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