NUR 149 2nd SEMESTER

A.Y. 2022-2023 e&V, RE&s,g&c

ASSESSMENT AND DIAGNOSTIC EVALUATION OF THE EXTERNAL, MIDDLE AND INNER
EARS

ANATOMY OF THE EARS Tympanogram Measures middle

ear muscle reflex
Tympanic
membrane
to sound compliance
stimulation and
compliance of the
tympanic
membrane by
changing the air
pressure in a
sealed ear canal.
Electro- Measurement and Oculomotor
nystagmography graphic recording and vestibular
of the changes in system for
electrical Meniere's
potentials created diseases or
by eye any
movements during pathological
spontaneous, findings in the
positional, or middle and
calorically evoked inner ear.
nystagmus.
Platform Investigates Balance and
posturography postural control equilibrium
capabilities such
as vertigo.
Sinusoidal Used to assess Oculomotor
harmonic the vestibule- and vestibular
acceleration ocular system by system for
analyzing Meniere's
compensatory eye diseases or
movements in any
response to the pathological
clockwise and findings in the
counterclockwise middle and
rotation of the inner ear.
chair.
Middle ear Evaluates Anatomy of
endoscopy suspected the middle
perilymphatic and inner ear
fistula and new-
DIAGNOSTIC EVALUATIONS onset conductive
NAME DEFINITION EALUATION hearing loss, the
OF: anatomy of the
Audiometry round window
1. Pure-tone 1. The sound • Frequency
before
audiometry stimulus • Pitch
transtympanic
2. 2.Speech consists of a • Intensity treatment of
audiometry pure or musical Ménière’s disease,
tone and the tympanic
2. The spoken cavity before ear
word is used to surgery to treat
determine the chronic middle ear
ability to hear and mastoid
and discriminate infections
sounds and
word

MS LEC EXTERNAL MIDDLE AND INNER EARS, TCGGUILLERMO

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 HEARING LOSS
Sensori Neural Hearing Loss - SNHL - Inner
Ear Hearing Loss
- A damage to the inner ear, the auditory nerve or
the central auditory pathways usually leads to a so-
called Sensorineural Hearing Loss (SNHL). In that
case the sensory receptors - the hair cells - within
the organ of Corti are damaged. Various inner and
outer hair cells of the cochlear are connected to the
nerve fibers of the auditory nerve. If a damage in
those sensory receptors occurs, the supporting
nerve fibers start degenerating. There is not much
degeneration as long as the support through the
hair cells is still appropriate.
CAUSES:
• Presbycusis (age related hearing loss)
• Noise induced
• Genetics
• Diseases
• Ototoxicity (of medical drugs or other
substances)

Conductive Hearing Loss – SNHL – Inner Ear

Hearing
- Loss If the sound cannot be transferred
(completely) via the outer and the middle ear
into the inner ear, the reason is a Conductive
Hearing Loss (CHL). The cause for that
blockage can be anywhere on the pathway
from the outer to the inner ear- in the pinna,
the external auditory canal, the tympanic
membrane, the ossicles. A pure Conductive
Hearing Loss is not accompanied by a
sensorineural component; therefore, the
inner ear hears normal as soon as the sound
can be transferred to it.
CAUSES:
• Excessive Cerumen
• Exostosis
• Aural Atresia
• Chronic Otitis Externe
• Chronic Otitis Media
• TM perforation
• Cholestestome
• Otosclerosis
• Ossicular chain
• disarticulation

• Mixed Hearing Loss – MHL

- As soon as a patient's hearing loss shows
conductive and sensorineural characteristics,
it is called a Mixed Hearing Loss (MHL). A
Mixed Hearing Loss may be pure

MS LEC EXTERNAL MIDDLE AND INNER EARS, TCGGUILLERMO

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 sensorineural at the beginning leg
Presbycusis) and a conductive component Otitis External
develops over time-for example as a result of
an Otitis Media. As well, the hearing loss may
be conductive first and a sensorineural DEFINITION
component develops over time (e.g., due to - Inflammation of the external auditory canal
an infection). It is also possible that the CAUSE
conductive and the sensorineural component - Bacterial: Staphylococcus aureus and
develop simultaneously due to a head trauma Pseudomonas species - Fungal:
or due to surgery for example. Aspergillus
CAUSES: CLINICAL MANIFESTATION
• The causes for Mixed Hearing Loss are diverse - Otalgia
- Visible wet/dry wax in the EAC
and could be any combination of pathologies - Aural tenderness
that lead to a SNHL or CHL - Fever, cellulitis, and lymphadenopathy
TYPE OF HEARING LOSS
- Conductive
MANAGEMENT
- Analgesic for pain Burow's solution (ear
wick dipped in HC otic solution to
decrease inflammation of the EAC
Antibiotics and antifungal

Perforated Tympanic Membrane

PATHOLOGIES OF THE EXTERNAL AUDITORY CANAL DEFINITION

- Hole in the tympanic membrane
CAUSE
- Middle ear infection (OM) Trauma or
Barotrauma (loud sounds or blasts foreign
body/objects
CLINICAL MANIFESTATION
- Visible hole the TM (Otoscopy)
TYPE OF HEARING LOSS
- Conductive
MANAGEMENT
- Tympanoplasty

Exostosis (Swimme’s or Surfer’s ear)

