1
Q
Cranial nerves for ear, nose, and throat (7)
A
1: Olfactory
5: Facial sensation
7: Facial movement, tears, taste, acoustic reflex
8: Hearing and Equilibrium Taste
9: Taste
10: Taste, swallowing
12: Tongue movements
2
Q
Conductive Hearing Loss
A
refers to impairment of the outer and/or middle ear conductive mechanism only; caused by something blocking in the ear (wax)
3
Q
Sensory hearing loss
A
refers to damage to the cochlea (outer hair cells or outer and inner hair cells).
4
Q
Mixed hearing loss
A
Refers to the presence of both conductive and sensory
impairment.
5
Q
Neural hearing loss
A
Refers to damage to the auditory neurons (spiral ganglia) and/or the auditory branch of the eighth nerve.
*Auditory Neuropathy and dysynchrony are examples of neural hearing loss.
6
Q
Central hearing loss
A
Refers to damage to auditory structures in the brainstem, thalamo-cortex and/or cortex.
7
Q
Newborn hearing loss
A
- Otoacoustic emission (like a tympanogram listens for action potential of the cochlea (ear talk) and that is what it picks up—picks up cochlea function
- BAER more accurate (assesses wiring of auditory pathway—misses low and high frequency loss)
- Brain stem evoked response is the diagnostic test
8
Q
Otoacoustic emissions
A
Introduce sounds and see how baby responds
Auditory brainstem testing: more involved; baby must be asleep as sounds are introduced;
looks for the brain to show that the baby is hearing the sound
9
Q
Types of hearing loss (3)
A
- Conductive
- Sensori-neural
- Auditory Processing (Central)
10
Q
Early hearing loss
A
- First trimester structure of ear highly metabolic and therefore exposure to metabolic and highly susceptible to illness and exposure to medication in the mother
- - Maternal rubella
- - Cytomegalovirus
- - Genetic disorders leading to malformation of the cochlea
- - Sepsis with prolonged acidosis
- - Oxygen deprivation and hyperbilirubinemia
11
Q
Anatomic Hearing Loss (4)
A
1 Meningitis
- Congenital hypothyroidism
- Medications—Lasix, aminoglycosides, vancomycin
- Large Cochlear Aqueduct syndrome
12
Q
Large Cochlear Aqueduct Syndrome (4)
A
- Onset of hearing loss 6 to 7 months with progressive worsening
* Child passes newborn hearing but then develops progressive hearing loss around 6-7 months - Balance is off, progressive loss
- Tends to stabilize at 50 decibels
- They need to not play football
13
Q
Reasons for Hearing Loss (5)
A
- Wax
- Foreign objects
- Deafness due to hyperbilirubinemia, CMV
- - Cranial facial, tags ! Genetic Syndromes - Genetic Syndromes
- Medications
14
Q
Genetic Syndromes leading to hearing loss
A
- Waardenburg syndrome
- Deafness associated with long QT syndrome - Jervell Syndrome
- Lange Nielsen syndrome “ Ion channelopathies
- Progressive hearing loss
– 80% are recessive
– Rest are autosomal dominant
– 3% carrier rate (same of CF). Mild to moderate
hearing loss
15
Q
Looking at history with hearing loss (4)
A
- Looking at hearing loss early on; wear a hearing aide if they are younger than 60 year
- History of renal abnormalities (8 weeks in utero develop at the same time)
*Ears andkidneys are formed at the same time in utero; if someone has a kidney anomaly
you must also check their hearing (and vice versa) - Alport’s syndrome; associated with hearing loss and hematuria
- Genetic mediation for hearing loss in old age
16
Q
Hearing Loss (3)
A
- Can progress throughout childhood
- Both high- and low-frequency progressive hearing loss represent a wide diversity of gene mutations that are observed in a large number of syndromic and non-syndromic diseases
- Human KCNQ4 mutations known as DFNA2 cause non-syndromic, autosomal- dominant, progressive high-frequency hearing loss in which the cellular and molecular basis is unclear
17
Q
Newborn hearing screening
A
Repeated on follow up center
-Goal: Early intervention by age 6 months
18
Q
Genetic hearing loss screening (4)
A
- Syndromic— 1/3 of family members
- Non syndromic 2/3—mitochondrial defect
- Hereditary hearing loss may not be congenital
- Is it stable or progressive?
