2nd exam N202
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Name 4 parts of the outer ear (auricle or pinna).
What does EAC stand for, how long is it, and where does it terminate?
- EAC- stands for external auditory canal
- 2-3 cm
- It terminates at the tympanic membrane
What is EAC lined with and what does it secrete?
Ciliated and secretes cerumen
What two structures does the tympanic membrane separate?
the EAC and the middle ear
What is the cone of light and what is another name?
- Reflection of light from otoscope off the tympanic membrane.
- AKA light reflex
Name 7 structures that can be seen through the tympanic membrane.
pars tensa, pars flaccida, umbo (part of malleus), manubrium (parts of malleus), annulus, cone of light, and short process of malleus
What are the three bones behind the tympanic membrane that make up the middle ear?
Incas, stapes, malleus
Is it normal to have fluid in the middle ear? If you do what could it indicate and how does it feel?
No, URI, and an ear ache
Name 2 jobs of the middle ear.
Conduction and equalization of pressure.
Why is it important not to fly with a cold?
the because the middle ear opens up the eustachian tube to equalize pressure, and if the eustachian tube is swollen then you may not be able to equalize pressure and your ear drum may rupture.
Why is it common to have an ear infection when you have an URI?
Because bacteria can travel from the nose to the ear by means of the eustachian tube.
Name 2 jobs of the inner ear.
Balance and conduction of sound
Name 3 structures of the inner ear.
- Semicircular canals
Give the process of sound transmission through the ear.
- 1) Sound goes through EAC and causes tympanic membrane to vibrate
- 2) Vibrations of tympanic membrane cause movement in the bones of the middle ear
- 3) The bones of the middle ear cause vibration to the oval window
- 4) then transmitted to the Organ of corti (in cochlea) to the 8th cranial nerve to the temporal lobe of the brain
- 5) the round window disperses the vibrations.
Name the 2 types of conduction, and which one is the most productive.
- Air conduction and bone conduction.
- Air conduction is the most productive.
Explain bone conduction.
If air conduction pathway is blocked then sound can vibrate off the skull bones. This vibration can go straight to the inner ear and be conducted in that manner.
When does conductive sound loss occur?
when there is an obstruction in the external or middle ear.
What is another name for perceptive hearing loss and malfunction to what areas cause this?
- Sensorineural loss.
- This occurs with problems to the middle ear, 8th cranial nerve, or the auditory area of the temporal lobe
What is presbycusis? What population does it occur in?
- Presbycusis is gradual hearing loss due to nerve damage.
- It generally occurs in the elderly
What two things is the 8th cranial nerve responsible for?
Equilibrium and hearing.
What is vertigo and what causes it?
- It is the feeling that the room is spinning around them.
- A swollen labyrinth
When does the inner ear develop during gestation?
If a mother were to develop rubella or mumps in the first trimest what could occur?
The organ of Corti can be affected and the baby may be born deaf
Why is there an increase in ear infections in children?
They have a shorter and wider eustachian tubes.
Name 4 signs of hearing loss in a child.
- Delayed speech
- Reacts more to movement & facial expression than to sound
- Speech is monotonous or garbled; mispronounces sounds
- Appears shy & withdrawn
What are four signs of presbycusis?
- 1) begins around age 40
- 2) Can't hear high pitched sounds as well.
- 3) harder to hear constants
- 4) hearing difficulty increases with background noise
Name three causes of decreased hearing in the elderly.
- 1) increased coarseness of cilia
- 2) cerumen is drier and more occlusive d/t atrophy of the apocrine glands
- 3) Presbycusis
After what age is auditory reaction time decreased?
What are the 2 types of ear wax and which groups are they common in?
- Moist honey colored in african americans and caucasians
- Dry flakey in native americans and asian americans
What groups of people are otitis media most common?
African Americans, those bottle fed as babies, Canadian Eskimos, Down syndrome, and premature infants
What areas can ear pain be referred from? (3)
What is tinnitus, what is it s sign of, and when are the symptoms generally worse?
- It is a ringing, crackling, or other sound in the ear
- It is the first sign of hearing loss
- It is worst at night when rooms are silent
Name 2 causes of a rupture tympanic membrane?
Infection or trauma
Name three types of medications that are ototoxic.
- Salicylates (Aspirin)
- Aminoglycoside Ab
Why is a child having 2 episodes of ear infections in one year a problem? Why can tonsils be a problem?
