Week 4, Thursday

The Ear ppt

Common conditions:

  • Otalgia= earache

  • Otorrhea= ear drainage

  • Itching (Pruritus) in the ear canal

  • pain in the ear canal

  • Pain int e middle ear/tympanic membrane (TM)

  • Loss of hearing

  • Dizziness w/ spinning sensation (vertigo)

  • Disequilibrium

  • Fainting (syncope)

  • Nausea, committing (emesis)

  • Ringing in the ears (tinnitus)

Anatomy of external ear:

  • helix: outer ring

  • Antihelix: inner ring

  • Tragus: small protrusion in the anterior portion

  • Lobule: ear lobe

Anatomy of Middle & Inner ear (lateral to medial):

  • cartilage around opening

  • Ear canal

  • Bone deep to cartilage

  • Tympanic membrane (should be a pale, pearl white color)

  • Middle ear cavity

  • Ossicles:

    • Malleus (superior to middle ear cavity)

    • Incus

    • Stapes

  • Eustachian tube (protruding inferior from the middle ear cavity)

    • Eustachian tube swells when under too much pressure (like when changing elevation or altitude quickly), forcing the ear to feel like it needs to “pop”

  • Semicircular canals

  • Cochlea (inferior to semicircular canals)

  • Cochlear nerve (CN VIII)

Anatomy of the Ear drum:

  • Short process of Malleus (protrusion on superior portion)

  • Handle of Malleus (inferior to malleus)

  • Umbo (inferior to handle)

  • Cone of light (inferior to Umbo)

  • Pars flaccida (deep to malleus)

  • Pars Tensa (inferior to visible Incus)

Otological Otalgia:

  • earache originating in the ear

Non-Otological Otalgia:

  • Earache originating from somewhere else (referred pain)

Otitis Externa -OE:

  • Swimmer’s ear

  • Bacterial otitis externa

  • Inflammation of the external auditory meatus (EAM) potentially affecting the auricle

    • EAM is the only skin-lined cul-de-sac in the body

  • Often 2 degrees infection by bacteria or fungi

The outer third of the canal is cartilaginous with hair follicles, sebaceous glands and ceruminous glands

  • Medial 2/3- skin overlying the osseus canal easily traumatized

  • Outer 1/3- cartilaginous with hair follicles, sebaceous and ceruminous glands

Maceration:

  • softening of the skin that turns white and wrinkled

    • Loss of the skin’s barrier function

  • Appearance= pruning of the skin

  • Cause= prolonged, repeated exposure of the skin to water

  • Compromised skin barrier may = 2-degree infection

Otitis externa:

  • sense of fullness in the ear

    • Mild - severe pruritus

    • Mild- excruciating Otalgia

  • Pressure on tragus, pulling of auricle= Otalgia

  • Maneuvering of the otoscopic speculum = Otalgia

  • Otorrhea

  • Mild hearing loss

    • transient, conductive hearing loss

  • swimmer’s ear vs infectious diffuse OE

Otitis Media:

  • OME (otitis media w/ effusion)

    • Aka Serous OM

  • AOM (acute otitis media)

  • Fluid visible in middle ear cavity through the tympanic membrane

    • OME:

      • Non-bacterial ME= inflammation with visible fluid appearing clear

    • AOM:

      • Bacterial ME= infection with noticeable swelling/bulging of the tympanic membrane

      • Severe otological Otalgia= Eustachian tube may become blocked, and the middle ear may fill with pus

Child’s Eustachian tube:

  • shorter and more horizontal than an adult’s

    • Makes it easier for bacteria to travel from the throat to the middle ear

Virtual URTI (98% of adults and children) leads to ETD to OM to OME or AOM

  • Caused by:

    • Decreased ME ventilation

    • Accumulation of ME effusion

Non-otological Otalgia can comes from:

  • Teeth

    • Dental disease

    • Impacted molars

    • Gingivitis

  • Parotid

  • Temporomandibular joint (TMJ)

    • TMJ dysfunction

  • Tongue

  • Oropharynx

  • Larynx and hypopharynx

  • Cervical spine issues (C2 &C3)

    • Cervical spondylosis

    • Facet arthrosis

    • Uncovertebral joint arthrosis

  • Esophagus

    • Acid reflex

  • Nose and sinuses

  • Cancer

    • Malignancies of the upper GI tract or the nasopharyngeal ay = referred Otalgia

  • URTI w/ tonsillitis

  • Post-tonsillectomy

  • In adults, the TMJ and cervical spine are common origins for referred Otalgia

  • NOTE*** malignancies of the upper GI tract or the Nasopharynx may = referred otalgia