PHYSIOLOGY & HX
Interpretation of sound waves
Hearing
The top of the auricle should be above an imaginary line from ______ to ______.
INNER CANTHUS OF EYE
to
MOST PROMINENT PROTUBERANCE OF OCCIPUT
What are the two initial hearing test options?
FINGER RUB
or
WHISPER
Low set or increased angle of auricles may represent...
Chromosomal Aberration: Trisomy 21
or
Renal Disorders
Leah is a 15 year old female who comes to the urgent care with complaints of progressive loss of hearing in the L ear. Pt is afebrile and vital signs are WNL. Pt denies recent swimming or URI. PE shows yellow brown build up in L ear. What is your diagnosis?
Cerumen Impaction
Portion of ear that is an air-filled canal in the temporal bone
Middle Ear
During fetal development, abnormalities in shape or positioning of what structure of the ear may indicate other associated abnormalities (due to its formation at a time when many other critical organs, such as the kidneys, are developing)?
PINNA
If hearing loss exists in the finger rub/whisper test, proceed to...
Webber and Rinne
Painful visible hematoma occurring several hours after initial event between the cartilage and overlying skin
-->
Tissue hardens in ~14 days, resulting in a keloid mass, development of new cartilage, and PERMANENT DEFORMITY OF THE EXTERNAL EAR
(UNTREATED AURICULAR HEMATOMA)
CAULIFLOWER EAR
Josh is a 17 year old male who comes in to your office 1 week after his teammate knocked into his R ear during wrestling practice. He complains of a hardened and swollen ear. Pt denies pruritus, drainage, or hearing loss. What is your treatment for Josh?
Aspiration and drainage with application and frequent changing of a pressure dressing may be necessary
The external portion of the ear
Pinna/Auricle
Otoscope exam: method of pulling the auricle in adults vs infants
Adults: pull UP, OUT, AND BACK
Infants: pull DOWN AND OUT
This test helps to assess UNILATERAL HEARING LOSS
Webber Test
Classic finding always present in OTITIS EXTERNA
TRAGAL TENDERNESS
A mother brings in her 6 month year old son for a check up at the office. Although the baby was smiling when you walked in, the baby is now fussy and crying on your exam. When doing the otoscope exam, you see a bright red tympanic membrane. The mom is worried. What do you tell her?
The TM is red because the baby is crying. Repeat when the baby calms down.
Describe SUBJECTIVE vs OBJECTIVE
Subjective: personal feeling or opinion that cannot be measured
Objective: fact-based and measurable via physical exam
Which side of the examiner's hand should be rested against the patient's head for stabilization during otoscope inspection?
ULNAR
This test assesses the difference between AIR AND BONE CONDUCTION
Rinne Test
Normal Rinne Findings
Air Conduction: Bone Conduction
2:1
A 65 year old female musician comes into your office with her husband who complains that she is not listening to him anymore. Pt admits she has to turn up the volume on the remote and has history of ear infections. What diagnostic test would you perform and what would your results show?
Sensorineural loss
Webber test: sound lateralizes to the good ear.
Rinne test: air conduction is longer than bone conduction in affected ear but has less than a 2:1 ratio
Define each statement as SUBJECTIVE or OBJECTIVE vertigo:
1. "The room is spinning"
2. "I am spinning"
1. Objective
2. Subjective
LIST 4 things noted on direct visualization of the tympanic membrane
Color
Cone of Light
Landmarks (malleus, manubrium, umbo)
Any fluid behind TM
Inflammation
Perforation
"Can you hear it now?"
"Tell me when you can no longer hear it."
This dialogue is typical of which test?
RINNE
WEBER TEST
1. Where does sound lateralize to in sensorineural hearing loss?
2. Where does sound lateralize to in conductive hearing loss?
1. to the BETTER ear
2. to the AFFECTED ear
24 year old male was recently given antibiotics for a TM rupture. He tells you he has been using his antibiotics as prescribed and is starting to feel better. On his follow up exam, what would you expect to visualize using your otoscope?
White flecks with dense plaques