure tone audiometer

give a precise quantitative measure of hearing by assessing the person's ability to hear sounds of varying frequency.

6-8 months should respond?

infant turns head to localized sound, responds to own name

enlarged, tender lymph nodes in the ear region indicate?

inflammation of the pinna or mastoid process

Presbycusis

is a type of hearing loss that occurs with 60% of those older than 65 years. It is a gradual sensorineural loss caused by nerve degeneration in the inner ear that slowly progresses after the fifth decade.

Tuning Fork Tests

measures hearing by air conduction or by bone conduction in which the sound vibrates through the cranial bones to the inner ear. -the air conducting route through the ear canal and middle ear is usually more sensitive route. -do not provide reliable data. not used!

tympanic membrane (eardrum) colors

normal-shiny, translucent, pearly gray otitis media w/ effusion (serous)-yellow amber acute otitis media-red air/fluid or air bubble-serous otitis media dark oval areas-perforation, drum rupture diminished/absent landmarks-thickened drum, chronic OM black/white dots on drum or canal-colony growth, fungal infection

Crusts and scaling occurs with?

otitis externa eczema contact dermatitis seborrhea

2. acute otitis media with perforation

purulent discharge

1. external otitis

purulent, sanguineous or watery discharge

Tinnitus

ringing or buzzing in the ear -originates within the person -seems louder with no competition from the environment noise -medication that have ototoxic sequelae:aspirin

Newborn should respond?

startled (Moro) reflex, acoustic blink reflex

child being treated for chronic otitis media, you may not the presence of?

tympanostomy tube in the eardrum -this is inserted surgically to equalize pressure and drain secretions.

vibratility

when examining infant/child, a pneumatic bulb attachment enables you to direct a light puff of air toward the drum to assess vibratility. -choose the largest speculum that will fit in the ear canal. tympanic member should move inward with air puff and out when released

Aging adult eardrum appearance

whiter in color and more opaque, duller than in younger adult also may look thickened

Factors that increase the risk for OM

-Passive and gestational smoke -Daycare attendance -bottle feeding

Characteristics of hearing loss

-cerumen expands and becomes impacted as after swimming or showering -can cause social isolation and lessen pleasure of leisure activities -person speech sounds garbled, possibly vowel sounds distorted

Whisper Voice Test

-mask hearing in one ear (tragus) -shield your lips -30-60 cm/1-2 ft away from person ear -whisper in ear slowly a 3 random number and letter combo -if response of combo is incorrect, repeat whisper test using a different combo -passing score is correct repeating of at least 3 out of a possible 6 combo

Infant/children: exam external ear and also the position and alignment of the head

-top of the pinna should match an imaginary line extending from the corner of the eye to the occiput and 10 degrees vertical

test hearing acuity in an infant with?

Developmental Milestones to assess hearing in an infant. -room silent -make a loud, sudden noise (hand clap) out of the baby's peripheral range of vision and note response.

eardrum assessment for infants and children is?

MANDATORY for requiring care for illness or fever. -otoscope exam for last (adults perform otoscope first then hearing test)

Otalgia

May be directly due to ear disease or may be referred pain from a problem in teeth or oropharynx (earache)

Otitis media (OM)

Middle ear infection Occurs b/c of obstruction of the eustachian tube or passage of nasopharyngeal secretions into the middle ear. -most common illness in children -most important cause in environment

Vertigo: objective and subjective

"true twirling motion" occurs with dysfunction of ladyrinth -Objective vertigo: feels like the room spins -Subjective vertigo: person feels like he/she spins