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AssessI, Chpt2
CNRAssessI, Chpt1,Earache
| Question | Answer |
|---|---|
| Otalgia means? | ear pain |
| Otalgia is generally caused by? | an inflammatory process |
| In children, inflammation most commonly occurs in which part of the ear? | middle ear |
| In adults, inflammation most commonly occurs in which part of the ear? | external ear conditions or from referred pain from other head and neck structures |
| AOM? | acute otitis media; refers to any inflammation of the middle ear and encompasses a variety of clinical conditions |
| Other names for Otitis media with effusion (collection of fluid in the middle ear? | serous otitis media, nonsuppurative otitis |
| 5 Questions for earache to figure out if its an acute infection (AOM)? | How old are you? Do you have a fever? Have you had an URI? Have you had ear infections before? Is there a family history of ear infections? |
| 5 Questions to find out if pt is at increased risk of AOM due to their environment? | 1. Does anyone around you smoke? Do you smoke? 2 Have you been swimming recently? 3. Have you recently been in an airplane or been scuba diving? 4. Child: Do you attend day care? 5. Child: Does infant take a bottle lying down? |
| 3 questions to help determine if this is a systemic disease? | Do you have diabetes? Have you ever had dermatitis, eczema, or psoriasis? Child: Does the child have a nonrepaired cleft palate? |
| 5 questions to ask concerning pain? | Where is the pain felt specifically? 1/2 ears; How sever is the pain? Does it interfere with activities? How long? Constant or intermittent? Radiation? |
| 4 Questions to assess hearing loss? | Do you have any difficulty hearing? Dizziness? Ringing in ear? Child:Can child hear normally? Child: Does child turn head to listen |
| Incidence of AOM declines at what age? | after 6 |
| AOM over 6 years is likely caused by? | secondary otalgia by disorders of the head, face and neck; sinus or periodontal disease; and malignancy |
| Incidence of fever with AOM? | present in 60% of children; high fever accompanying OM is more likely to occur as part of a systemic illness like pneumonia/ meningitis |
| Fever with AOM is uncommon with which pts? | pts under 2 months old |
| How can URI cause AOM? | mucous membr of the nasopharynx/sinuses b/c infected, bact. forced up lumen of eust tube. Mucosa inflam/ enlarged adenoids obstruct the eust. opening-air in middle ear replaced by mucus. (great for bact growth) |
| At what age do infants have a high risk of recurrence? | Infants younger than 3 mo who have their first AOM run a high risk of recurrence |
| Why are infants with chronic otitis media predisposed to additional ear infect? | Chronic OM can result in anatomical changes to the tympanic membrane and middle ear ossicles, which may predispose the pt to additional ear infect. |
| How does family history affect the incidence of OM? | having a sibling or parent with chronic OM makes it twice as likely of the illness to develop in the child. |
| How does smoke exposure affect the incidence of OM? | second hand cigarette smoke exposure has been assoc with a 2x increased risk of OM (leads to functional eust tube obstruction and decreases the protective cilliary action in the tube) |
| How does day care attendance affect the incidence of OM? | exposure to the organism from other children |
| How does bottle propping affect the incidence of OM? | lying supine while drinking from a bottle- swallowing while lying down allows nasopharyngeal fluid to enter the middle ear with subsequent infection |
| How does swimming affect the incidence of OM? | prolonged immersion in H2O results in loss of protective cerumen and chronic irritaition with maceration from excessive moisture in the canal (otitis externa-swimmer’s ear) |
| How does airplane travel/diving affect the incidence of OM? | barotrauma is a cause of acute serous otitis related to pressure changes from scuba diving or flying-failure of the eusta. Tube to open and equilibrate during descent results in a collection of s.s. fluid in the middle ear |
| How does DM affect the incidence of OM? | predisposes adults to malignant otitis externa (cellulites involving the ear and surrounding tissue. Pts w/ DM are also at more risk for otitis media and mastoiditis |
