Ear

• Auricle (pinna)


  cartilage surrounding the opening to the ear canal channels sound waves into the ear canal
• tragus


  can occlude external auditory canal
• external auditory canal


  the meatus opens into the canal

  short (2.5 cm) narrow (0.5 cm) passage

  squamous epithelium

  lined with fine hairs at opening, sebaceous glands and ceruminous glands
• lobule/ lobe


  lower, inferior portion

  not cartilage
• middle ear


  air filled, mucosa lined cavity between the TM and the inner ear

  located in the temporal bone of the skull

  connected to the nasopharynx through the eustachian tube
• tympanic membrane


  thin, semitransparent membrane

  vibrated when sound waves make contact with it

  transmits these waves to the ossicles
• cone of light


  shiny part seen from reflection of light with otoscope
• malleus


  bone that connects directly on TM from posterior side
• umbo


  lower part of malleus
• pars tensa


  tense area where cone of light is not bright
• ossicles


  bones that vibrate and transmit sound waves from the TM to the oval window of the inner ear
• malleus lay man term

  hammer
• incus lay man term

  anvil
• stapes lay man term


  stirrup- against oval window
• inner ear


  systems of channels within the bone made up of interconnecting sacs and ducts
• semicircular canals


  each is on a different plane

  a swelling ampulla at the end contains receptors and fluid which respond to angular movements of the head
• vestibule


  part in middle where the oval window is located
• cochlea


  shell like portion composed of three ducts

  the middle of which contains the hearing portion known as the organ of Corti
• organ of corti


  tiny area with hair cells that push against a membrane initiating a nerve impulse that is transmitted to the auditory cortex in the temporal lobe
• cerumen impaction


  cerumen is a protective secretion produced by the outer 1/3 of the ear canal
• in most persons, the ear canal is

  self- cleansing
• pt education cerumen impaction

  never put anything smaller than your elbow in your ear
• recommended hygiene for cerumen


  cleansing the external opening with a washcloth over the index finger without enter the canal itself
• in most cases cerumen impaction


  is self- induced through ill- advised attempts at cleaning the ear
• symptoms for cerumen impaction


  decreased hearing, full sensation, tinnitus, dizziness
• treatment cerumen impaction


  debrox, other OTC drops, mineral oil, irrigate or other ENT procedures such as suction
• arnold's reflex


  cough resulting from stimulation of the Auricular or Arnold's branch of Xth nerve (innervates posterior portion of EAM)
• otitis externa


  inflammation/ infection of the canal itself
• lay person term for otitis externa


  swimmer's ear
• risk factors otitis externa


  absence of cerumen

  retained water in ear canal

  skin conditions such as psoriasis, eczema

  trauma from cotton swabs, hearing aids, foreign bodies

  high humidity/ increased temperatures
• symptoms otitis externa


  progressive otalgia

  pressure in ear

  pruritus

  maybe discharge

  maybe hearing loss
• PE findings


  pain with tugging on pinna/ occluding tragus

  erythema, edema, exudate in canal

  visualize TM

  pneumatic otoscopy to check movement of TM
• bacterial otitis externa


  pseudomonas species, staphylococcus species, anaerobes, gram - organisms
• fungal otitis externa


  candida

  aspergillus
• prevention of otitis externa


  remove/ reduce risk factors
• treatment for mild cases of otitis externa


  analgesics- tylenol, ibuprofen

  acetic acid solution- domeboro
• bacterial tx otitis externa


  ofloxacin otic, ciprofloxacin otic

  can be combined with hydrocortisone drops as well
• fungal tx otitis externa


  otic clotrimazole
• how long to keep ear dry/ plugged for?

  a week or so during treatment
• complication of otitis externa


  malignant otitis externa