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HEENT Ears
HEENT Examination
| Question | Answer |
|---|---|
| movable cartilage covered with skin | auricle/pinna |
| separated from the mouth by a fold of tissue on each side called anterior tonsillar pillars | Oropharynx |
| lymphoid tissue behind tonsillar pillars | Tonsils |
| movable cartilage covered with skin | auricle/pinna |
| Mastoid process= important Landmark | auricle/pinna |
| S-shaped pathway leading to the Middle ear | External Auditory Canal |
| 2.5 to 3 cm. long in adult | External Auditory Canal |
| This canal lining is protected and lubricated with cerumen | External Auditory Canal |
| Lymphatic drainage of the external ear | parotid , mastoid, superficial cervical nodes |
| air filled cavity in the temporal bone | Middle ear |
| It contains the ossicles ( malleus, incus,stapes) that transmit sound from the TM to the oval window of the inner ear | middle ear |
| Conducts sound vibration from outer ear to inner ear Protects the inner ear by reducing the amplitude of loud sounds Eustachian tube allows equalization of air pressure on each side of the ear drum to avoid rupture ( high altitudes) | Functions of Middle ear |
| Contains the Bony Labyrinth which holds the sensory organs for hearing and equilibrium | Inner ear |
| normal pathway of hearing, the most efficient | Air Conduction |
| bones of the skull vibrate and transmit vibrations to the inner ear and acoustic nerve | Bone Conduction |
| begins when the patient responds to your questions and directions. The patient responds without excessive requests for repetition | Rough quantitative test for hearing loss |
| Speech with a monotonous tone and erratic volume may indicate hearing loss | Rough quantitative test for hearing loss |
| Begins with the history:Conversational tone | Whisper test |
| may indicate the presence of hearing loss but not the degree | Whisper test |
| Sounds equal on both ears with normal neurosensory hearing and no conductive loss | Positive Weber Test |
| lateralization of the sound to one ear indicates a conductive loss on the same side or a perceptive loss/sensorineural loss on the other side | Negative Weber test |
| Rinne test= AC>BC both ears | Positive Rinne Test |
| a.Outer ear- cerumen, foreign body,polyp in the external auditory canal | Tinnitus |
| Middle ear – inflammation ,otosclerosis | Tinnitus |
| Internal ear- fever, suppuration of the labyrinth, SY, acoustic nerve tumor fracture at the base of the skull, meniere syndrome | Tinnitus |
| quinine, salicylates, aminoglycosides, gentamicin | Tinnitus |
| pain may arise from inflammation of structure in the ear or be referred from other pharyngeal sites including the thyroid | Otalgia |
| trauma,hematoma,frostbite,burn,eczema, lnsect bites, impetigo, herpes zoster | Otalgia (auricle) |
| otitis externa ,carbuncle, eczema, hard cerumen, FB, herpes zoster | Otalgia (middle ear) |
| unerrupted lower third molar, carious teeth, tonsillitis, carcinoma of pharynx, trigeminal neuralgia , subacute thyroiditis | Otalgia (referred) |
| - described as being unsteady, weak, light headed or having the feeling of turning | Dizziness |
| Idiopathic: multisystem atrophy Infectious: tabes dorsalis, meningitis, encephalitis, brain abscess Metabolic/ nutritional : pellagra, Vit.B1 def.,fluid & electrolyte imbalance | Dizziness |
| Endocrine: hypothyroidism, pregnancy Neurologic :migraine, peripheral neuropathy Vascular: hypertension, orthostatic hypotension | Dizziness |
| persistent stimulation of the semicircular canals or vestibular nucleus when the head is at rest | Vertigo |
| It gives a hallucination of motion When the eyes open, the patients surrounding seems to be whirling or spinning - When the eyes closed, the patient continues to feel in motion | Vertigo |
| Causes: Peripheral labyrinthine System: otitis media with effusion, otosclerosis,temporal bone fracture Central labyrinthine system: migraine,intracranial abscess | Vertigo |
| Cranial VIII infections: Acute meningitis, tumors tuberculous meningitis, Brainstem nuclei: encephalitis, brain abscess,multiple sclerosis, hemorrhage | Vertigo |
| Hearing loss seen in people with external or middle ear problems | Conduction deafness |
| Causes include: obstruction of external auditory canal (FB, impacted cerumen) Disorder of the eardrum & middle ear ( perforated TM, pus/blood in the ME ) Overgrowth of bone with fixation of the stapes ((Otosclerosis) | Conduction Deafness |
| Hearing loss involving the internal ear | Sensorineural deafness |
| Causes: - disorders of the cochlea or the acoustic nerve (CN 8) Aging ( Presbycusis ) due to nerve degeneration Trauma Drug toxicity Tumors infections Heredity/congenital deafness | Sensorineural deafness |
| Microtia | small ear |
| Macrotia | Large ear |
| Satyr ear | pointed pinna |
| aztec or cagot ear | lobe development failure |
| Right angle protrusion of the Pinna | Lop or bat ear |
| untreated hematomas heal as nodular and bulbous irregularities of the helix and antihelix -result of blunt trauma and necrosis of the underlying cartilage | Cauliflower ear |
| harmless developmental eminence in the upper 3rd of the posterior helix | Darwin's Tubercle |
| whitish uric acid crystals covering parts of the ear | gouty tophus |
| due to excessive production of wax or a narrowed meatus leads to partial or complete obstruction of the canal - complete obstruction leads to partial deafness acc. by tinnitus or dizziness | cerumen impaction |
| Seen in Serous Otitis media - more concave TM - accentuated bony landmarks - distorted light reflex | Retracted Tympanic Membrane |
| seen in Acute suppurative otitis media more conical loss of bony landmarks distorted light reflex | Bulging tympanic membrane |
| Yellow otorrhea discharge | melted cerumen |
| serous discharge: eczema in the meatal wall,early ruptured acute OM | Otorrhea |
| Bloody otorrhea | temporal bone fracture |
| chronic external otitis media chronic suppurative OM,cholesteatoma, TB, polyps | otorrhea, purulent |
| Chronic suppurative otitis media | ass. with permanent perforation of the eardrum -hearing is always impaired - painless aural discharge - pain and vertigo indicates development of complications like brain abscess |
| collection of desquamated epithelial cells in the middle ear | Cholesteatoma |
| foul smelling discharge, marginal perforation,hearing loss, pearly gray mass | Cholesteatoma |
| most frequent cause of vertigo | Acute Labyrinthitis |
| patient gradually develop a sense of whirling that reaches a climax in 24-48 hrs. disappear gradually in 3-6 wks | Acute Labyrinthitis |
| Benign Paroxysmal positional Vertigo (BPPV | Calcium deposits in the labyrinth ( otoliths) are dislodged and move in response to gravity eliciting a feeling of motion |
| Benign Paroxysmal positional Vertigo (BPPV | More common in older individuals Sudden onset, often when rolling over in bed or arising in the morning No headaches/fever but with nausea and inability to stand |
Created by:
betahelix
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