common foreign bodies that children may have stuck in their ear
beads, erasers, pen/pencil tips, food, insects
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if a foreign body is retained for a long period of time what may develop
irritation, edema, inflammation and infection
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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
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removal of cerumen impaction
irrigation or wire loop with lukewarm water
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how is a live insect in the ear removed
mineral oil, alcohol, or light
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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
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if there is a perforation of the TM from foreign body
refer to ENT
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If there is a laceration of the canal or TM of ear what is the patient education
keep ear dry
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What can trauma to external ear produce?
superficial abrasion, contusion, hematoma, laceration, partial or complete avulsion
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How are abrasions treated
same a derm
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What muscle could have contusion on external ear
post auricular muscles, muscles of mastication
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auricle hematoma may occur when what is torn
perichondrium
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accumulation of blood between perichondrium and cartilage that presents with edema, fluctuant ecchymotic pinna with landmark loss
auricle hematoma
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What is most important for treatment of auricle hematoma
early recognition, evaluation, irrigation
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Treatment of lacteration of external ear/pinna and canal
fine sutures, antibiotic drops
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Diagnostic measures and treatment for external ear canal laceration with TM perforation
may heal spontaneously, assess hearing status, patch over perforation if needed
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What fracture should be considered in trauma with laceration
temporal bone
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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
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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
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Injury that occures with sudden accelerations, decelerations or blows to head
inner ear injuries
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Hydraulic forces transmitted to the ossicles can cause
rupture between fluid cavities within labyrinth, tear of structures or bleeding
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Symptoms of hydraulic forces transmitted to ossicles causing rupture between fluid cavities within labyrinth, tear of structures or bleeding
hearing loss, dizziness, vertigo, disequilibrium
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Inner ear injuries usually involve
vestibular and cochlear systems
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Inner ear injuries are associated with fractures of
temporal bone
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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
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labyrinithine concussions are similar to
benign parosxymal positional vertigo
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prognosis for labyrinthine ocncussion
good, spontaneous remission 6 months occassionaly up to 2 years
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Air conduction
sound waves transmitted from TM to the ossicles in the fluid filled middle ear
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how can the sound still reach the cochlea if air conduciton is lost or impaired
bone conduction through temporal bone
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High frequency sounds activated
sensory cells in basilar region
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low frequency tones activated
all sensory cells
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A defect in any portion of the conduction system that can result in the misidentification of acoustic information
hearing impairment
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Factors that can result in hearing loss
external envrionment, sensorineural coding, transmission of signals in the CNS
conductive to affected side, sensorinerual to unaffected side
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Hearing loss if bone conduciton is better than or equal to air conduction on affected side
conductive hearing loss
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Air conduction better than bone conduction indicates
normal hearing or sensorineural
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pure tone testing that can be done through air conduction or bone conduction to assess the patients threshold
audiometry
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test done to note if the patient can repeat words correctly
speech reception threshold
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measures the ability to understand speech
speech discrimination
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test that reflects the energy fro the cochlea, 8th cranial nerve and brain stem
Brain stem evoked response
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air-bone gaps with conduction threshold outside normal range
mixed hearing loss
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0-25 decibles
WNL for hearing
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26-50 dB
mild hearing loss, difficulty with soft sounds/background noise/distance
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51-70 dB
moderate loss, signifiant difficulty with conversation
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71-90 dB
severe hearing loss, cannot hear conversation
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91+ dB
profound loss, only loud environmental sounds
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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
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In conductive hearing loss where is there impaired transmission
external anal, across ossicles, through oval window
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with conductive hearing loss there is an equal loss in
all frequencies
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With conductive hearing loss speech can be discriminated when levels are
above the loss
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What type of hearing loss is associated with cerumen impaction
conductive
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Most causes of conductive hearing loss **can/cannot** be corrected
can
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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
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Treatment of small overgrowth of bony wall fo external canal
none
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treatment of large overgrowth of bony wall of external canal
removal by ENT
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what can cause conductive hearing loss of middle ear and TM specifically when movement is impaired
Results from negative middle ear pressure and impaired mobility of the TM resulting in conductive hearing loss
eustachian tub dysfunction or barotitis
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What part of the ear does otosclerosis invole and is formed with the stapes from cartilage during development
bony otic capsule
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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
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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
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\ t/f
otosclerosis can be unilateral or bilateral
true
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\ t/f
those with otosclerosis often have a family history
true
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Form of hearing loss that usually follows perforation and is a buildup of squamous epithelium in middle ear
cholesteatoma
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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
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Presentation of cholesteatoma
otorrhea, conductive hearing loss, tinnitus, retraction of TM with whitish mass behind intact TM
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formation of cholesteatoma usually requires
ET dysfunction
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What should be done when a pt presents with cholesteatoma
cranial nerve evaluation
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Complication to bone in cholesteatoma
bone erosion
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treatment for cholesteatoma
prevention infection, surgical evaluation and intervention, tympanomastoidectomy
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type of hearing loss that include disorders within cochlea, auditory nerve and connection to brain stem
sensorineural
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Causes of sensorineural hearing loss
neural degeneration, decreased cilia, problems in ossicles
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sensorineural loss is unequal at
different frequencies
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there is better hearing for ___ tones than __ tones in sensorineural hearing loss
low, high
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With sensorineural hearing loss it is difficult to hear what wiith background noise
speech
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which gender is presbycussis more common in
males
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presentation of presbycusis
gradual progressive bilateral hearing loss, symmetrical high frequency hearing loss that may be associated with tinnitus
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causes of presbycusis
degeneration of the sensory and nerve fibers at the base of the cochlea
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treatment of presbycusis
hearing aids
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acute unilateral deafness ususaly has a basis with
cochlea
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causes of cochlear damaage
bacterial or viral infection of the labyrinth of head trauma
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A viral infection of teh cochlear and auditory nerve termainals in young adults often results in
acute, reversible unilateral hearing los
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Sudden hearing loss with vertigo and tinnitus may be caused by
perilymphatic fistula
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Recurrent and perogregressive group of symptoms that includes hearing loss, tinnitus, dizziness and vertigo
Meniere’s disease or endolymphatic hydrops
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Cause of meniere’s disease or endolymphatic hydrops
unknonw
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symptoms of meniere’s disease occur from
distention of endolymphatic compartment of inner ear leading to hair cell atrophy
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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
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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
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cranial nerve that may be involved in acoustic neurma
5
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Complications caused by large tumor (Acoustic neuroma/estibular schwannoma)
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