19
Q
Conductive hearing loss causes (5)
A
- Eustachian tube dysfunction
- Ear fluid
- Hole in eardrum
* Hole in eardrum can occur from trauma; do tympanal plasty to fix tympanic membrane - Fixed middle ear bone
- Wax
20
Q
Sensorineural hearing loss (4)
A
- Noise induced hearing loss
- Presbycusis
- Ménière’s Disease
- Tumors of the auditory nerve
**If hearing loss becomes preogressive, make sure there is no acoustic neuroma (tumor that can cause hearing loss)
21
Q
Assessment of the External Ear (5)
A
- Pliability
- Direction of canal
- Illuminate the surface of TM
- Shape
- Size; Large ear is found in Fragile X
- Symmetry
- Variations from normal
- Abnormalities - Presence of dimples, tags, nodules
- Represents remnant of first brachial cleft
22
Q
Position of auricle
A
Should be along a straight plan with outer canthus of eye
Low set ears can be associated with kidney or chromosomal abnormalities
23
Q
Mastoid Bone
A
- Behind the ear; must look at it when inspecting external ear
- If the mastoid bone is very small and has a tiny hole = there is ear microcia (ear/auricle is too small)
24
Q
Otoscope Basics (5)
A
- Make sure your light is getting full power otherwise drum will look yellow
- Speculum should never enter the canal more than 10-15 mm
- Examine the canal before you try to look at drum—look for furuncle or vesicle
- Hold the otoscope firmly, rest the hand on child head or face
- Place the speculum just inside the ear to gain child s confidence
25
Most common reasons for ear redness
1. Touching the ear canal with the tip of the speculum.
2. Red reflex of the drum
3. Red drum with normal landmarks
26
Canal Direction assessment of ear (4)
1. In newborns pull the auricle down and back
2. In older children, canal faces downward and forward
- - Pull the tip of auricle up and back
3. If painful indicates furuncle or external otitis media
4. Tell child that they must be quiet to ear the song. Then look in ear, ask if they heard the song
27
Assessment of the ear: Cerumen (2)
1. TM's blocked by cerumen
- There are OTC products for cerumen removal
2. A quick and easy way to get rid of lots of wax in the ears so you can actually see what's going on in there is to instill a few cc's of Colace and let it sit for 10-15min, then irrigate the ear with water like usual.
28
Assessment of the ear: foreign bodies
1. Solid objects such as stone, beads, paper, dead roaches are commonly found
2. Should be removed as soon as possible
29
External Otitis Media (5)
1. Pain on movement of the auricle and sense of fullness
* Will present as pain on movement of front of the ear on the tragus
* If you pull the canal/auricle it will be painful as well
2. Canal may be red, friable, and full of pus
3. Inspect the entire TM looking at landmarks, color, contour and perforations.
* Want to inspect skin for redness and then look at the TM
4. Related to changes in pH in the ear canal; external otitis caused by change in pH (becomes alkaline) and then bacteria grows
5 Can be caused by any organism— fungal, viral, bacteria, yeast; Pseudomonas is common
30
What indicates otitis externa? (2)
1. Tenderness to palpation of the tragus is indicative of otitis externa
* Always look at the mastoid bone for redness and evaluate for tenderness
2. When looking in the ear, may see that the drum is completely blocked
31
Etiology of Otorrhea
Excessive moisture, excessive cleaning
disrupts the surface epithelium
- Bacterial, viral (HSV, Varicella), Fungal (candida, aspergillus niger)
32
Treatment of Otitis Externa (4)
1. Debridement of ear canal
2. Topical antibiotics (concentration are 100-1000 times greater than with systemic therapy
3. Expandable methylcellulose Oto-Wick or sponge (ear wick); Change wick every 2 days
4. Fungal infection: Acetic drops or antifungal drops
* Use ear drops, not done orally
33
Pathophysiology of Otitis Media (6)
1. Middle ear cavity filled with air and is sterile under normal circumstances
2. Air enters the middle ear when you swallow through the eustachian tube (ET)
3. When the ET does not function, middle ear cavity does not ventilate normally
4. Negative air pressure results as the air is absorbed
5. Fluid effused in the middle ear
6. Bacteria comes from nasopharynx into the middle ear cavity leading to AOM
* As you grow, the eustachian tube becomes longer, more narrow, and upward going
34
Pathophysiology of Otitis Media under 3 years old (4)
1. Eustachian tube is different: Shorter, Wider, Straighter
2. Makes it easier for the infection to travel up the Eustachian tube
3. Assess the movement of the tympanic membrane to determine if a patient has otitis media
4. Changes in the appearance of the tympanic membrane suggestive of acute infection
* Bulging or purulent material visualized behind the tympanic membrane
35
Tympanic Membrane Assessment (4)
1. Color: pearly grey
2. Note the landmarks - Malleus, Borders of TM, Light reflex
3. Presence of perforation and of tympanostomy tubes
4. Presence of fluid
36
What does amber TM indicate?
