1
Q
What is the pinna composed of (except for the lobule)
A
thin cartilage covered by a thin layer of skin
2
Q
what is the function of the pinna
A
funnel sound waves into ear canal
protect entrance of ear canal
vertical localization
3
Q
where is the helix on the ear
A
upper portion
4
Q
where is the conchae cymba and cavum
A
point on physical ear
5
Q
where is the tragus on ear
A
protector
6
Q
where is the antitragus
A
opposite from tragus
7
Q
where is the lobule on ear
A
on bottom
8
Q
explain the technical dimensions of the external auditory canal/meatus
A
s shaped tube
2.5-3.5 cm long
6-9 diameters long
lateral 1/3-1/2 is cartilaginous (covered by a thin layer of skin)
medial 1/2-2/3 is bone (covered by an even thinner layer of skin)
9
Q
What do glands do in the cartilaginous portion of the ear canal
A
secrete oil and cerumen
(lubricates and deters insects)
10
Q
what pushes cerumen and debris outward in the external auditory canal
A
cilia
11
Q
what is more painful to the touch: cartilaginous or boney portion of eac
A
boney
12
Q
The condyle of the mandible rests where
A
below the osseocartilaginous junction of the EAC
13
Q
In regards to the EAC, movement of the jaw does what
A
pushes cerumen outward
14
Q
TMJ disorder may cause what
A
otalgia (ear pain)
15
Q
What is the function of he EAC
A
protect more delicate structures
quarter wave resonator
16
Q
What does quarter wave resonator mean
A
open on one end and closed on the other
17
Q
what frequencies does the EAC resonate
A
2500-3500 Hz (average is 2800)
18
Q
The resonance peak in the EAC does what
A
increases mid to high frequency amplitude by approx 10 dB which helps us to hear our consonants better
19
Q
What is the tympanic membrane
A
interface between outer and middle ear.
it is semitransparent, oval shaped, concave
20
Q
how many layers of the TM are there
A
3
21
Q
explain the three layers of the TM
A
- outer layer is continuous with the epidermis of ear canal
- central layer is fibrous layer that provides support
- inner layer is continuous with the mucus membrane of the middle ear
22
Q
what are the two sections of the TM
A
pars tensa and pars flaccida
23
Q
explain the pars tensa
A
comprises more 7/8 of the TM surface
24
Q
explain the pars flaccida
A
small superior section of the TM that does not contain central layer
25
What is the function of the TM
vibration in concordance with sound waves
point of transduction from acoustic energy to mechanical energy
26
explain the steps for assessment of the outer ear
first do a visual inspection of the pinna
then do otoscopy for visual inspection of EAC and TM
next, tympanometry can assess volume of EAC and movement of TM
27
what will hearing loss/ test results look like in outer ear
hearing loss will be conductive
word recognition scores will still be excellent
absent acoustic reflexes and oaes
28
what is microtia
pinna is abnormally small
29
what is anotia
pinna is entirely absent
30
what is the underlying cause of microtia/anotia
due to congenital malformation, accident of surgical removal (cancer)
31
what are audiological considerations for someone with microtia or anotia
does not indicate hearing loss but will need to check to insure there are no malformations for the auditory system that cannot be seen
32
treatment for someone with microtia or anotia
artificial auricles or concealing hairstyles
plastic surgery (can be invasive)
33
What is atresia
absence or malformation of ear canal
34
what is the underlying cause of atresia
congenital abnormality
possibly genetic Treacher Collins
or trauma/injury (burn)
35
audiological considerations for someone with atresia
will present conductive hearing loss but possibly mix hearing loss if inner ear is malformed as well
36
treatment for atresia
surgical canalization if only cartilaginous portion is involved and atresia is bilateral
or bone anchored hearing aid/implant
37
does stenotic (narrow)EAC directly cause hearing loss
no
37
What is basal cell carcinoma
common form of skin cancer that may present on the pinna
crusted over
38
what is the cause of basal cell carcinoma
high exposure to UV radiation from the sun
39
audiological considerations for basal cell carcinoma
will not impact hearing but audiologist might be first point of contact for derm referral
40
what is treatment for basal cell carcinoma
surgical excision
41
Do children like to stick foreign bodies in their ears
yes
42
what are the audiological considerations for foreign bodies
may cause conductive hearing loss at the time, but priority is to remove the foreign object safely to prevent structural damage, infection, irritation
43
