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Ear
The document describes various equipment, techniques, and procedures used in otolaryngologic examinations. It includes descriptions of: - Examination chairs and mirrors used to examine patients' ears, nose, and throat - Techniques for examining infants and children with an assistant's help - Common tests performed including tuning fork tests, audiometry, and tympanometry - Otoscopic examination techniques using different specula and equipment - Examination of the ear drum and conditions that affect its appearance - Surgical and non-surgical treatment options for various ear conditions
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Ear
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- 3. Diagnostic ENT Unit PatientChair Examiner Chair
- 4. • This mirroris concave • It reflects the light beam coming from a fixed source behind and above the left shoulder of the patient • It is placed just in front of the examiner’s right eye The Head Mirror
- 5. The head Lamp •Easy to use • Allows movement of the examiner • Portable so allows bed side examination
- 6. Examination of infant The assistantsits on the examination chair The infant is lying on the lap of the assistant The infant head is held by one of the assistant hand The body is held by the other assistant hand
- 7. • Examination ofchild patient The assistant sits on the examination chair The child sits on the lap of the assistant The child hands are grasped against the abdomen by one assistant hand The child head is grasped against the assistant chest by the other hand • Examination of child patient The assistant sits on the examination chair The child sits on the lap of the assistant The child hands are grasped against the abdomen by one assistant hand The child head is grasped against the assistant chest by the other hand
- 8. • The auricleis pulled upwards and backwards, Why? Answer: this will straighten the outer cartilagenous part because: • The outer cartilagenous part is directed upwards, backwards and medially • The inner bony part is directed downwards, forwards and medially
- 9. Hand Held Speculum •It is held by examiner’s hand • The speculum is placed in the cartilagenous part • The largest speculum that is comfortable is used to provide the best vision
- 10. Otoscopic Examination Advantage of Otoscope 1-Easyto use 2-Provides magnified view 3-Allows free movement of the examiner 4-portable
- 11. Pneumatic examination Left :Seigle’s Speculum Right : Pneumatic Otoscope To assess Mobility of Drum To perform Fistula test Valveless Rubber Pump
- 12. Examination under Microscope •Mention 2 advantages 1- provides magnified view with good illumination 2-allows the use of both hands
- 13. Enumerate2 tests doneby this instrument Mention the principle of every test Mention the results of each test in normal case and in conductive and sensorineural hearing loss Tunning fork
- 14. •Pure Tone Audiometry •Value: Usefull for diagnosis of: 1- Degree of Hearing Loss ( mild, moderate severe or profound) 2-Type of Hearing loss, ( CD, SNHL Or Mixed)
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- 16. • This audiogramshows normal hearing.
- 17. • This audiogramshows a typical picture of conductive deafness in a child’s left ear.
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- 19. Mixed conductive and sensorineuralhearing loss ?
- 20. • An exampleof a mixed deafness in the right ear. Both the bone conduction and air conduction tests show that there is a hearing loss and Air Bone Gap is also seen
- 21. • The audiogramhere shows a severe SN hearing loss.
- 22. 35 years oldmale patient C/O diminished hearing & tinnitus in Rt. Ear + vertigo 250 500 1000 2000 4000 8000 Hz Speech Discrimination Scores = Rt. Ear: 84% Lt. Ear: 100% 250 500 1000 2000 4000 8000 Hz 0 10 20 30 40 50 60 70 80 90 100 110 120 0 10 20 30 40 50 60 70 80 90 100 110 120 dB Q1- Comment on the type hearing loss. Q2- Give one possible etiology. dB Answer Right Sensorineural Hearing loss affecting the lower tones Left Normal Hearing One possible etiology is Meniere’s Disease
- 23. Tympanometry This graph isknown as……… type…….. and is diagnostic of…………. Normal Tympanogram Type Ad Type B Type C Secretory otitis media ET dysfunction Ossicular discontinuity Ossicular fixation e.g Otosclerosis
- 24. 30 years oldfemale patient Q1 – Comment on the type of tympanograms. Q2 – Give one possible etiology. Type AsTympanogram ( decreases compliance and normal pressure) One etiology: Otosclerosis
- 25. • On applicationof a loud sound to an infant (below 6 month) the infant responds by a reflex movement • This movement may be a jerk of the whole body called Moro or Startle reflex The Moro reflex
- 26. • This testis known as Positional Test • One disease diagnosed by this test is Benign Paroxysmal Positional Vertigo (BPPV)
- 28. 1- The Handelof Malleus 2-The Cone of Light 3-lateral process of Malleus 4-Pars Tensa 5-Pars Flaccida Normal Tympanic membrane 1 2 3 4 5
- 29. • The bonenumber…… is that one included in otosclerosis • The handle of the bone number…….. is foreshortened when the drum is retracted 1 2 3 • The bone number 3 is that one included in otosclerosis • The handle of the bone number 1 is foreshortened when the drum is retracted
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- 33. • Microtia withatresia of the External Auditory Canal Investigations • CT scan of Temporal bone • Audiological evaluation Treament Plastic surgery
- 34. Atresia of theexternal auditory canal Treatment Meatoplasty
- 35. Bat Ear Pre operativeand postoperative
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- 38. • Infected Preauricularsinus • Infection is clear (left) Investigations: • Culture and sensitivity of the discharge Treatment: - Systemic antibiotic - Analgesic antipyretic - Incision for drainage of pus - Later on: excision
- 39. Foreign body (FB)inthe external auditory canal - On the left side it is animate FB (insect), the treatment is to kill the insect by alcohol or oil before removal - On the left side it is animate FB (insect), the treatment is to kill the insect by alcohol or oil before removal
- 40. Cerumen impaction • Treatment -Removal by ear wash or instruments - If wax is hard, it should be softened by glycrine bicarbonate or hydrogen peroxide before ear wash
- 41. A brownish massin the external canal • Hearing loss & Tinnitus Wax accumulation Q- Symptoms in this patient are: 1-………….. 2-…………..