| How does h/o of seborrheic dermatitis/ psoriasis affect the incidence of OM? | Chronic inflame. Dermatitis from overproduction of sebum can occur in the external canal and cause otitis externa |
| How does cleft palate affect the incidence of OM? | nonrepaired anomalies anatomically predispose a child to otitis media because of functional obstruction of the eustachian tubes |
| Pain of otits exterena is described as? | tenderness around the outer ear or opening to the ear canal that worsens with manipulation of the pinna-usually bilateral, may be accompanied by itching |
| Pain of mastoiditis is described as? | severe pain or tenderness over the mastoid bone |
| Pain of AOM is described as? | referred pain that’s usually unilateral, deep pain or a blockage of the ear |
| Pain of serous otitis is described as? | painless/ a bubbling, popping or stuffy sensation in the ear |
| Pain of cerumen impaction is described as? | milder pain or vague discomfort of stuffed ears |
| Severity of pain of AOM? | is severe enough to interfere with sleep and may be suddenly relieved if the eardrum perforates; chronic ear pain that is unresponsive to tx may indicate a tumor |
| Pain of TMJ is described as? | severe pain lasting a few minutes and recurring 3/4 times a day sometimes associated with a headache. Worse in the morning b/c of nighttime teeth grinding; intermittent; can be acute r/t trauma or overextension of the mouth |
| Chronic jaw pain may indicate? | dental malocclusion or rheumatoid arthritis |
| Look for what s/s to indicate compression/ increased pressure in the ears with infants? | infants may cry when sucking to indicate pain with compression and increased pressure in the ears. |
| Nocturnal onset of otalgia from a developing infection is caused by? | increased vascular pressure in the reclined position, causing the TM to bulge and stimulate pain sensation Itching /drainage from the ear usually indicates? |
| Cholesteatoma? ) | epidermal inclusion cyst of the middle ear or mastoid, a perforation of the TM and associated foul smelling discharge may occur |
| Cerumen impaction can csuse? | hearing loss, tinnitus, pressure sensation, vertigo and infection |
| Tinnitus? | ringing in the ears |
| How does loud noise affect hearing? | exposure ot high pitched and loud noises for a prolonged period of time destroys the cochlear hair cells |
| S/S of infants with ear pain? | exhibit behavioral changes that may indicate pain, such as irritability, lethargy, poor appetite, vomiting, diarrhea, young children may also tug at their ears |
| Hearing loss can indicate? | blockage of the ear canal by cerumen or a foreign body, inflammation of the middle or inner ear, or a neoplasm, conductive hearing loss, chronic OM (infection spreads to other parts of the ear causing hearing loss), perforated nonhealing TM |
| Most frequent cause of hearing loss is? | conductive hearing loss caused by blockage of the external canal, usually by cerumen |
| How do you remove cerumen obstructions? | lavage or by separating an impaction with an ear curette so that irrigation fluid can penetrate behind the impaction; the curette must be manipulated cautiously b/c trauma to or inflammation of the sensitive perichondrium elicits sever pain and bleeding |
| When should a ear lavage not be performed? | if history suggests perforation of the TM |
| Battle’s sign? | hemorrhage over the mastoid bone may occur with a basal skull fracture |
| Psoriasis? | eczematous seborrhea manifests as redness and scaling of the skin that can extend into the external ear canal. Fungal and yeast infections of the ear appear as? |
| Hot swollen and erythematous ear of surrounding skin may indicate ? | cellulitis |
| Furuncles? | Boil, skin dx caused by the infection of hair follicles, results in the localized accum. of pus and dead tissue. Indiv. boils can cluster together and form an network of boils called carbuncles. may develop to form abscesses. |
| With mastoiditis, palpation of the ears reveals? | pinna is displaced forward and swelling may be present behind the ear, severe tenderness |
| Postauricular swelling may indicate? | extension of infection into the mastoid cavity |
| Preauricular nodes may be enlarged with? | AOM and otitis media |
