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EENT Ear Exam and Otitis
KYCOM Block 10
68
Medical
Graduate
10/01/2013

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Term
what are the 4 reasons to do an audiology evaluation
Definition
determine degree and configuration of hearling loss
determined site of lesion
determine need for nonsurfical intervention (hearing aid, lip reading, sign language)
determine need for futher testing
Term
what are the three areas of audiology testing
Definition
pure tone auditometry
speech audiometry
immittance/impedence measures
Term
what are the two pure tone auditometry tests
Definition
air conduction
bone conduction
Term
speech audiomatey two tests
Definition
speech reception thresholds
speech discrimination thresholds
Term
immittance/impedence measures two
Definition
tympanomatry and acustic reflexes
Term
what is a speech reception threshold test
Definition
lowest dB pt can repeat spondiaic (spondless) words at 50%
Term
what is a spondee
Definition
two syllable word with equal ephsis on both syllables
Term
what is the specificity of the speech reception test
Definition
can confirm tone thresholds within 10dB of PTA at the average air conduction of 500, 100, and 200 Hz
Term
what is PTA
Definition
pure tone audiometry
Term
what is the difference between Hz and dB
Definition
dB is the volume
Hz is high or low pitch
Term
what is a speech detection threshold
Definition
lowest dB level in the patient responds to speech
Term
who gets a speech detection threshold
Definition
kids, mentally retarded, language barriers, when speech repetition cannot be done
Term
what does a speech discrimination score determine
Definition
how clear a pt can hear speech
Term
how is speech discrimination score done
Definition
patient repeats a list of 50 phonetically balanced words, tessl about th einner ear, nerve, and brain
Term
what is the scoriing for speech discrimination testing
Definition
90-100% correct is normal
76-88% correct is slight difficulty
60-74% correct is moderate difficulty
40-58% correct is poor
<40% correct is very poor
Term
what does an A tympanogram mean
Definition
normal: pressure on both sides of TM are equal, middle ear and ossicles are functing normally
Term
what does an Ad tympanogram mean
Definition
increased: TM is floppy due to atrophy or disarticulation of the ossicles
Term
what does an As tympanogram mean
Definition
stiff Tm from osicular fixation or diffuse tympanosclerosis
Term
what does an C tympanogram mean
Definition
decreased: pressure in the middle ear is negative related to external. most commonly caused by eustachian tube dysfunction but could be from otitis media
Term
what does a B tympanogram mean
Definition
immobility of the TM, middle ear is incompressable due to hole in TM or fluid filled middle ear
Term
webber test: how is it done, what do the results mean
Definition
place fork in midlike and the tone should be heard in both ears equally

in conductive loss it is louder in the bad ear

in sensorineural loss it is louder in the good ear
Term
rinne test: how is it done, what do the results mean
Definition
compares air and bone conduction. alternate position between pinna and mastoid

tone should be louder in air.

in conductive loss tone is louder at the mastoid

in sensorineural loss the tone is louder at the ear
Term
what is the main goal in infant screening
Definition
screen them before they leave the hospital (or by 3 mo)
Term
what what age in infant screening do we begin rehabilitation or correction, basically when can we confirm hearing problem
Definition
6 mo
Term
what tests do a newborn get
Definition
ABR: auditory brainstem response: response to sound recorded via brain waves

OAE: otoacustic emissions
Term
at birth how should a baby respond to noise
Definition
eyes wide
blinking
stirring or arousal
startle
Term
what 6 mo how should a babay respond to noise
Definition
head turn towards noise
Term
at 13 mo how should a baby respond to noise
Definition
direct or localize sound from any direction
Term
what are the denoted symbols in pure tone audiometry
Definition
left ear : right ear

X: good air conduction :O

square: masked air conduction :triangle

>: good bone conduction :<

]: masked bone conduction :[

right arrow: no response :left arrow
Term
what is the scale of dB for hearing impairment
Definition
-10 - 20 normal

21-40 mild loss
41055 moderate loss
56-70 mod to severe loss
71-90 severe loss
>90 profound loss
Term
what is conductive hearing loss
Definition
problem with the hardware, more outer ear

ossicles, ET, drum, mastoid, pinna
Term
what is sensorineural hearing loss
Definition
problems with the wiring, more inner ear

