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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. • Annulus Fibrosa – thickened outer margin where the drum is attached to external canal • • Upper 1/5th – Pars Flaccida Lower 4/5th- Pars Tensa • Handle of Malleus – downwards and backwards • 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). • 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? • • • • Causes? • Management? BILATERAL MILD SENSORINEURAL HEARING LOSS Conductive or Sensorineural ? Right or Left Ear? Mild/Moderate/Severe/Profound? • • • • Causes? • Management? BILATERAL MODERATE SENSORINEURAL HEARING LOSS • • • Conductive or Sensorineural ? Right or Left Ear? Mild/Moderate/Severe/Profound? • Causes? • Management? PRESBYACUSIS RIGHT SIDED Conductive or Sensorineural ? Right or Left Ear? Mild/Moderate/Severe/Profound? • • • • Causes? • Management? PRESBYACUSIS, LEFT SIDED • • • Conductive or Sensorineural ? Right or Left Ear? Mild/Moderate/Severe/Profound? • Causes? • Management? HEARING LOSS DUE TO MENIERE’S • • • 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