Week 3 - Ears .pptx

EARS Chapter 16 Structure and Function External ear External auditory canal Tympanic membrane Middle ear Malleus, incus, and stapes Eustachian tube Inner ear Vestibule and semicircular canals (bony labyrinth) Cochlea Copyright © 201...

EARS Chapter 16 Structure and Function External ear External auditory canal Tympanic membrane Middle ear Malleus, incus, and stapes Eustachian tube Inner ear Vestibule and semicircular canals (bony labyrinth) Cochlea Copyright © 2019 Elsevier, Inc. Pathways of Hearing Air conduction Bone conduction Copyright © 2019 Elsevier, Inc. Developmental Considerations Infants Shorter, more horizontal eustachian tube and Lumen easily occluded Greater risk for middle ear infections children Adults Otosclerosis Accumulation of cerumen (impacted) Older Presbycusis Recommendations for regular hearing adults tests Copyright © 2019 Elsevier, Inc. Cultural and Social Considerations Increased incidence of otitis media in: Aboriginal children Premature infants Infants with Down’s syndrome Infants bottle fed in supine position Cerumen Genetically determined; dry and wet cerumen Hearing loss third most common chronic condition in older adults Audism: discrimination based on hearing ability Copyright © 2019 Elsevier, Inc. Subjective Data: Health History Earaches Additional history for infants Infections and children Ear infections Discharge Hearing loss Hearing loss Injury Environmental noise Tinnitus Vertigo Self-care behaviours Copyright © 2019 Elsevier, Inc. Objective Data: Physical Exam Preparation Position Cleaning the ear canal Equipment Otoscope with bright light External ear—Inspect and palpate Size and shape Skin condition Tenderness External auditory meatus Copyright © 2019 Elsevier, Inc. Otoscopic Exam Otoscopic examination Position of head and ear Method of holding and inserting otoscope External canal Colour Swelling Lesions/foreign bodies Discharge (colour, odour) Copyright © 2019 Elsevier, Inc. Tympanic Membrane Colour and characteristics Position Integrity of membrane Copyright © 2019 Elsevier, Inc. Testing Hearing Test hearing Vestibular acuity Conversational speech apparatus Romberg test Whispered voice test Tuning fork tests (Weber, Rinne) —do not yield reliable or precise data Copyright © 2019 Elsevier, Inc. Development (1 of 2) Infants and young Children Ear position Timing of otoscopic exam Positioning of child Testing hearing acuity and developmental milestones Behavioural manifestations of hearing loss Copyright © 2019 Elsevier, Inc. Development Older adult Loss of elasticity of pinna Eardrum whiter, more opaque, duller Loss of hearing of high-tone frequencies and consonants in whispered voice test Isolation in groups Copyright © 2019 Elsevier, Inc. Abnormal Findings Abnormalities of the external ear Frostbite Otitis externa (swimmer’s ear) Branchial remnant and ear deformity Cellulitis Cerebrospinal fluid otorrhea Sebaceous cyst Tophi Chondrodermatitis nodularis helicis Keloid Carcinoma Copyright © 2019 Elsevier, Inc. Abnormal Findings (2 of 2) Abnormalities in the ear canal Excessive cerumen Otitis externa Osteoma Foreign body Exostosis Furuncle Polyp Copyright © 2019 Elsevier, Inc. Abnormal Tympanic Membranes Retracted eardrum Otitis media with effusion Acute (purulent) otitis media Perforation Insertion of tympanostomy tubes Cholesteatoma Scarred eardrum Blue drum (hemotympanum) Bullous myringitis Fungal infection (otomycosis) Copyright © 2019 Elsevier, Inc.