Common ear problems

common foreign bodies that children may have stuck in their ear

beads, erasers, pen/pencil tips, food, insects

if a foreign body is retained for a long period of time what may develop

irritation, edema, inflammation and infection

What should you do if a patient has a foreign body in the ear

exam of head and neck, patient should not attempt to remove

removal of cerumen impaction

irrigation or wire loop with lukewarm water

how is a live insect in the ear removed

mineral oil, alcohol, or light

If a foreign body cannot be removed and there is bleeding what is the a possible suspect

polyp from chronic infection, refer incase attached to ossicles or facial nerve

if there is a perforation of the TM from foreign body

refer to ENT

If there is a laceration of the canal or TM of ear what is the patient education

keep ear dry

What can trauma to external ear produce?

superficial abrasion, contusion, hematoma, laceration, partial or complete avulsion

How are abrasions treated

same a derm

What muscle could have contusion on external ear

post auricular muscles, muscles of mastication

auricle hematoma may occur when what is torn

perichondrium

accumulation of blood between perichondrium and cartilage that presents with edema, fluctuant ecchymotic pinna with landmark loss

auricle hematoma

What is most important for treatment of auricle hematoma

early recognition, evaluation, irrigation

Treatment of lacteration of external ear/pinna and canal

fine sutures, antibiotic drops

Diagnostic measures and treatment for external ear canal laceration with TM perforation

may heal spontaneously, assess hearing status, patch over perforation if needed

What fracture should be considered in trauma with laceration

temporal bone

Dislocation of ossicles/ossicle chain, stapes is sublexed out of oval window or transmited through the cochlea and rupture round window causing leaking of perilymph producing

hearing loss and vertigo

Diagnosis: Dislocation of ossicles/ossicle chain, stapes is sublexed out of oval window or transmited through the cochlea and rupture round window causing leaking of perilymph producing hearing loss and vertigo

head trauma with basilar skull fracture and ossicular injury

Injury that occures with sudden accelerations, decelerations or blows to head

inner ear injuries

Hydraulic forces transmitted to the ossicles can cause

rupture between fluid cavities within labyrinth, tear of structures or bleeding

Symptoms of hydraulic forces transmitted to ossicles causing rupture between fluid cavities within labyrinth, tear of structures or bleeding

hearing loss, dizziness, vertigo, disequilibrium

Inner ear injuries usually involve

vestibular and cochlear systems

Inner ear injuries are associated with fractures of

temporal bone

patients present with post traumatic vertigo following a blow to the head and no temproal bone fracture, high frequency hearing loss, and tinnitus

lanyrinthine concussion

labyrinithine concussions are similar to

benign parosxymal positional vertigo

prognosis for labyrinthine ocncussion

good, spontaneous remission 6 months occassionaly up to 2 years

Air conduction

sound waves transmitted from TM to the ossicles in the fluid filled middle ear

how can the sound still reach the cochlea if air conduciton is lost or impaired

bone conduction through temporal bone

High frequency sounds activated

sensory cells in basilar region

low frequency tones activated

all sensory cells

A defect in any portion of the conduction system that can result in the misidentification of acoustic information

hearing impairment

Factors that can result in hearing loss

external envrionment, sensorineural coding, transmission of signals in the CNS

normal ear detects frequencies in what range

20-20,000 Hz

range of most hearing

500-4000 Hz

Physical exam testing used for hearing los

whispered word, weber, rinne, audiometry, speech reception, threshold, speech discrimination, brain-stem auditory evoked responses

How does weber lateralize

conductive to affected side, sensorinerual to unaffected side

Hearing loss if bone conduciton is better than or equal to air conduction on affected side

conductive hearing loss

Air conduction better than bone conduction indicates

normal hearing or sensorineural

pure tone testing that can be done through air conduction or bone conduction to assess the patients threshold

audiometry

test done to note if the patient can repeat words correctly

speech reception threshold

measures the ability to understand speech

speech discrimination

test that reflects the energy fro the cochlea, 8th cranial nerve and brain stem

Brain stem evoked response

air-bone gaps with conduction threshold outside normal range

mixed hearing loss

0-25 decibles

WNL for hearing

26-50 dB

mild hearing loss, difficulty with soft sounds/background noise/distance

51-70 dB

moderate loss, signifiant difficulty with conversation

71-90 dB

severe hearing loss, cannot hear conversation

91+ dB

profound loss, only loud environmental sounds

mechanical inefficiency in the mechanical portion of the auditory system or any or all of anatomic portion of external or middle ear

conductive hearing loss

In conductive hearing loss where is there impaired transmission

external anal, across ossicles, through oval window

with conductive hearing loss there is an equal loss in

all frequencies

With conductive hearing loss speech can be discriminated when levels are

above the loss

What type of hearing loss is associated with cerumen impaction

conductive

Most causes of conductive hearing loss **can/cannot** be corrected

can

Other than cerumen impaction what else can cause conductive hearing loss in external ear

infection of soft tissue, Otitis externa with exudate, overgrowth of boney wall of canal from cold water swimming, tumors atresia of canal, fibrotic stenosis form recurrent infection