treatment for foreign bodies
removal by instrumentation
44
What is Otitis Externa
infection of skin in EAC, aka swimmers ear
45
underlying cause of otitis externa
bacterial infection or fungal infection
46
symptoms of otitis externa
itching, pain, redness/inflammation, swelling, weeping dermitis
47
audiological considerations for otitis externa
may cause mild conductive hearing loss but evals are often deterred until pain has resolved
48
treatment for otitis externa
eardrops, avoid water, paste that kills infection
49
what is myringitis
inflammation of TM due to viral infection
similar symptoms as otitis externa
50
what is impacted cerumen
complete blockage of EAC due to wax
51
underlying cause of impacted cerumen
personal differences in wax production
small ear canals
older (collapsed) ear canals
q-tip use
hearing aid use
52
symptoms of impacted cerumen
muffled hearing
occlusion effect
tinnitus
53
audiological considerations for impacted cerumen
will only produce conductive hearing loss if there is a complete blockage
tymp will show type B reduced EAC volume with absent pressure/compliance peak
54
treatment for impacted cerumen
removal via irrigation, suction, or curette
55
what is exostosis
benign bony growth in EAC
widely attached, occurs in multiples, bilateral
55
what is the etiology of exostosis
seen in people who regularly swim in cold water
56
what is osteoma
benign bony growth in EAC unilateral, single growths and pedunculated (stick out)
57
what is the etiology of osteoma
spontaneously occur
58
symptoms of exostosis and osteoma
none/painless, may lead to infection due to accumulation of debris or water in a tighter space
59
audiological considerations for exostosis and osteoma
does not affect hearing unless eac is completely occluded
60
treatment for exostosis and osteoma
none unless size of growths produce conductive hearing loss or recurrent infections
61
What is TM perforation
hole in TM
62
etiology of TM perforation
direct trauma, rupture from middle ear infection, sudden pressure, barotrauma
63
symptoms of TM performation
muffled hearing, ear drainage, if ruptured infection pain upon incident
64
audiological considerations for TM perforation
conductive hearing loss
tympanometry will reveal large eac volume with absent pressure/compliance (type b open)
may or may not be able to visualize perforation with otoscopy
65
treatment of TM perforation
self healing, surgical repair, hearing aids
65
What is tympanosclerosis
thickened scar tissue on TM
66
etiology of tympanosclerosis
infection, healed TM perforation, healed PE tube site
66
symptoms of tympanosclerosis
NONE
67
treatment for tympanosclerosis
none
67
audiological considerations of tympanosclerosis
no heaing loss, tymp could be type A, AD, or AS
68
explain the technical terms /dimensions of the middle ear
small
6mmx4mm
air filled
lined with mucous membrane
69
how many sections are there of the middle ear
2
69
name the 2 sections of the middle ear
tympanic cavity/tympanum
epitympanic recess/attic
69
name some things that are found in the middle ear space
opening of eustachian tube
ossicles
muscles and ligaments
portion of cranial nerves
portion of jugular vein and near carotid artery
oval window and round window
70
explain the eustachian tube
it is a tube that runs from the nasopharynx to middle ear. approx 35 mm in length, lined with mucous membrane and cilia.
71
for the eustachian tube, is the opening on the side of the nasopharynx open or closed
closed except when yawning, sneezing, or swallowing
71
explain the direction of the eustachian tube in children versus adults
horizontal in young children and diagonal in adults
72
what is the function of the eustachian tube
pressure equalization
ventilation/drainage of middle ear space
73
what are the ossicles
smallest bones in the human body
malleus, incus, stapes
73
what does the chain of ossicles connect
TM to oval window
74
what are the ossicles supported by in the middle ear
ligaments
74
what is the function of the ossicles
passes mechanical vibrations from TM to oval window
impedance matching
74
what is impedance matching
there is an impedance mismatch between air filled middle ear space and fluid filled inner ear space.
sound waves encounter more resistance in fluid causing attenuation of sound.
impedance matching is the fixing of this
74
why is the middle ear designed to increase sound pressure by around 30 dB
overcome the resistance from middle ear to inner ear. impedance matching
74
what is the main way of impedance matching
the difference in surface area of tm compared to the oval window.
the TM is abour 17x bigger than the oval window.
