1. The external ear (auricle/pinna)

2. The middle ear

3. The inner ear

1. Movable cartilage

2. Skin

1. Helix

2. Antihelix

3. External auditory meatus

4. Tragus

5. Antitragus

6. Lobule

Pearly grey

Anterioinferior 

1. Umbo

2. Manubrium (the handle)

3. The short process 

1. Parotid

2. Mastoid

3. Superficial cervical 

1. Malleus

2. Incus

3. Stapes

Oval window

Round window

It connects the middle ear with the nasopharynx. 

It allows passage of air. 

1. Conducts sound vibrations from the outer ear to the central hearing apparatus in the inner ear.

2. Protects the inner ear by reducing the amplitude of loud sounds. 

3. Eustachian tube allows equalization of air pressure on each side of the tympanic membrane so that the membrane doesn't rupture. 

Vestibule 

Semicircular canals

1. Peripheral

2. Brainstem

3. Cerebral Cortex

1/2

VIII- Vestibulocochlear

Bone conduction. (BC)

The bones of the skull vibrate. These vibrations are transmitted directly to the inner ear and to cranial nerve 8. 

1. Impacted cerumen

2. Foreign bodies

3. Perforated tympanic membrane

4. Pus or serum in the middle ear

5. Otosclerosis

1. Presbycusis

2. Ototoxic drugs

What is "Presbycusis?"

Labyrinth (in the inner ear).

It constantly feeds information to your brain about your body's position in space. 

Verticality and depth. 

The ears plumb lines register the angle of your head in relation to gravity. 

Posteriorly.

Eye.

Ear canal is shorter and has a slope opposite to that of the adults. 

Infants--> Shorter eustachian tube, lumen surrounded by lymphoid tissue

90%

2 years

1. Absense of breast feeding in 1st 3 months

2. Exposure to tobacco smoke

3. Daycare attendance

4. Male gender

5. Pacifier use

6. Seasonality (fall/winter)

7. Underlying diseases

Gravity and Sucking

*Urge parents to breastfeed whenever possible!

1. Prop the bottle

2. Let the baby take a bottle to bed

1. Dry Cerumen

2. Wet cerumen

1. Grey

2. Flakey

3. Frequently forms a thin mass in the ear canal

1. honey brown to dark brown

2. moist

*More frequent in Caucasians and African Americans

A history of chronic ear problems suggests possible _____.

A. Otorrhea

B. Sequelae

C. Presbycusis 

D. Tinnitus

__________ suggests infected canal or perforated eardrum. 

A. Otorrhea

B. Microtia

C. Atresia

D. Perforation

Straight

Eye

Mineral oil

Hydrogen peroxide

Warm

________: Ears are smaller than 4 cm vertically

A. Macrotia

B. Microtia 

__________: Ears are larger than 10 cm. (Edema with infection or trauma)

A. Macrotia

B. Microtia

Firm

Pain

Test one ear at a time (block unused ear).

Shield your lips (no lip-reading).

Keep head 1-2 feet away.

Whisper 3 random numbers and letters. 

Patient repeats back. 

If response is incorrect, do it again.

Passing: 3 out of 6

Amniotic fluid

Vernix caseosa

whiter

opaque

Reddish blue discoloration and swelling of auricle after exposure to extreme cold. Vesicles or bullae may develop, the person feels pain and tenderness, and ear necrosis may ensue. 

A. Keloid

B. Tophi

C. Brachial remnent and ear deformity 

D. Frostbite

An infection of the outer ear, with severe painful movement of the pinna and tragus, redness and swelling of pinna and canal, scanty purulent discharge, scaling, itching, fever, and enlarged tender regional lymph nodes. Hearing is normal or slightly diminished. More common in hot, humid weather/ Swimming causes canal to become waterlogged and swell; skinfolds are set up for infections. Prevent by using rubbing alcohol of 2% acetic acid eardrops after every swin. 

A.Exostosis

B.Otitis Externa 

C. Furuncle

D.Osteoma

A facial remnant or leftover of the embryologic branchial arch usually appears as a skin tag. They occur most often in the preauricular area, in front of the tragus. When bilateral, there is increased risk for renal anomalies. 

