E T N M O D U L

E : T N M O D U L S R A E E 7 O S C E R E V IS IO N

ANATOMY

EAR ANATOMY : OUTER EAR

EAR ANATOMY: INNER EAR

OT Y P O C OS

OTOSCOPY • Pearly grey appearance, thin TM, semi-transparent, long process of incus and Eustachian Tube can be seen through the TM. • Annulus Fibrosa – thickened outer margin where the drum is attached to external canal • • Upper 1/5 th – Pars Flaccida Lower 4/5 th- Pars Tensa • Handle of Malleus – downwards and backwards • Light Reflex Normal Tympanic Membrane Right or Left Ear drum?

DIAGRAMMATIC REPRESENTATION OF NORMAL OTOSCOPE

OTOSCOPE QUIZ

WAX (CERUMEN) IMPACTION • Description? • Complications? • Tx?

AOM WITH EFFUSION (GLUE EAR) • Description? • Complications? • Tx? Bonus Question: What would a Tympanogram look like for this copndition?

OTITIS MEDIA (SEROUS) • Description? • Complications? • Tx?

CENTRAL PERFORATION OF EAR DRUM • Description? • Complications? • Tx?

GROMMET INSERTION • Description? • Indications? • Complications?

A R G O I UD S AM

UNDERSTANDING THE AUDIOGRAM • Volume : vertical axis represents volume (loudness) measured in decibels (d. B). • Pitch: horizontal axis represents frequency (pitch) which is measured in hertz (Hz). • 0 d. B does not mean that there is no sound at all. It is simply the softest sound that a person with normal hearing ability would be able to detect at least 50% of the time. • Normal conversational speech is about 45 d. B.

DIFFERENT SENSITIVITIES OF THE AUDIOGRAM Noticed by family and friends, between 21 d. B and 40 d. B Difficulty following speech, 41 d. B and 70 d. B Unable to hear speech, traffic unless its loud, 71 d. B to -95 d. B Greater than 95 d. B, unable to hear most sounds unless very loud

DIAGRAMMATIC REPRESENTATION OF THE AUDIOGRAM Speech Banana

NORMAL AUDIOGRAM Right ear air conduction = O bone conduction = [ or Δ Left Ear air conduction = X bone conduction = ] or triangle Δ.

AUDIOGRAM QUIZ

RIGHT SIDED, CONDUCTIVE DEAFNESS • • • Conductive or Sensorineural ? Right or Left Ear? Mild/Moderate/Severe/Profound? • Causes? • Management?

BILATERAL MILD SENSORINEURAL HEARING LOSS • • • Conductive or Sensorineural ? Right or Left Ear? Mild/Moderate/Severe/Profound? • Causes? • Management?

BILATERAL MODERATE SENSORINEURAL HEARING LOSS • • • Conductive or Sensorineural ? Right or Left Ear? Mild/Moderate/Severe/Profound? • Causes? • Management?

PRESBYACUSIS RIGHT SIDED • • • Conductive or Sensorineural ? Right or Left Ear? Mild/Moderate/Severe/Profound? • Causes? • Management?

PRESBYACUSIS, LEFT SIDED • • • Conductive or Sensorineural ? Right or Left Ear? Mild/Moderate/Severe/Profound? • Causes? • Management?

HEARING LOSS DUE TO MENIERE’S • • • Conductive or Sensorineural ? Right or Left Ear? Mild/Moderate/Severe/Profound? • Causes? • Management?

: Z I M A R AN A R T X E QU G O I UD A HTTP: //WWW. AUDSTUDENT. COM/TUTORI ALS/AUDIOTUTORIAL 2/AUDIOGRAMTUTO RIAL 2. HTM

Y R ET M Y T P M O N A

UNDERSTANDING THE TYMPANOGRAM A tympanogram provides several pieces of information including: • Compliance of the middle ear system (eardrum movement) • Ear canal volume • Middle ear pressure (normally equal to atmospheric pressure in healthy ears) Vertical – Compliance (can also give indication of Ear Canal Volume) Horizontal – Pressure in da. Pa Shaded area – normal tymanogram would fall into this area • A pattern that corresponds to various disorders

DIFFERENT PATTERNS OF A TYMPANOGRAM Type A Tympanogram Peak compliance occurs near the atmospheric pressure indicating normal pressure within the middle ear AD: A deep curve with a tall peak indicates an abnormally compliant middle ear system, as typically seen with ossicular chain dislocation or loss of elastic fibers in the tympanic membrane. AS: A shallow curve indicative of a stiff system, as seen in otosclerosis or thickened tympanic membrane.

DIFFERENT PATTERNS OF A TYMPANOGRAM Type B Curve • No Sharp peak in the curve • May be due to fluid within the middle ear space (otitis media), TM perforation or debris within the external ear (otitis externa)

DIFFERENT PATTERNS OF A TYMPANOGRAM Type C Peak compliance significantly below 0, less than – 200 indicating negative pressure (subatmopsheric) within the middle ear space, suggest Eustachian Tube Dysfunction or middle ear fluid

D O O G U L K C