Use of otoscope for adults
pull up, out, and posterior
Use of otoscope for children
pull down, out, and posterior
Normal tympanic membrane
translucent and pearly
Structures of internal ear
- cone of light
- umbo = where eardrum meets tip of malleus
- malleus
- manubrium = handle of malleus
- pars tensa = portion of drum that is inferior to pars flaccida
- pars flaccida = superior to malleus
- chorda tympani = runs in superior par near pars flaccida
Conductive hearing loss
-external or middle ear problem
Sensorineural hearing loss
-inner ear, cochlear nerve or central brain connection problem
Whisper test
- doctor stand behind patient
- have patient occlude one ear
- doctor exhales fully and then whispers combo of numbers/letters
- patient repeats sequence
- normal: 3/3 or 3/6 for 2 sequences
- abnormal: 4/6 incorrectly identified
Weber Test
- lateralization
- place vibrating tuning fork on top of patients head
- normal: sound to both ears equally
- abnormal: sound lateralizes to one ear; either conduction loss in that ear or sensorineural loss in opposite ear
Rinne Test
- compares air and bone conduction
- vibrating tuning fork placed on mastoid bone behind ear and level with canal
- when patient no longer hears the sound, quickly place fork close to ear canal and inquire if can hear the sound and for how long
- normal: AC > BC
- if weber test was abnormal, and Rinne test normal, suspect sensorineural loss in opposite ear
- abnormal: AC = BC or BC > AC; indicates conductive loss to that ear
Healthy Ear results
no localization
Conductive Hearing Loss: Weber
- sounds will localize to affected ear
- ear receiving input from bone conduction only
- air conduction is affected
Sensorineural Hearing Loss: Weber
- sound will localize to opposite ear (louder in unaffected ear)
- ear is receiving input from bone conduction
- affected ear is not receiving input from the bone conduction on the affected side, causing a louder sound in the unaffected ear
Conductive Loss: Rinne
BC > AC or BC = AC
- air conduction is impaired secondary to the outer ear structures involved
- bone conduction is not affected, so BC > AC due to lack of air conduction via the affected ear
Sensorineural Loss: Rinne
AC > BC
- inner ear not receiving information via bone conduction
- air conduction is how the affected ear is receiving auditory information
- AC will be prolonged in affected ear
Viral rhinitis mucosa
red, edema
Allergic mucosa
pale, bluish or red
Septal perforation
cocaine, meth, trauma, surgery
Function of turbinates
cleansing, humidification, temperature control of inspired air
Order in which to palpate lymph nodes
1) preauricular
2) posterior auricular
3) occipital
4) tonsilar
5) submandibular
6) submental
7) superficial cervical
8) posterior cervical
9) deep cervical chain
10) supraclavicular
Normal lymph node characteristics
pea sized, round, spongy, non tender, mobile, baseline
Abnormal lymph nodes
large, irregular shape, hard, tender, fixed, red, warm, edematous
Sinuses
- frontal (do not open until after 7 years of age)
- maxillary
- ethmoid
- sphenoid
- palpate by pressing up on frontal and maxillary sinuses
Labial frenulum
connects lip with gingiv
Lingual frenulum
connects tongue with floor of mouth