| With cerumen impacation, upon inspection, what will you see? | no structures can be visualized |
| Vesicles on the external ear can and auricle may indicate? | herpes zoster (Ramsay Hunt Syndrome |
| What kind of discharge is usually seen with otitis externa? | chessy, green blue or gray discharge |
| How does a normal TM look? | translucent and pearly gray in color; mild diffuse redness can occur from crying or coughing, mild vascularity is sometimes seen in the normal eardrum, especially on the handle of the malleus |
| Whitening and opacification of the TM can be caused by? | scarring and effusion |
| What is the contour of the normal TM? | concave; |
| Fullness or bulging of the TM indicates? | either increased air pressure or more commonly increased hydrostatic pressure within the middle ear. |
| Concavitiy or retraction of the eardrum is associated with? | negative middle ear pressure or postinflammatory adhesions |
| As the eardrum retracts, what happens? | the handle of the malleus short process become more visible |
| Myringitis? | is a red inflamed eardrum without effusion |
| Bullous myringitis? | describes an extremely painful condition of small blisters on the TM caused by bacterial otitis media |
| What can lead to cholesteatoma? | chronic otitis media, the cholesteatoma mass can grow to cause necrosis of the ossicles. Examination will reveal a collection of white granulation tissue with perforation of the TM |
| Insufflation? | tests the mobility of the TM. It can be an insensitive test for otitis media if poor technique fails to create a seal |
| How do you perform insufflation? | use a large speculum to create a seal. A normal finding elicits a slight motion of the TM when air is insufflated. This movement is compared with the opposite ear. |
| With insufflation, a TM that has been retracted as a result of negative middle ear pressure or adhesions does what? | does not move with inflation, but rebound mobility is seen when the bulb is released. |
| What inhibits movement of TM when air is insufflated? | Any accumulation of liquid in the middle ear (effusion) or scarring |
| How is hearing acuity tested? | whisper test and a tuning fork for the Rinne and Weber test |
| How do you test to determine whether air or bone conduction loss is present with ear pain? | the sensory function of the acoustic nerve (CN VIII) |
| The Weber test is preformed with? | 512 HZ or higher frequency tuning fork |
| How do you perform the Weber test? | firmly place the vibrating tuning fork on a midline pt of the skull. If here is unilateral conductive hearing loss, sound will lateralize to the ear with loss |
| With the Weber test, why does the sound lateralize to the ear with loss? | because the better ear is being distracted b ambient noise. |
| With the weber test, what happens if the pt has unilateral sensorineural loss? | the sound will lateralize to the better ear because the neural pathway is interrupted on the affected side. |
| With the weber test, equal perception of vibration can indicate? | normal hearing or bilateral hearing loss |
| What does the Rhinne test do? | It compares air conduction with bone conduction |
| What should the result of the Rhinne test be? | ratio should be 2:1 |
| With the Rhinne test, what does better sound transmission through the bone than though air indicates? | a 20-30 decibel (dB) conductive loss |
| Conductive hearing loss? | results when sound transmission is impaired through the external or middle ear |
| Sensorineural hearing loss results from? | defect in the inner ear |
| What action should be taken if referred pain is suspected? | conduct a more extensive neuro exam and assess for TMJ disorder |
| Intraotic manipulation is used for? | to help diagnose TMJ. Pain will be elicited in 90% of pts with TMJ disorder |
| How do you perform Intraotic manipulation? | TMJ pain can be replicated by instructing the pt to open the mouth wide. Face the pt, insert a single fingertip in each ear, and pull the pt toward you as the pt opens and closes the mouth |
| What cranial nerves do you assess for ear pain? | evaluate cranial nerves V,VII, and IX |
| CNV? | ask pt to bite and clench the teeth; assess intactness of sensation to pain and light touch using a sharp/dull stimulus over the three branches of CNV |
