Download osce_ent_-ears-presentation

ANATOMY
EAR ANATOMY : OUTER EAR
EAR ANATOMY: INNER EAR
OTOSCOPY
•
Pearly grey appearance, thin
TM, semi-transparent, long
process of incus and
Eustachian Tube can be seen
through the TM.
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Annulus Fibrosa – thickened
outer margin where the drum
is attached to external canal
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Upper 1/5th – Pars Flaccida
Lower 4/5th- Pars Tensa
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Handle of Malleus –
downwards and backwards
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Light Reflex
Normal Tympanic
Membrane
Right or Left Ear drum?
DIAGRAMMATIC REPRESENTATION OF NORMAL
OTOSCOPE
OTOSCOPE QUIZ
WAX (CERUMEN) IMPACTION
• Description?
• Complications?
• Tx?
AOM WITH EFFUSION (GLUE EAR)
• Description?
• Complications?
• Tx?
Bonus Question: What would a
Tympanogram look like for this
copndition?
OTITIS MEDIA (SEROUS)
• Description?
• Complications?
• Tx?
CENTRAL PERFORATION OF EAR DRUM
• Description?
• Complications?
• Tx?
GROMMET INSERTION
• Description?
• Indications?
• Complications?
UNDERSTANDING THE AUDIOGRAM
•
Volume : vertical axis
represents volume
(loudness) measured
in decibels (dB).
•
Pitch: horizontal axis
represents frequency
(pitch) which is
measured in hertz (Hz).
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0 dB does not mean
that there is no sound
at all. It is simply the
softest sound that a
person with normal
hearing ability would
be able to detect at
least 50% of the time.
•
Normal conversational
speech is about 45 dB.
DIFFERENT SENSITIVITIES OF THE AUDIOGRAM
Noticed by family and friends,
between 21dB and 40dB
Difficulty following speech,
41dB and 70dB
Unable to hear speech,
traffic unless its loud, 71dB
to -95dB
Greater than 95dB, unable to
hear most sounds unless
very loud
DIAGRAMMATIC REPRESENTATION OF THE
AUDIOGRAM
Speech
Banana
NORMAL AUDIOGRAM
Right ear
air conduction = O
bone conduction =
[ or Δ
Left Ear
air conduction = X
bone conduction =
] or triangle Δ.
AUDIOGRAM QUIZ
RIGHT SIDED, CONDUCTIVE DEAFNESS
Conductive or Sensorineural ?
Right or Left Ear?
Mild/Moderate/Severe/Profound?
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Causes?
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Management?
BILATERAL MILD SENSORINEURAL HEARING LOSS
Conductive or Sensorineural ?
Right or Left Ear?
Mild/Moderate/Severe/Profound?
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Causes?
•
Management?
BILATERAL MODERATE SENSORINEURAL HEARING
LOSS
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Conductive or Sensorineural ?
Right or Left Ear?
Mild/Moderate/Severe/Profound?
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Causes?
•
Management?
PRESBYACUSIS RIGHT SIDED
Conductive or Sensorineural ?
Right or Left Ear?
Mild/Moderate/Severe/Profound?
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Causes?
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Management?
PRESBYACUSIS, LEFT SIDED
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Conductive or Sensorineural ?
Right or Left Ear?
Mild/Moderate/Severe/Profound?
•
Causes?
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Management?
HEARING LOSS DUE TO MENIERE’S
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Conductive or Sensorineural ?
Right or Left Ear?
Mild/Moderate/Severe/Profound?
•
Causes?
•
Management?
HTTP://WWW.AUDSTUDENT.COM/TUTORIALS
/AUDIOTUTORIAL2/AUDIOGRAMTUTORIAL2.H
TM
UNDERSTANDING THE TYMPANOGRAM
A tympanogram provides several
pieces of information including:
• Compliance of the middle ear
system (eardrum movement)
• Ear canal volume
• Middle ear pressure
(normally equal to
atmospheric pressure in healthy
ears)
Vertical – Compliance (can also give indication of Ear Canal
Volume)
Horizontal – Pressure in daPa
Shaded area – normal tymanogram would fall into this area
• A pattern that
corresponds to various disorders
DIFFERENT PATTERNS OF A TYMPANOGRAM
Type A Tympanogram
Peak compliance occurs near the
atmospheric pressure indicating normal
pressure within the middle ear
AD: A deep curve with a tall peak
indicates an abnormally
compliant middle ear system, as
typically seen with
ossicular chain dislocation or loss of
elastic fibers in the
tympanic membrane.
AS: A shallow curve indicative of a stiff
system, as seen in
otosclerosis or thickened tympanic
membrane.
DIFFERENT PATTERNS OF A TYMPANOGRAM
Type B Curve
• No Sharp peak in the
curve
• May be due to fluid within
the middle ear space
(otitis media), TM
perforation or debris
within the external ear
(otitis externa)
DIFFERENT PATTERNS OF A TYMPANOGRAM
Type C
Peak compliance
significantly below 0,
less than – 200
indicating negative
pressure (subatmopsheric) within
the middle ear space,
suggest Eustachian
Tube Dysfunction or
middle ear fluid