A. Chondrodermatitis Nodularis Helicus

B. Branchial Remnant and Ear Deformity

C. Sebaceous Cyst

D. Keloid

Inflammation of loose, subcutaneous connective tissue. Shows as thickening and induration of auricle with distorted contours. 

A. Cellulitis

B. Carcinoma

C. Tophi

D. Sebaceous Cyst

Location is commonly behind lobule, in the postauricular fold. A nodule with central black punctum indicates blocked sebaceous gland. It is filled with waxy sebaceous material and is painful if it becomes infected. Often are multiple. 

A. Polyp

B. Excessive Cerumen

C. Carcinoma

D. Sebaceous Cyst

Small, whitish yellow, hard, nontender nodules in or near helix or antihelix; contain greasy, chalky material of uric acid crystals and are a sign of gout. 

A. Keloid

B. Tophi

C. Furuncle

D. Osteoma

Painful nodules develop on the rim of the helix (where there is no cushioning subcutaneous tissue) as a result of repetitive mechanical pressure or environmental trauma (sunlight). They are small, indurated, dull red, poorly defined, and very painful. 

A. Chondrodermatitis Nodularis Helicus

B. Brachial Remnant and Ear Deformity

C. Frostbite

D. Carcinoma

Overgrowth of scar tissue, which invaded original site of trauma. It is more common in dark-skinned people, although it also occurs in whites. In the ear it is most common at lobule at the site of a pierced ear. 

A. Carcinoma

B. Tophi

C. Keloid

D. Sebaceous Cyst

Ulcerated, crusted nodule with indurated base that fails to heal. Bleeds intermittently. Must refer for biopsy. Usually occurs on the superior rim of the pinna, which has the most sun exposure. May occur also in ear canal and show chronic discharge that is either serosanguineous or bloody. 

A. Exotosis

B. Foreign Body

C. Carcinoma

D. Furincle

Produced or impacted because of narrow, tortuous canal or poor cleaning method. May show as round ball partially obscuring drum or totally occluding canal. Even when canal is 90% to 95% blocked, hearing stays normal. But when last 5% to 10% is totally occluded, person has ear fullness and sudden hearing loss.

A. Polyp

B. Exotosis

C. Foreign Body

D. Excessive Cerumen

Sever swelling of canal, inflammation, tenderness. 

A. Furuncle

B. Polyp

C. Osteoma

D. Otitis externa

Usually it is children who place a ____body in the ear, which is later noted on routine examination. Common objects are beans, corn, breakfast cereals, jewelry beads, small stones, sponge rubber. Cotton is most common in adults and becomes impacted from cotton-tipped applicators. A trapped live insect in uncommon but makes person frantic.

A. Strange Body

B. Foriegn Body

C. Unwanted Body

D. Problematic Body

Single, stony, hard, rounded nodule that obscures the drum; nontender; overlaying skin appears normal. Attached to inner third, the bony part, of canal. Benign, but refer for removal.

A. Furuncle

B. Polyp

C. Exostosis

D. Osteoma

More common than osteoma. Small, bony hard, rounded nodules of hypertrophic bone, covered with normal epithelium. They arise near the drum but usually do not obstruct the view of the drum. They are usually multiple and bilateral. They may occure more frequently in cold-water swimmers. They condition needs to treatment, although it may cause accumulation of cerumen, which blocks the canal.

A. Otitis externa

B. Excessive Cerumen

C. Exostosis

D. Polyp

Arises in canal from granulomatous or mucosal tissue; redder than surrounding skin and bleeds easily; bathed in foul, purulent discharge; indicates chronic ear disease. Begign, but refer for excision. 

A. Polyp

B. Furuncle

C. Keloid

D. Tophi

Exquisitely painful, redenned, infected hair follicle. It may occur on the tragus on the cartilaginous part of the ear canal. Regional kymphadenopathy often accompanies it. 

A. Polyp

B. Sebaceous Cyst

C. Furuncle

D. Osteoma