semicircular canals, facial nerve, cochlea, auditory nerve, vestibular nerve, brain
Term
what are some examples of conductive hearing loss
Definition
cerumen impaction
foreign body
atresia of ET or auricle
ossicular fixation
otosclerosis
tumor
tympanosclerosis
TM perforation
Term
what are some examples of sensorineural hearing loss
Definition
ototoxicity, neurologiclal disorders, hematological disorders, infection, bone disease, autoimmune, prebyscus, endocrine, metabolic, hededitary,
Term
what is mixed hearing loss
Definition
conductive
Term
define otitis media
Definition
inflammation of the middle ear
Term
define middle ear effusion
Definition
liquid resulting from otitis media
Term
define otorrhea
Definition
discharge through the perforated tympanic membrane
Term
what are the 5 types of effusion describe them
Definition
serous: thin, watery (transudate)
mucoud: thick, viscous, mucous like
purulent: puss like
blood
CSF
Term
where is otitis media with effusion in rank with childhood diseases
Definition
second to URI
Term
what are some factors that statistically increase chances of otitis media with effusion
Definition
under 3 yo
male>female
cleft palate
Term
define atelectasis
Definition
collapse (passive) or retraction (active pulling inward) of TM
Term
define retraction pocket
Definition
localized area of aelectasis of TM
Term
what is the most important factor to pathogenesis of the middle ear
Definition
abnormal function of the eustachian tube
Term
what are 5 underlying causes of eustachian tube dysfunction
Definition
immaturity of the tube
immaturity of the muscles of the soft palate
submucosal clefts / cleft palate
adenoid hypertrophy
retrograde migration of bacteria
Term
what are the three functions of the eustachian tube
Definition
ventelation, protection, drainage
Term
pathogenesis of acute otitis media
Definition
congestion of respiratory and ET mucosa cause obstruction
secretions in middle ear accumulate and allow for pathogens to proliferate
Term
how do microbes get into the middle ear
Definition
infection is secondary to aspiration, insufflation, or reflux of nasopharyngeal bacteria up the tube and into the middle ear
Term
what are 5 pathologies of the eustachian tube
Definition
functional obstruction: floppy tube, poor tensor veli palatini function

mechanical obstruction: intrinsic (inflammation), extrinsic (adenoids or tumor)

abnormal patency: patulous ET
Term
what are 7 ddx to otitis media
Definition
allergies
craniofacial abnormalities
oxidative and hydrolytic enzymes
cilliary dyskinesia
drugs: NSAIDS, steroids
Term
what are the systemic symptoms of otitis media (5)
Definition
fever, irritability, anorexia, vomiting, diarrhea
Term
what are the local symptoms of otitis media (6)
Definition
otalgia: pain
otorrhea
tinnitus
vertigo
facial paralysis
swelling behind the ear
Term
what is seen when someone has otitis media on an otoscope exam
Definition
TM is full, bulging, opaque, limited or no mobility
Term
what statistically increases incidence of otitis media
Definition
6-13 mo
males>females
day care, big family
winter
bottle feeding
american, canadian, and escimo indians
Term
what are the common bacterial causes of otitis media
Definition
S. pneumoniae, H. influenza

mycoplasm pneumonia, anaerobic bacteria, chalmydia trachomatous, diptheria, TB
Term
what are the common viral causes of otitis media
Definition
RSV, influenza, coxsackie, adenovirus, parainfluenza
Term
what is the most common causes of otitis media
Definition
nothing! nothing shows on smear at all
Term
what are the initial treatments for otitis media
Definition
amoxicillin, TMP/SMX, amoxicillini/clauvonic acid, cefprozil, cefuroxime, omnicef
Term
what are the adjunctive therapies for otitis media
Definition
anaglesics, antipuretics, local heat, decongestants, antihistmaines, topical steroid nasal sprays
Term
what do you do if someone has a chronic otitis media
Definition
ventilation tubes
Term
when do you give otitis media treatment as a topical (drop)
Definition
TM perforation and discharge present
Term
what is the prophylaxis for otitis media
Definition
no longer used, not benificial
Term
what is a myringotamty, when do you do it
Definition
hole in the TM

acute mastoiditis, labyrinthitis, facial paralysis, severe otalgia, intracranial suppurative complications
Term
when do you do tympanostomy tubes
Definition
regulate middle ear pressure
drain secretions down ET
protect from nasopharyngeal secretions
prevent complications
restore hearing
Term
what is the most common complication of otitis media
Definition
hearing loss
Term
what are the intracranial complications of otitis media
Definition
meningitis, extradural abscess, subdural empyema, focal otitis encephalitis, brain abscess, lateral sinus thrombosis, otitic hydrocephalus
Term
how do you identify there is an intracranial complication of otitis media
Definition
stiff neck, focal seizures, ataxia, blurred vision, papilledema, diplopia, hemiplegia, aphasia
Term
what are the intratemporal complications of otitis media
Definition
hearing loss, perforation of TM, chronic suppurative otitis media, retraction pocket, cholesteatoma, adhesive otitis media, tympanosclerosis, ossicular discontuniuty

ossicular fixation, mastoiditis, petrositis, labrynthitis, facial paralysis, cholesterol granuloma
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