| Which two CN innervate taste sensation to the tounge as well as sensation to the inner ear? | CNIX (posterior 1/3) and CN VII(anterior 2/3) |
| How do you test CNII? | test taste sensation by having the pt protrude the tongue and apply sweet and salty substances separately to each half of the tounge |
| How do you test CNIX? | test taste sensation by having the pt protrude the tongue and apply bitter and sweet substances |
| How do you assess tympanometry? | Insert a probe into the external ear canal while pressure against the eardrum is continually changed to assess the mobility of the TM |
| Tympanometry assesses? | Mobility of the TM |
| What does a typanogram provide? | An indirect measure of pressure in the middle ear |
| With typmapnometry, under normal middle ear pressure in the middle ear, what shape does the TM take? | ), The TM absorbs the sound energy waves and produces a bell-shaped pattern that peaks when sound pressure is introduced (Under normal middle ear pressure) |
| With typmapnometry, with negative or positive middle ear pressure in the middle ear, what shape does the typanogram take? | ), The tympanogram results in a flat pattern or an early peak pressure |
| Audiometry assesses? | the frequency and intensity of sound that can be perceived. |
| How do you perform audiometry? | an air conduction audiometer transmits a pure tone via earphones; the tone has variable frequency and intensity settings to test each ear separately |
| What is the goal of audiometry? | to test the lowest decibel intensity that can be heard for each frequency tested |
| What is considered a normal threshold for audiometry? | a threshold of up to 20 dB; at a higher level, hearing loss is graded as mild, moderate, moderately server, severe or profound |
| When do radiographs of the mastoid bone show clouding of the air cells? | when otitis media is present |
| On radiography, chronic mastioditis may reveal? | decalcification of the bony wall between the mastoid air cells |
| CT of the temporal bone is helpful in diagnosing? | choesteatoma and congenital syndromes |
| External otitis is more common in ? | adults, especially those with diabetes, ear pickers, or swimmers |
| 4 S/S with external otitis? | biltateral itching; discharge; inflame , swollen external canal; pain with movement of pinna; |
| With otitis media, how does the TM look? | TM is normal or not visible |
| Diagnostic study with external otitis? | none |
| Acute otitis media is most common in what type of pts? | Children under 6 years of age; those with smoke exposure; recent URI; severe or deep pain |
| 8 physical findings with acute otitis media? | unilateral; sensation of fullness; red bulging TM; fever; decreased light reflex; opague TM; decreased TM mobility |
| Diagnostic studies for acute otitis media? | none initally |
| Serous otitis is more common in which pts? | more common in children but occurs in adults with recent URI |
| Physical finding with serous otitis? | sensation of crackling; decreased hearing; fluid line or air observed behind TM; conductive hearing loss; decreased TM mobility |
| Diagnostic study with serous otitis? | tympanogram |
| Common pt complaints with cholesteatoma? | hearing loss; recent peforated TM |
| Physical findings with Cholesteatoma? | Pearly white lesion on or behind TM |
| Diagnostic studies to detect Cholesteatoma? | Immediate referral |
| Common pt complaints with mastoiditis? | history of recent otitis media; chronic otitis pain behind the ear |
| Physical findings with Mastoiditis? | swelling over mastoid process; fever; palpable tenderness and erythema over the mastoid process |
| Diagnostic studies to detect Mastoiditis? | Radiograph of mastoid sinuses reveals cloudiness; referral |
| Foreign body or cerumen impaction is most common is what type of patients? | children and adults |
| Common pt complaints with foreign body or cerumen impaction? | c/o pain or vague sensation of discomfort; decreased hearing |
| Physical findings with foreign body or cerumen impaction? | visualize foreign body or cerumen; may detect foul odor; conductive hearing loss |
| Diagnostic studies to detect foreign body or cerumen impaction? | none |
| Physical findings with barotrauma? | Retraction or bulging of TM; perforation of TM; fluid in canal |