Treatment of small overgrowth of bony wall fo external canal

none

treatment of large overgrowth of bony wall of external canal

removal by ENT

what can cause conductive hearing loss of middle ear and TM specifically when movement is impaired

otitis mediat, perforation, scar tissue, calcium deposit

OM fluid impairs air conduction to the cochlea in

otoslcerosis of ossicles

Results from negative middle ear pressure and impaired mobility of the TM resulting in conductive hearing loss

eustachian tub dysfunction or barotitis

What part of the ear does otosclerosis invole and is formed with the stapes from cartilage during development

bony otic capsule

35 y/o female (postpartum 4 months) patient presents with slow progressive unilateral hearing impairment, she noticed it began during her last pregnancy. on exam you note a normal otoscopic results. pt explains that her mom experienced something similar to this when she was pregnant. you do a CT and MRI to confirm diagnosis. what is your diagnosis?

otosclerosis

35 y/o female (postpartum 4 months) patient presents with slow progressive unilateral hearing impairment, she noticed it began during her last pregnancy. on exam you note a normal otoscopic results. pt explains that her mom experienced something similar to this when she was pregnant. you do a CT and MRI to confirm diagnosis. what treatment?

corrected with stapedectomy or observation, amplification

\
t/f

otosclerosis can be unilateral or bilateral

true

\
t/f

those with otosclerosis often have a family history

true

Form of hearing loss that usually follows perforation and is a buildup of squamous epithelium in middle ear

cholesteatoma

What can be a complication of cholestatoma cause if is causes erosion of the ossicles and bony labyrinth along with possible nerve problems

mixed conductive-sensorineural hearing loss

Presentation of cholesteatoma

otorrhea, conductive hearing loss, tinnitus, retraction of TM with whitish mass behind intact TM

formation of cholesteatoma usually requires

ET dysfunction

What should be done when a pt presents with cholesteatoma

cranial nerve evaluation

Complication to bone in cholesteatoma

bone erosion

treatment for cholesteatoma

prevention infection, surgical evaluation and intervention, tympanomastoidectomy

type of hearing loss that include disorders within cochlea, auditory nerve and connection to brain stem

sensorineural

Causes of sensorineural hearing loss

neural degeneration, decreased cilia, problems in ossicles

sensorineural loss is unequal at

different frequencies

there is better hearing for ___ tones than __ tones in sensorineural hearing loss

low, high

With sensorineural hearing loss it is difficult to hear what wiith background noise

speech

which gender is presbycussis more common in

males

presentation of presbycusis

gradual progressive bilateral hearing loss, symmetrical high frequency hearing loss that may be associated with tinnitus

causes of presbycusis

degeneration of the sensory and nerve fibers at the base of the cochlea

treatment of presbycusis

hearing aids

acute unilateral deafness ususaly has a basis with

cochlea

causes of cochlear damaage

bacterial or viral infection of the labyrinth of head trauma

A viral infection of teh cochlear and auditory nerve termainals in young adults often results in

acute, reversible unilateral hearing los

Sudden hearing loss with vertigo and tinnitus may be caused by

perilymphatic fistula

Recurrent and perogregressive group of symptoms that includes hearing loss, tinnitus, dizziness and vertigo

Meniere’s disease or endolymphatic hydrops

Cause of meniere’s disease or endolymphatic hydrops

unknonw

symptoms of meniere’s disease occur from

distention of endolymphatic compartment of inner ear leading to hair cell atrophy

Patient presents with hearing loss, tinnitus, vertigo, Nausea and vomiting lasting minutes to hours with feelings of unsteadiness after episodes. Weber lateralized ot unaffected side and Rinne AC>BC. Diagnosis and treatment

meniere;s diseases, restriction of diuretics and salt, surgery

Benign neoplastic cause of hearing loss that involves gradual unilateral hearing loss, tinnitus, vertigo, ataxia, brainstem dysfunction, high frequency loss is first, sensorineural loss, poor speech discrimination

acoustic neuroma/vestibular schwannoma

cranial nerve that may be involved in acoustic neurma

5

Complications caused by large tumor (Acoustic neuroma/estibular schwannoma)

6th nerve palsy, facial paralysis, ipsilateral cerebellar deficits, increased ICP and papilledema

How is acoustic neuroma diagnoses

MRI

treatment of acoustic neuroma

surgical

gender more at risk for acoustic neruoam

females

noise induced hearing loss

acoustic trauma

cause of acoustic trauma

chronic noise exposure or explosion

acoustic trauma begins around __ Hz

4000

when does acoustic trauma begin to affect speech discrimination

later in course