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Ear:

cause you could choose to


hear or listen
Telinga : HEARING AND EQUILIBRIUM
1. Anatomy
2. Physiology of hearing
3. Describe the auditory and
equilibrium pathways.
1.Anatomy
(1) the external ear,
which collects sound waves and channels them
inward

EAR (2)the middle ear,


which conveys sound vibrations to the oval window;

(3)the internal ear ,


which houses the receptors for hearing and
equilibrium.
EXAMINATION ANATOMY
Common Symptoms of Ear Disease

Common Symptoms of Ear Disease


History
Patients may have symptoms from any of the three parts of the ear:
1. Outer ear: symptoms : itch, erythema and discharge (perforated
drum and infection or
otitis externa). The pinna can be damaged by trauma or affected by acquired
or inherited diseases of cartilage. Otorrhoea is a more chronic scanty but
offensive discharge. It may be due to a cholesteatoma. This is a growth of
stratified squamous epithelium that begins in the middle ear or mastoid. It is
a benign, slowly growing lesion that destroys bone and ear tissue as it grows.
When perforation of the tympanic membrane occurs, cheesy white discharge
can occur. It results in loss of hearing if the ossicles are involved.
Accumulations of ear wax are a cause of deafness.
2. Middle ear: symptoms : infection, which is common in children, and
causes pain and, if the eardrum ruptures, a purulent discharge.
Otosclerosis is an inherited abnormality that affects the ossicles and causes
deafness. Middle ear tumours and chronic middle ear infection are a cause of
deafness.
3. Inner ear: deafness and balance problems: vertigo are the usual
symptoms of inner ear disease. Tinnitus, which is usually described as a
EXAMINATION METHOD
Ear examination consists of :
- inspection
- Palpation
- Otoscopy
- tuning fork assessment
- testing hearing
- peripheral vestibular examination.
Inspect
- The position of the pinna and note its size and
shape. Note any scars or swelling around the ears.
- Look for an obvious accessory auricle (separate piece
of cartilage away from the pinna), cauliflower ears
(haematomas from recurrent trauma, which obscure the
normal anatomical features of the pinna) and bat ears
(protrusion of the ears from the side of the head).
- Look for inflammation externally and any
obvious ear discharge. Inspect the auditory meatus
and outer ear.
Inspect
There are four types of otitis externa, a condition associated with
inflammation of the skin of the external canal:
1. Acute localised otitis externainvolves the outer third of the auditory canal
where the skin overlies cartilage and hair follicles are present. Itis a form of
furunculosis and is usually a result
of
2. S. aureusinfection.
Acute diffuse otitis externais often called swimmers ear although it occurs
in people who have not been swimming. Excessive moisture, heat and humidity,
loss of protective cerumen and an increase in pH are responsible for skin
maceration and irritation. Infection may occur with Pseudomonas
aeruginosa. The initial symptom is itching, which can progress to pain and is
made worse by movement of the pinna. The appearance on examination
ranges from mild erythema to severe erythema and swelling. There may be
a small amount of white, clumpy discharge.
Inspect
3. Chronic otitis externais usually the result of repeated local
irritation. This may be due to
persistent drainage of a chronic middle ear infection but can also be
caused by the insertion
of foreign bodies into the ear (e.g. cotton swabs, ear picks). Itch is a
more prominent symptom
than pain. The appearance is of scaly erythematous dermatitis. It must
be distinguished from other forms of dermatitis such as psoriasis, atopic
dermatitis and seborrhoeic dermatitis.
4. Malignant (invasive) otitis externais an aggressive and sometimes
life-threatening condition. It affects elderly diabetics and
immunocompromised patients. It begins in the external auditory canal and
spreads slowly inwards. Untreated it can cause osteomyelitis of the base of
the skull and reach the meninges and the brain. Pseudomonasinfection is the
most common cause but other organisms can be responsible. Deep otalgia is
the most predominant symptom. The appearance at first is like that of severe
chronic otitis externa. On examination there is discharge and the canal
Then look for signs of gouty tophi(nodular, firm,
pale and non-tender chalky depositions of urate in
the cartilage of the ear, specific but not sensitive
for
gout)
Palpate thepinnafor swelling or nodules. Pull down the pinna gently;
the manoeuvre is often painful when there is infection of the external
canal.

Otoscope examinationof the ears requires use of an earpiece that fits


comfortably in the ear canal to allow inspection of the ear canal and
tympanic membrane. This examination is essential for any patient
presenting with an upper respiratory tract infection, any symptom
related to the ears, dizziness, facial weakness or head injury.
Always examine both ears!
Inspect the tympanic membrane(ear drum)
by introducing the speculum further into the canal
in a forward but downward direction. The normal
tympanic membrane is a pearly grey colour. It is ovoid
in shape and semi-transparent (see Figure38.15). The
upper fifth is called the pars flaccida and the lower
four-fifths are called the pars tensa. The handle of
the malleus is often visible near the centre of the
pars tensa. From thelower end of the handle a bright
cone of light should be visible: the light reflex. The
presence or absence of the light reflex is not a sensitive
or a specific sign of disease (see Figures38.16 and
38.17). Note the colour, transparency and any
evidence of dilated blood vessels (hyperaemiaa sign of
otitis media; see Figure 38.17). Look for bulging
or retraction of the tympanic membrane. Bulging
can suggest underlying fluid or pus in the middle
ear. Retraction means a reduction in pressure in the
middle ear and is a sign of a blocked Eustachian tube.
Perforation of the tympanic membrane should be
noted (see Figure38.18).
If a middle ear infection is suspected, pneumatic
auriscopycan be useful. Use a speculum large enough
Ear:
with the same organ, understand
your position, Equilibrium
Source:
G. tortora & b. derrickson principles of anatomy &
physiology (12th ed)

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