DEFINITION
- Formation of a new bone on the surface
Cerumen Impaction
of the ear canal bone
CAUSE
DEFINITION
- Accumulation of excessive wax in the EAC - Hereditary Chronic irritation of the skin in
CAUSE ear canal Repeated exposure to cold
- Incomplete drainage of the wax water/weather.
CLINICAL MANIFESTATION CLINICAL MANIFESTATION
- Otalgia - Otalgia
- Visible wet/dry wax in the EAC
TYPE OF HEARING LOSS
- Visible bone growth (Otoscopy)
- Conductive TYPE OF HEARING LOSS
MANAGEMENT - Conductive
- Irrigation/suctioning - Manual removal via MANAGEMENT
curette - Abnormal bone removal via surgery
(chisel)

MS LEC EXTERNAL MIDDLE AND INNER EARS, TCGGUILLERMO

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 PATHOLOGIES OF THE MIDDLE EAR Otosclerosis

DEFINITION
- Fixation of the states due formation of a new
abnormal spongy bone around the oval
window.
CAUSE
- Unknown, but considered to be hereditary
CLINICAL MANIFESTATION
- Decreased hearing in the affected ear - May
or may not complain of tinnitus - Schwartze’s
Sign
TYPE OF HEARING LOSS
- Conductive
- Mixed hearing loss
MANAGEMENT
- Sodium fluoride use
- Hearing aids
Acute Otitis Media - Stapedectomy or stapedotomy

Motion sickness
DEFINITION
- Acute infection of the middle ear or DEFINITION
Eustachian tube - Disturbance of equilibrium
CAUSE CAUSE
- Streptococcus pneumoniae (most common) - Constant motion/vestibular overstimulation
- Haemophilus influenzae Moraxella CLINICAL MANIFESTATION
catarrhalis - Sweating
CLINICAL MANIFESTATION - Pallor
- Rapid onset otalgia Inflamed TM with middle - Nausea & vomiting
ear effusion Fever TYPE OF HEARING LOSS
TYPE OF HEARING - N/A
- Conductive (temporary) LOSS MANAGEMENT
MANAGEMENT - OTC antihistamines (Dimenhydrinate or
- Broad-spectrum antibiotics Myringotomy Meclizine HCL)
(Tympanotomy) - Anticholinergic (Scopolamine)

Chronic Otitis Media Benign Paroxysmal Positional Vertigo

DEFINITION
DEFINITION - Occurs when the position of the patient’s
- Recurrent AOM causing irreversible head is changed with respect to gravity,
tissue pathology and persistent typically by placing the head back with the
perforation of the tympanic membrane. affected ear turned down.
CAUSE CAUSE
- Same as AOM - Disruption of crystals within the semicircular
CLINICAL MANIFESTATION canal
- Persistent foul CLINICAL MANIFESTATION
- -smelling otorrhea - Dizziness
- Mastoiditis - May or may not have tinnius
- Cholesteatoma - Vertigo (via electronystagmography (ENG) or
TYPE OF HEARING LOSS videonystagmography (VNG)
- Conductive MANAGEMENT - Nausea & vomiting
- Suction (visible otorrhea) TYPE OF HEARING LOSS
- HC Otic instillation - N/A
- Tympanoplasty MANAGEMENT
- Ossiculopathy - Bedrest Meclizine HCL - Canalith repositioning
- Mastoidectomy (Sermont and epley maneuver)

MS LEC EXTERNAL MIDDLE AND INNER EARS, TCGGUILLERMO

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Meniere’s Disease CAUSE
- Usually arises from the Schwann cells
covering this nerve and grows slowly or
DEFINITION not at all
- Abnormal inner ear fluid balance caused CLINICAL MANIFESTATION
by a malabsorption in the endolymphatic - Hearing loss
sac or a blockage in the endolymphatic - Tinnitus
duct. - Vertigo
CAUSE - Facial numbness and weakness or loss
- caused by endolymphatic hydrops of the of muscle movement
labyrinthine system of the inner ear TYPE OF HEARING LOSS
CLINICAL MANIFESTATION - Sensorineural
- Triad: Vertigo, tinnitus, hearing loss MANAGEMENT
- Sensation of fullness in the affected ear - Removal of the neuroma via surgery
TYPE OF HEARING LOSS
- N/A
MANAGEMENT
- Low-sodium diet
- Antihistamine, antiemetics, diuretics
- Gentamicin and cortisone injections
Endolymphatic sac, or shunt, surgery
- Vestibular nerve section Labyrinthectomy

Tinnitus

DEFINITION
- An underlying disorder of the ear that is
associated with hearing loss.
CAUSE
Conductive HL:
- external ear infection
- acoustic shock
- cerumen
- middle ear effusion
- superior canal dehiscence
SNHL:
- excessive or loud noise
- presbycusis
- Meniere’s disease
- acoustic neuroma
- mercury or lead poisoning
- ototoxic medications
CLINICAL MANIFESTATION
- Roaring, buzzing, or hissing sound in one
or both ears
TYPE OF HEARING LOSS
- Conductive or Sensorineural AURAL REHABILITATION
MANAGEMENT
- No known treatment but auditory Hearing Aids (two types)
rehabilitation/ conditioning is considered. o Occluding the EAC
▪ Complete in the canal (CIC)
Motion sickness ▪ In the canal (ITC)
▪ In the ear (ITE)
DEFINITION
▪ Behind the ear (BTE)
- Slow-growing, benign tumors of cranial
o Do not occludes the EAC
nerve VIII, usually arising from the
▪ Open fit hearing aids
Schwann cells of the vestibular portion of
▪ Contralateral routing of sound (CROS)
the nerve.
HAs

MS LEC EXTERNAL MIDDLE AND INNER EARS, TCGGUILLERMO

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Implanted Hearing Devices
o Cochlear implants
o Bone conduction device
o Auditory brainstem implant
Hearing Guide Dogs

MS LEC EXTERNAL MIDDLE AND INNER EARS, TCGGUILLERMO