this increases sound pressure by 25dB
75
what is the second way of impedance matching
lever action of the ossicles
the length of malleus is greater than incus
this increases sound pressure by 2-3dB
75
what is the last way of impedance matching
the buckling effect
conical shape of TM results in greater movement
increases sound pressure by 2-3 dB
75
what are the two middle ear muscles
tensor tympani and stapedius
75
what is the tensor tympani
attaches to malleus from wall of tympanum
75
what is the stapedius
attaches to stapes from posterior wall of tympanum
75
what are the functions of the tensor tympani and stapedius
contraction of muscles to stiffen ossicular chain
contraction is part reflex to protect hearing put there are limitations to this
reflex is seen in both ears
76
what is the oval window
stapes sits in oval window, attached by ligament
where sound is transmitted from the middle ear to the inner ear
76
what is the round window
inferior to oval window
membrane separates middle ear from inner ear
flexible membrane helps pressure decompression in the inner ear
77
what would an assessment of the middle ear be like
otoscopy would allow for a visual inspection of some middle ear structures
tympanometry can assess pressure of middle ear and compliance
hearing loss will be conductive
word recognition scores will be excellent
acoustic reflexes and OAEs will be absent
77
what is Eustachian tube dysfunction
reduced ability to open eustachian tube for the purpose of pressure equalization; mucous membrane of middle ear continues to absorb oxygen and nitrogen even if pressure equalization cannot occur
77
etiology of eustachian tube dysfunction
swelling due to infection or allergies. overgrown adenoids or structural abnormalities
77
symptoms of Eustachian tube dysfunction
negative middle ear pressure which may cause muffled hearing
may lead to pain if TM is severely retracted
patient is likely to experience a lot of congestion issues
77
audiological considerations of eustachian tube dysfunction
may cause conductive hearing loss , tymp will be type C, otoscopy may reveal retracted TM
77
treatment for eustachian tube
decongestants, adenoid removal, Eustachian tube balloon dilation or PE tubes if chronic issue
78
what is otitis media
inflammatory process of the middle ear with fluid accumulation
79
etiology of otitis media
negative middle ear pressure eventually pulls fluid out from mucous membrane which cannot drain due to dysfunctional eustachian tube
79
what are the two types of otitis media
noninfectious and infectious
79
what is noninfectious otitis media
fluid is sterile, non bacterial growths
79
symptoms of noninfectious otitis media
muffled hearing and occlusion effect, no pain
80
treatment for noninfectious otitis media
waiting, decongestants, PE tubes
80
what is infectious otitis media
fluid is filled with bacteria, may contain pus (suppurative) or blood (purulent)
80
symptoms of infectious otitis media
pain, fever, muffled hearing, occlusion effect, drainage with odor or abnormal color through perforation if TM ruptures
80
treatment for infectious otitis media
systemic antibiotics or PE tubes
80
audiological considerations for otitis media
both will present with a conductive hearing loss, tymp will be type B, otoscopy may reveal waterline or bubbles behind Tm, bulging TM, redness/inflammation around TM, or possibly bloody fluid behind Tm
80
could chronic otitis media impact the inner ear
yes
80
can otitis media lead to meningitis
yes
81
who is more susceptible to otitis media
cleft palate, down syndrome, facial disorders, inner city residents, children in daycare, smokers, or people exposed to tobacco.
81
What is Cholesteatoma
erosive growth in the middle ear following a recovery from middle ear infection
82
etiology of cholesteatoma
ingrowth of skin cells within the healing mucous membrane of the middle ear
82
symptoms of cholesteatoma
muffled hearing foul smelling otorrhea
82
audiological considerations for cholesteatoma
present with conductive or mixed hearing loss depending on whether the inner ear is impacted , tymp will be type b, otoscopy may or may not reveal abnormal TM, confirm with CT scan.
82
treatment for cholesteatoma
due to erosive nature, surgical removal is required. it is called a mastoidectomy. have to get all the infected material. might be residual hearing loss but that can be managed with hearing aids or bone anchored aids
82
What is otosclerosis
ossicles are stuck due to a bony growth around the stapes footplate. might invade inner ear
82
etiology of otosclerosis
hereditary or triggered by pregnancy
82
symptoms of otosclerosis
onset in 20s or 30s. progressive hearing difficulties, tinnitus
82
audiological considerations for otosclerosis
conductive or mixed hearing loss, hearing loss will be present with a Carhart notch. tymp will be As
82
what is a carhart notch
no air bone gaps at 2000 hz.
82
treatment for otosclerosis
waiting, hearing aids, surgical procedure to replace stapes with a prostetic but that is invasive
83
what is ossicular chain disarticulation
stiff connection between Tm and oval window is interrupted
83
etiology of ossicular chain disarticulation
head impact, resorption of ossicles from infection
83
symptoms of ossicular chain disarticulation
muffled hearing
83
audiological considerations of ossicular chain disarticulation
conductive hearing loss, tymp will be Ad, confirm with CT scan
83
treatment for ossicular chain disarticulation
ossicular chain reconstruction surgery (exploraory) or hearing aid.
83
what is glomus jugular tumor
benign mass on the jugular vein
83
etiology of glomus jugular tumor
unknown
83
symptoms of glomus jugular tumor
muffed hearing, pulsatile tinnitus (hearing your own heart beat)
83
audiological considerations for glomus jugular tumor
conductive hearing loss, normal or abnormal tymp , otoscopy may reveal red glow through TM
83
treatment for glomus jugular tumor
surgical removal of tumor