- 42. Complications ? • Perichondritis •Cauliflower ear Auricular hematoma
- 43. • Diagnosis :……….. •It is a complication of 1- ………….. 2-…………… • Diagnosis Cauliflower ear • It is a complication of 1- hematoma auris • 2- perichondrtitis
- 44. • Painless, slowlygrowing, solid tumor that distorts the auricle and changes the normal architecture. It resembles a cauliflower ear, but it is much harder and cannot be compressed by squeezing it with the fingers Chondroma of the Auricle
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- 46. • A 64-year-oldman presented with a 7-day history of pain and increased swelling behind his left ear. This 2-cm fluctuant, mass represented ………………………….., that required incision and drainage Infected sebaceous cyst
- 47. • Severe perichondritisof the left auricle with abscess formation
- 48. • Squamous cellcarcinoma (left) • Basal cell carcinoma (right) • Describe the character of each ulcer seen Everted edge Inverted beaded edge Necrotic floor
- 49. • Right Facialparalysis + vesicular eruptions of the concha • Diagnosis ? Ramsay Hunt Syndrome
- 50. Frunculosis of the externalauditory canal
- 51. Otomycosis • Right: whitishmassa filling the external canal ( Candida Albicans) • Left: black mass with hyphae and spores (asprigillus Niger) What is the main symptom that patient in patient ? • Itching
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- 54. Traumatic drum perforation Centralperforation in the pars tensa elliptical in shape with irregular hyperaemic sharp edge • In this pateint: 1-surgical treatment is mandatory 2- conservative treatment is not successful in most cases 3- The use of antibiotic ear drops is helpful 4- surgical treatment is indicated when the perforation fails to heal after 3 months Answer: 4
- 55. •Retracted Tympanic Membrane • Whatare the signs of Retracted Drum seen in this case? • Prominent lateral process of malleus • Fore-shortened handel of malleus • Distorted cone of light
- 56. Hyperaemic tympanic membrane Noticethe hyperaemia at the periphery of the tympanic membrane
- 57. • Bulging TympanicMembrane • Treatment of this patient : Myringotomy In infants, the tympanic membrane is thicker than in adults, so it does not bulge easily Don’ t wait for bulging drum and MYRINGOTOMY is done if there is persistent pain & fever for 48 hours
- 58. Right Lower MotorNeurone Facial Paralysis
- 59. Schirmer test • Principle:……………………………………………. •It is significant when…………………and this is seen if the lesion of ………….nerve is …………. A B
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- 61. central drum perforation SubtotalDrum Perforation
- 62. Moderate central perforation •Thickened Hyperaemic middle ear mucosa • Yellowish discharge is seen Before myringoplasty control of infection is needed
- 63. Attic drum perforationwith cholesteatoma
- 64. Chronic Suppurative otitismedia Granulation tissue
- 65. Atelectatic ear The drumis thin
- 66. Secretory otitis mediawith air bubles
- 67. Grommet tube inthe antero-inferior part of the tympanic membrane • The arrow points to ………….. which is situated in the…………quadrant of the ……….. • This patient is suffering from …………. • The arrow points to Grommet tube which is situated in the anteroinferior quadrant of the tympanic membrane • This patient is suffering from secretory otitis media
- 68. T tube inposition
- 69. Right Auricle ispushed anteriorly and inferiorly ?? Postauricular Mastoid abscess
- 70. • A patienton the operating table for mastoidectomy and drainage of Bezold abscess
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- 72. - Positive Kernigsign inability to extend the knee completely when the hip is flexed This sign is positive in MENINGITIS
- 73. Poaitive Brudzniski sign Reflexflexion of the hip and knees when the neck is flexed This sign is positive in MENINGITIS
- 74. Glomus tympanicum • Theearliest symptom in this disease is: ……… Pulsating tinnitus
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- 76. • Post AuralHearing Aid
- 78. • ITE (In-The-Ear)hearing aids