Ear Pain

Middle ear effusion=

accumulation of fluid in middle ear (w/ no inflammation)

where is the lateral/short process of maaleus?

at edge, pointing at you

how do you get inflammation in middle ear?

bacteria find warm, fluidy cavity and chill there, immune system reacts, get inflammation and increased pressure in middle ear cavity

pneumatic ottoscope works how?

blows air down autidtory canal, if tympanic membrane moves, then eustachian tube is open, allowing air to move back and forth if it doesnt move, then eustachian tube is closed and middle ear chamber is under high pressure

Tip of malleus (tip of handle of malleus) is on

centre of membrane, forming umbo/dimple

what three things do you need to have a middle ear infection?

closed eustachian tube accumulation in middle ear cavity inflammation

color of tympanic membrane is typically

cloudy white

why do infants and children get way more middle ear infections

eustachian tubes are way more horizontal in children, more secretions into esutachian tubes, more oppurtunities for blockages

AOM=

infection of middle ear cavity

acute otitis media (AOM)

infection of the middle ear (rapid onset b.c acute)

otitis media= otitis media with effusion (OME)

inflammation of middle ear inflammation of middle ear with accumulation of fluid (tho this doesn't even have inflammation, so just fluid really with no inflammation !!)

otitis?

inflammation of the ear

Which ossicle touches the tympanic membrane?

malleus (short process and handle, which forms dimple in tympanic membrane)

How do you get fluid in middle ear cavity (middle ear effusion)

once eusachian tube is closed, air from middle ear cavity get absorbed into wall of cavity, creates pressure, causes fluid to drip into cavity, also encourage fluid to creep in from nasopharynx, pool of fluid, now have middle ear effusion

how does esustachian tube close?

opening in posterior nasopharynx gets closed b.c of inflammation during URTI

What is ear pain called?

otalgia

vast majority of AOM gets better on

own

What is the light reflex/cone of light and where is it?

reflection of ottoscope light back at you from tympanic membrane. Forms a triangle with base at umbo

when handle of malleus and cone of light point to right, means looking in which ear?

right

ear pain is commonly referred from 4 areas:

teeth, neck, jaw, throat

To see tympanic membrane, should pull ____ on ear

up and out

Once you take a look in ear, and you see the exam is abnormal, what are the 4 options?

1. AOM (acute otitis media) 2. MEE (Middle ear effusion) 3. AOR (Acute Otitis externa) 4. Foreign body stuck in ear

3 signs are super useful for diagnosing AOM:

1. Bulging tympanic membrane (51 RR) 2.. Cloudy tympanic membrane (34 RR) 3. Distinctly impaired tympanic membrane mobility (31 RR) **distinctly red doesn't help as much (8 RR)

What are the three "badness" cases of ear pain?

1. Temporal arteritis 2. mastoiditis 3. cancer/tumour

Do symptoms help diagnose AOM?

NO

Serous Otitis Media (SOM) =

OME

MEE=

OME and SOM

Once you take a look in ear, and you see the exam is normal, what does it mean? Whats the next step?

Pain is referred check red flags (smoker, over 50, mastoiditis (bump behind ear), temporal arteritis (knotty temporal artery, and abnormal ESR) If there are some red flags, do an MRI/CT for cancer and ESR test for temporal arteritis If no risk factors, check out other common referred pain areas (jaw, teeth, neck, throat)

what is mastoiditis?

The mastoid is that bony prominence behind your ear. It contains air spaces that are connected to the middle ear. Inflammation/Infection of the mastoid process. Occurs when an infection extends from the middle ear to the air cells of the mastoid bone behind the ear. It is a severe infection which requires IV antibiotics and often surgical resolution. **check behind ear if ear looks fine

non-suppurative otitis media

=OME, SOME

Suppurative Otitis Media=

AOM

what is temporal arteritis?

An inflammatory vasculitis that can lead to blindness if not treated promptly with steroids. Often presents as a headache or ear pain. Can be comfortably ruled out where there are no signs of a knotty tender temporal artery and the patient has a normal erythrocyte sedimentation rate (ESR). Typically in patients over 50 (women more!)

acronym for AOM signs?

BC ID Bulging Cloudy Immobile Distinctly Red