N112 EAr

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N112 EAr
2010-12-07 17:36:10

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  1. Tympanic membrane
    (eardrum) has a translucent, pearly gray appearance and serves as a partition stretched across the inner end of the auditory canal, separating it from the middle ear. Membrane is concave and located at the end of the auditory canal in a tilted position, such that the top of the membrane is closer to the auditory meatus than the bottom.
  2. Middle ear
    or tympanic cavity is a small, air filled chamber in the temporal bone. It is separated from the external ear by the eardrum and from the inner ear by a bony partition containing two openings, the round and oval windows.
  3. The middle ear contains 3 auditory bones
    the malleus, the incus and the stapes. These bones are responsible for transmitting sound waves from the eardrum to the inner ear through the oval window. Air pressure is equalized on both sides of the eardrum by means of the Eustachian tube which connects the middle ear to the nasopharynx.
  4. Inner ear
    ear or labyrinth is fluid filled and is made up of the bony labyrinth and an inner membranous labyrinth.
  5. The bony labyrinth has 3 parts
    the cochlea, the vestibule, and the semicircular canals
  6. The inner cochlear duct contains
    the spiral organ of Corti, which is the sensory organ for hearing
  7. Sensory receptors located in
    • in the vestibule and the membranous semicircular canals sense position and head
    • movements to help maintain both static and dynamic equilibrium Nerve fibers form these areas form the vestibular nerve which connects with the cochlear nerve to form CN VIII (acoustic or vestibulocochlear nerve)
  8. Earache can occur with
    ear infections, cerumen blockage, sinus infections, or teeth and gum problems
  9. Otitis media
    is an inflammation or infection of the middle ear, which often causes fluid to build up behind the ear drum. Often begins when a throat or respiratory viral infection spreads to the middle ear. Children are more susceptible than adults to otitis media which is related to their shorter, straighter, narrower eustachian tubes.
  10. Tinnitus
    ( ringing in the ears) may be associated with excessive ear wax buildup, high blood pressure or certain ototoxic medication (such as streptomycin, gentamicin, kanamycin, neomycin, ethacrynic acid, furosemide, indomethacin or aspirin).
  11. Vertigo
    • (true spinning motion) may be associated with an inner ear problem. It is termed “subjective vertigo” when client feels that he is spinning around and “objective vertigo” when the client feels that the room is spinning around him.
    • It is important to distinguish vertigo from dizziness.
  12. Checking for Tenderness of the Ear
    Move pinna and push on tragus. They should feel firm, and movement should produce no pain. Palpating mastoid process should also produce no pain.
  13. Cerumen
    •usually present. The color varies from gray-yellow to light brown and black, and texture varies from moist and waxy to dry.

    •Cerumen can obscure

    Elderly– more cerumen
  14. Inspection of the ear
    •Adult and older child - pull pinna up and back

    •Infant and child under 3 years of age - pull pinna down
  15. Why are Children prone to ear infections
    shorter eustacian tubes
  16. Sections of malleus are visible through translucent ear drum They are...
    umbo, manubrium, & short process.
  17. A cone-shaped reflection of the otoscope light is normally seen at
    at 5 o’clock in the right ear and at 7 o’clock in the left ear. The short process and handle of the malleus and the umbo are clearly visible.
  18. Tympanic Membrane Abnormalities
    •Red - occurs with acute otitis media

    •Bulging drum from increased pressure in otitis media
  19. conductive hearing
    Transmission of sound waves through the external and middle ear
  20. perceptive or sensorineural hearing.
    the transmission of sound waves in the inner ear
  21. conductive hearing loss would be related to a
    dysfunction of the external or middle ear (impacted ear wax, otitis media, foreign object)
  22. A sensorineural loss would be related to
    • dysfunction of the inner ear ( inner ear pathology, CN VIII, or auditory areas of the
    • cerebral cortex)
  23. Tuning Forks
    measure hearing by air conduction (AC) or by bone conduction (BC), in which sound vibrates through the cranial bones to the inner ear
  24. Weber’s Test
    • •strike tuning fork softly with the back of hand and place it in the center of person’s head. Centering is the important part. Ask whether person hears the sound better in one ear or the
    • same in both ears.

    •Normal: vibrations are heard equally well in both ears.
  25. Conductive hearing loss
    lateralization of sound to the affected ear.

    client “hears” the sounds in their poor ear. The good ear is distracted by background noise, conducted air, which the poor ear has trouble hearing. Thus the poor ear receives most of the sound conducted by bone vibration.
  26. Sensorineural hearing loss
    lateralization of sound to unaffected ear

    • client reports lateralization of sound to the good ear, because of limited perception
    • of the sound due to nerve damage in the bad ear, making sound seem louder in the unaffected ear.
  27. CAM
    conductive affected ear and it’s a mechanical problem
  28. SUN
    -Sensory neural unaffected ear
  29. Rinne Test
    • •strike a tuning fork and place the base of the fork on the person’s mastoid process. Ask person to tell you when the sound is no longer heard. Move the prongs of tuning fork to the
    • front of external auditory canal. Ask person to tell you when sound is no longer heard.

    •Normal: air conduction sound is normally heard twice as longer than bone conduction sound (AC > BC).

    •Conductive loss, bone sound is heard longer than or equally as long as air (BC > AC).

    Sensorineural loss, reduced overall (AC > BC)
  30. Pendulous earlobes with linear wrinkling due to loss of
    elasticity of pinna
  31. Presbycusis
    • is nerve degeneration in the inner ear or auditory nerve causing progressive hearing
    • loss

    What you can do for this patient- Amplification devices Cochlear implants
  32. 90 to 95% of ear canal can be blocked by
    cerumen and person will still hear. Hearing will be lost when last 5 to 10% is blocked
  33. Labyrinthitis
    • inflammation of the bony labyrinth, which are a series of intricate structures in the inner ear
    • that play a role in hearing and balance.
  34. Labyrinthitis symptoms
    •vertigo (sensation of spinning), nausea and vomiting, nystagmus, temporary hearing loss, and ringing in the ears (tinnitus).