Week 5, Tuesday

The Ear ppt (continued)

Evaluation for Hearing:

• Whispered Voice Test for Auditory Acuity

  • stand 2 feet behind seated patient so they cannot read your lips

  • Occlude one ear

  • Whisper a combination of 3 letters or numbers

    • I.e. 3-U-1

    • Something they can’t predict

    • Use a different combination for te other ear

  • Interpretation:

    • Normal= patient repeats correctly

      • Patient responds incorrectly, so tested a second time with a different combination, and patient repeats at least 3 of the 6 possible letters/numbers correctly

    • Abnormal= 4 of 6 numbers and letters are incorrect

      • Conduct further testing with audiometers

• Tuning Forks

  • Works using air conduction carrying the sound waves

• Weber’s test

  • Tuning fork placed on top of head

  • Ask “do you hear this in both ears”

  • Sound to impaired ear= conductive hearing loss

  • Sound to “good ear”= sensorineural hearing loss

  • Interpretation:

    • Normal= hearing in both ears

    • Abnormal=

      • Conductive Hearing Loss

        • Occlusion of sound traveling through ear

          • I.e. perforated ear rum, otitis media, impacted crewmen, foreign object, Osteo sclerosis of ossicles

        • Typically children- 40 y/o

      • Sensorineural Hearing Loss

        • No occlusion in ear, but issue with the Cochlear Nerve

          • Caused b y loud noise exposure, inner ear infections, trauma, acoustic neuroma, congenital and familial disorders, aging

        • Middle or later years

• Rinne Test

  • Tuning fork at External Auditory Meatus, then on Mastoid process

  • Interpretation of Hearing loss

    • Conductive

      • Air conduction is impaired, but vibrations through the bone to bypass the problem and reach the conchlear nerve

    • Sensorineural

      • Impulses to the cochlear nerve is diminished regardless of bone vibrations or air conduction

• Finger rub test

  • Rub fingers together while slowly moving away from patient

  • One ear at a time

Considerations associated with Hearing loss:

• Dizziness

• Vertigo

• Nystagmus

• Nausea

• Messi

• Neurological Focal signs and symptoms

• Conductive or Sensorineural Hearing loss

• Tinnitus

Vertigo + other symptoms= Dangerous

• Could indicate

  • Neurological abnormal findings

  • U/L progressive hearing loss

  • Sudden, severe nausea and Emesis

  • Headache

  • Signs of ICP (ie.e Papilledema)

Vertigo:

• a spinning sensation accompanied by nystagmus and ataxia

• Usually from peripheral vestibular dysfunction

  • ~40% of dizzy patients

• But maybe from a central brainstem lesion

  • ~10% caused by Atherosclerosis, Multiple sclerosis, Vertebrobasilar migraine, or Transient ischemic attach (TIA)

Galbreath Technique:

• a manipulative treatment for otitis media

Rhinosinusitis DDX - 21 ppt

URTI and Rhinosinusitis

• Viral URTI

• Acute viral Rhinosinusitis

• Acute bacterial Rhinosinusitis

• Chronic sinusitis

URTI causes:

• Almost always viruses

• Sometimes bacteria

• Occasionally fungi

• Rarely Protozoa

URTI symptoms and signs

• Rhinitis

  • Swelling of nasal mucosa

• nasal obstruction

• Coryza

• Rhinorrhea

• Mouth breathing

• Conjunctivitis

• Hearing loss or otalgia

• Erythema of pharyngeal mucosa

• Tonsillitis - Odynophagia

• Sore throat - Odynophagia

• Cough

• Hoarseness

• Fever

Difference between Bacterial and viral infections:

• many symptoms = viral

  • Generally viral spread in the whole URT/pharyngeal ucosa

• If cough= viral (typically)

• One dominant symptom= bacterial infection

  • Other than pneumonia

• secondary bacterial infection

  • Patient gets worse

  • Fever spike and new-aggravated symptoms