- It could be an indicator of future problems
- Tonsilitis can cause ear infections
What is microtia?
Ears of less than 4 cm in length
What is macrotia?
Ears of greater than 10 cm in length
What is the normal length of ears?
What angle should the pinna be at?
10 degrees of the vertical
What may an abnormal positioning of the ear indication (2)?
- GU problems
- Chromosomal abnormality
What is the name of a benign bump on the helix of the ear?
What does pain when the pinna or tragus indicate?
What does pain when the mastoid is touch indication? (2)
Otitis media or mastoiditis
Where is hair present in the ear canal?
The outer 1/3 of the canal
If a watery substance is found in the ear after a head trauma and test positive for glucose what is the substance?
What is atresia?
The ear canal closes or doesn't exist.
What is Exostistis and who is it common in?
It is hard bony nodules in the ear that is commonly found among cold water swimmers
What position should the cone of light be in in each ear?
The right ear it should be at 5 o'clock and 7 o'clock in the left ear
What is a retracted ear indicative of and how you can you tell it is retracted?
- It is indicative of serous otitis media or blocked eustachian tube
- You can tell because the cone of light may not be visible and the bones of the inner ear are very visible
Name two indicators of serous otitis media?
An amber colored tympanic membrane and air bubbles behind the ear drum
Name 3 symptoms of otitis media.
- red tympanic membrane
- loss of landmarks
- ruptured tm
What are three indications of a ruptured TM?
- 1) extreme ear pain
- 2) a popping sound
- 3) purulent discharge
Is it good or bad when the weber test is performed and the sound goes to the bad ear?
It is good because then there is not a sensorimotor nerve loss.
Is it good or bad when the weber test is performed and the sound goes to the good ear?
It is bad because then there is sensorimotor nerve damage to the bad ear.
For the Rinne test what does AC > BC indicate?
For the Rinne test what does BC > AC mean?
What does the Rommberg test test for?
Balance and propioreception.
What is acoustic neuroma?
A benign tumor of the acoustic nerve
What can anosmia be associated with?
Temporal lobe lesion, allergic rhinitis, smoking, and cocaine use
What 3 eye problems are caused by glaucoma?
Night blindness, peripheral vision loss, halos around lights
Name all six muscles attached to the eye.
Medial rectus, lateral rectus, inferior rectus, superior rectus, inferior oblique, superior oblique
What four eye movements does CN III control?
Diagonal upper right and left, diagonal lower left, and medial movment
What eye movement does CN VI control?
Lateral movement (lateral rectus)
What eye movement does CN IV control?
Left lower diagonal (superior oblique)
What is nystagmus?
Involuntary movement of the eye balls
What is esotropia?
A type of strabismus where the eye is turned inward
What is exotropia?
A type of strabismus where the eye is turned outward
What is Esophoria?
When an an inward drift
What is exophoria?
An outward drift of the eye
What do meibomian glands do?
Secrete lubricants for the eye lids that prevent evaporation of the tears, and provides an airtight seal when eyes are closed
What is hordeolum?
It is a staph infection of a hair follicle at the lid margin.
What is chalazion?
Infection or retention cyst of a meibomian gland (non tender)
What is blepharitis?
Infection of eyelids secondary to staph infection
What is lid lag?
It occurs with exothalamus, more eye exposed than should be
What is ptosis?
Drooping of the lower lid that may be due to injury to CN 3,5,7
Process of tear drainage.
Tears drain across the eye into the puncta then drain into the lacrimal sac through the nasolacrimal duct and empty into the inferior meatus in the nose
What is pinguecula?
yellow nodules on the bulbar conjunctiva due to wind, sun, and dust exposure
What is pterygium?
Overgrowth of conjunctival tissue. Starts from the inner canthus and moves toward the cornea. May affect vision
What 2 structures does the cornea protect?
Pupil and iris
What is corneal arcus?
Fat around the limbus that appears gray
What is keratitis?
Inflammation of the cornea
What nerves are involved with the blink reflex?
CN 5 and 7
What does CN 5 do?
Trigeminal nerve that carries afferent messages to the brain.
What does CN 7 do?
It is the facial nerve and it carries the efferent message that causes the blink reflex
What is another name for SNS pupil dilation?
What is another name for PNS pupil restriction?
What does PERRLA stand for
Pupils equal, round, reactive to light and accomidation
What is a normal intraoccular pressure?
13-22 mm Hg
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