Serous fluid
37
What does blue or deep red TM indicate?
blood in the middle ear
38
What does chalky white TM indicate?
thick TM indicative of recurrent infection
39
Cone of light
5: 00 in right ear
7: 00 in left ear
40
What does red TM indicate? (4)
1. Infection
2. Dullness of TM: fibrosis
3. White areas: healed perforations or inflammation
4. Air bubbles indicate middle ear fluid
41
Mastoiditis (4)
1. Infection of the mastoid air cells
2. Accumulation of the purulent exudate in middle ear does not drain through ET or perforated TM but spread to mastoid bone
3. Air cells are destroyed and progresses to coalescent phase
4. ENT referral
* Serious bacterial infection in which mastoid cells are full with area and infected and then become full of exudate; the air cells can get destroyed and you may have to take out the mastoid if the infection is severe (usually responds to antibiotics though)
42
Causes of Bacterial Otitis Media (5)
1. S. pneumoniae
2. H. Influenzae
3. Moraxella catarrhalis
4. Group A streptococcus
5. Enteric gram negative
43
Causes of Viral Otitis Media (4)
1. RSV
2. Influenza
3. Mycoplasma pneumoniae
4. Fungal
44
Normal Tympanogram
The lower curve is typical of normal ears. The open top curve shows high compliance but is a normal variant in young children. With these curves there is only a 1–2 percent probability of a middle ear effusion.
45
Trasitional Curve Tympanogram
These curves show compliance that is intermediate between the high peaks seen in normal ears and the flattening seen with most effusions. The lower curve has a steep gradient and a 14 percent probability of associated effusion. The upper, more gradual curve, because of its rounded peak, has an 82 percent probability of effusion.
46
Where is the malleus normally located?
1:30
47
Effusion or Flattened Cruve Tympanogram
These curves show decreased tympanic membrane compliance or mobility. When seen, there is an 82 percent chance that an effusion is associated. These curves are seen in patients with acute otitis, chronic otitis, or thickened or scarred tympanic membranes.
48
High Negative Curve Tympanogram
These are the curves characteristic of increased negative middle ear pressure. Otoscopy in such patients may show retraction or movement primarily on negative pressure. The lower, more gradual curve has a 67 percent probability of associated effusion, the upper peaked curve a 29 percent probability.
49
High Positive Curve Tympanogram
These curves reflect increased positive pressure in the
middle ear. The lower curve has a 57percent probability of effusion or ear disease and is a configuration seen commonly in early acute otitis media. The upper curve has only a 10 percent probability of effusion.
50
Cholesteatoma
Tumor of the middle ear; defect in the tympanic membrane through which persistent drainage occurs, or it can appear as a white cystic mass behind or involving the eardrum.
Occurs in the middle or bottom of the ear drum in a baby, occurs at the top of the ear (pars flasita) in adolescents and adults
51
Ear Trauma (4)
1. Can damage middle ear and/or inner ear.
2. Results from fall or fight.
3. Bleeding into the auricular cartilage may require drainage
* Needs to be removed ASAP
4. Hematomas need referral to ENT for evacuation
PNP: Physical Assessment
flashcards
Decks in class (21)
# Cards
-
Session 1: History48
-
Session 2: Development48
-
Session 2: Developmental Milestones55
-
Growth96
-
Dermatology93
-
Newborn Skin Assessment50
-
Head37
-
Eyes75
-
Ears51
-
Nose, Throat, Mouth53
-
Neck and Lymph41
-
Genetics74
-
Cardio0
-
Neuro62
-
Musculoskeletal45
-
Respiratory33
-
Abdomen70
-
Cranial Nerve Assessment12
-
Genitalia39
-
Newborn Assessment46
-
CBC and Urinalysis65