| Diagnostic studies to dectect barotrauma? | tympanogram |
| Barotrauma is most common is what type of patients? | pts with history of flying or diving |
| Common pt complaints with barotrauma? | Hearing loss; sensation of fullness; history of recent nasal congestion |
| Physical findings with trauma? | Peforation of TM |
| Diagnostic studies to detect trauma? | radiographs/CT sacn as directed by injury |
| Is most common is what type of patients trauma? | h/o trauma (penetrating or blunt) |
| Physical findings with cervical lymphadenitis? | Enlarged, tender, cervical lymph nodes; ma see early onset of AOM in children |
| Diagnostic studies to detect cervical lymphadenitis? | throat culture if indicated; in adolescents Monospot if indicated |
| Common pt complaints with cervical lymphadenitis? | history of cervical node swelling; pain in ear |
| Cervical lymphdenitis is most common in what type of pts? | children |
| Cervical nerves 2, 3 (referred pain) is most common is what type of patients? | |
| Assessment for referred pain from cervical nerves 2, 3? | dermatone evaluation of cervical nerve: pain is perceived in these areas; the ear examination will be normal |
| Common pt complaints with referred pain in cervical nerves 2,3? | pain in skin and muscles of neck and in ear canal |
| Common pt complaints with referred pain from cranial nerves? | history, depending on CN involved |
| Diagnostic studies to detect cervical nerves 2, 3 (referred pain)? | none |
| Assessment for referred pain with cranial nerves? | test function of CNs V, VII, IX and X; ear examination normal |
| Diagnostic studies to detect cranial nerves (referred pain)? | |
| Common pt complaints with TMJ disorder? | disccomfort to severe pain; unilateral; pain worse in morning |
| TMJ disorder is most common is what type of patients? | more common in adults; 50% related to dental problems |
| Physical findings with TMJ disorder? | malocclusion; bruxism; normal external and middle ear structures and function; jaw click; abnormal CN function; ear examination normal |
| Diagnostic studies to detect TMJ disorder? | none |
| Malocclusion? | a misalignment of teeth and/or incorrect relation between the teeth of the two dental arches |
| The upper dental arch is called the? | maxilla |
| The lower dental is called the? | mandible |
| Bruxism? | is the grinding of the teeth, and is typically accompanied by the clenching of the jaw; more common sleep disorder |
| Bruxism as a habit can lead to? | muscle spasm and inflammatory reactions, thus causing the initial pain. Changes in the normal stimuli or height of the teeth, misalignment of the teeth, and changes in the chewing muscles may cause temporomandibular joint changes |
| Another name for jaw click? | jaw tightening |
| Jaw click can be a symptom of ? | TMJ |
| How does Tetanus occur? | when a wound becomes contaminated with bacterial spores. Infection follows when spores become activated and develop into gram-positive bacteria that multiply and produce a very powerful toxin (poison) that affects the muscles. |
| Where are Tetanus spores found? | throughout the environment, usually in soil, dust, animal waste; bacteria (Clostridium tetani) enters any break in skin eg puncture wounds, caused by rusty nails, splinters, insect bites, burns; not transmitted from person to person. |
| S/S of tetanus? | severe, uncontrol. muscle spasms; jaw "locked" by spasms, causing the dx to sometimes be called "lockjaw." In severe cases, the muscles used to breathe can spasm, causing a lack of oxygen to the brain and other organs that may possibly lead to death |
| Mastication means? | chewing |
| TMJ syndrome can be caused by? | trauma, disease, wear due to aging, or habits |
| How can clenching lead to a clenched jaw? | Someone who clenches continually bites on things while awake. This might be chewing gum, a pen or pencil, or fingernails. The constant pounding on the joint causes the pain. Stress is often blamed for tension in the jaw, leading to a clenched jaw. |
| What does gnashing mean? | bruxism, due to clenching of the teeth other than in chewing and is associated with forceful lateral or protrusive jaw movements. This results in grinding or rubbing the teeth together |
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