Take this Quiz if You Dare!!!

1. Take this Quiz if You Dare!!! The Ear

2. Cerumen glands are found where? • In the outer half of the external ear that is made of cartilage • What is the inner half made of? • The inner half of the external ear is made of bone.

3. What is the course of an Adult Ear?How would you pull the auricle during the exam? • The canal has a downward and forward course • Up and back

4. What is the course of the ear in an infant? What do you do to the auricle? • There is a more superior course in infants • You must pull the auricle down and back

5. What is the name of an infection in the outer , middle, and inner ear? • Out = otitisexterna • Middle = otitis media • Inner = otitisinterna

6. Name the parts of the middle ear? • The auditory ossicles • Malleus • Incus • Stapes • The tympanic membrane

7. Embryologically, the middle ear is an outpouchingfrom what? • The pharynx. That is why it has a mucus membrane.

8. What connects the middle ear to the nasopharynx? • Theses all are the same • The auditory tube , estuation tube, or pharyngotympanictube

9. So have you had enough yet? • NEVERRRRRR

10. Otosclerosis refers to what? • stiffening of ossicles • Synovial joints connecting the ossicles which may under go ankylosis which is stiffing

11. The normal function(s) of the pharyngotympanicis/are to do what? • Regulate middle ear pressure. • Allow drainage of secretions from the middle ear

12. The middle ear receives its sensory innervation from what cranial nerve(s) • CN IX • Which is also called ? • Learning issue • Hint: Glossopharyngeal

13. What are the Two muscles associated with the middle ear what nerves control them? • Stapedius muscle (CNVII) • And tensor tympany (CN V 3rd branch aka mandibular branch)

14. What is the lateral wall of the middle ear space? • TM • which is divided into what two parts? • the larger pars tensa, • and the smaller more superior pars flaccida.

15. What way does TM sit and what structure(s) articulate with it and cross it? • TM faces forward and down • The lateral process and handle (manubrium) of the malleus are attached to the tympanic membrane via the what? • umbo : The most indrawn point on the tympanic membrane • The Chorda tympani nerve crosses the medial surface of the handle of the malleus

16. What makes up the medial wall of the middle ear? • Contains the promontory , labryrinithine • prominence formed by the cochlea, oval and round windows.

17. What makes up the Anterior wall of the middle ear and what is in it? • carotid wall • Bony separation between the tympanic cavity and the carotid canal containing the internal carotid artery. The pharyngotympanic (auditory) tube and the tensor tympani muscle are located in its superior portion.

18. What makes up the posterior wall and what is contained in it? • Mastoid wall • The aditus (entrance to the mastoid antrum) is located superiorly. • The stapedius muscle and facial canal (containing CN VII) are also located in the posterior wall.

19. The roof separates the middle ear from what and is made up of what? • tegmental wall • tegmentympani is the thin layer of bone that separates the middle ear from the middle cranial fossa.

20. The floor of the middle ear is made up of what? • The jugular wall

21. Name the nerve(s) associated with the CN VII or the facial nerve ? • Greater protrosol • Chorda tympanis

22. What is the function of the greater protrosl nerve ? • Parasympathetic to the lacrimal gland and mucous glands of the nasal and oral cavities.

23. What is the function of the Chorda Tympani? • Parasympathetic to submandibular and sublingual glands; and sensory (taste) from anterior 2/3 of tongue (sweet and salt).

24. The Greater Petrosal nerve is a branch of what CN? What nervous system is it ass.ed with? • It is a branch of the CN VII and is parasympathetic

25. Explain how otitis media may occur. • This occurs when the auditory tube is blocked which results in resorption of air and a consequent negative pressure in the tympanic cavity • The negative pressure may result in aspiration of nasopharyngeal secretions and bacteria

26. Why do younger children get so many darn ear infections? • This occurs because they have short and more horizontal auditory tubes than older people.

27. What is a treatment for a child who has many middle ear infections ? • Myringotomy and tympanostomy (myringotomy) tube may be inserted to ensure the opening remains patent, and allow proper ventilation of the tympanic cavity • What portion of the TM are these placed in? • These are placed in the par tensa

28. What other conditions can occur when a person has otitis media? • Complications of otitis media include mastoiditis, an infection of the mastoid air cells; • facial nerve palsy, • brain abscess, • meningitis, • extraduraland subdural abscesses, • and thrombosis of the sigmoid sinus.

29. Common pathogens of AOM: • Haemophilusinfluenzae (54%), • Streptococcus pneumoniae (31%), • Moraxellacatarrhalis (10-14%). S. • pneumoniaewas the most common pathogen prior to the availability of the Prevnar vaccine. S. pneumonia is an encapsulated gram positive cocci that colonizes the nasopharynx

30. Treatment of AOM include? • amoxicillin 80-90 mg/kg BID x 3-5 days

31. Possible complications of H. flu AOM include? • Serotype “b” is encapsulated and has a high risk of systemic infection until 6 years of age. It commonly causes the following infections: • meningitis, • cellulitis, • epiglotitisand pneumonia

32. What gram type are the most common AOM pathogens? • H flu = gram negative • H Flu non typable = NA • M. catarrhalis= gram negative • The other gram positive

33. What are the difference between chronic and recurrent OM • Chronic otitis media includes otitis media with effusion (OME) usually lasting longer than 3 months, • recurrent otitis media which is AOM that resolves and then recurs usually 3 or more times in 6 months

34. What are Biofilms and why are they hard to test? • Biofilms are thought to be the cause of chronic otitis media. A biofilm is a polymicrobial cluster of pathogenic bacteria encased within an extracellular matrix, adherent to a surface, and • resistant to antibiotics. • nearly all chronic infections are biofilms

35. Can you culture biofilms ? • NO because the pathogens associated with chronic infections are better identified by molecular markers than cultures because many of the bacteria in a biofilm are not amenable to culture.

36. Unilateral hearing loss is classified how? • As either conductive or sensorineural.

37. Describe Conductive hearing loss and what may cause it? • Conductive hearing loss results from a disorder of the external acoustic meatus or middle ear, • such as excess cerumen, • a perforated tympanic membrane, • or otosclerosis.

38. Describe sensorineural hearing loss and what may cause it? • Sensorineural hearing loss results from a disorder of a structure distal to the cochlear nuclei in the brainstem. • disorder of CN VIII. • Meniere’sdisease, • ototoxic drugs such as antiseizure medications or aminoglycosideantibiotics • viral infections • cerebellopontineangle tumors of which an acoustic neuroma (aka vestibular schwannoma) is the most common type

39. If Conduction loss is present the Weber test will lateralize to what ear. • In conductive hearing loss the sound will lateralize to the “bad” ear, i.e. the one with a conductive loss

40. When sensorineural loss is present with the Weber test what ear should hear the noise? • the “good” ear

41. After conducting a Weber test the patient states they hear the noise better in the right ear what does this mean in regards to conductive and sensory hearing. • It has two meanings either: • the right ear has a conductive problem or • Or the left hear has sensory loss, thus the right ear has proper sensory function

42. What is the Rinne test distinguishing? • The Rinne test distinguishes which problem is producing the lateralization

43. Rinee test shows that the patient can hear the vibration longer when the tuning fork is on the mastoid process what does this mean ? • conductive loss: bone conduction is greater than air conduction

44. Sensorineural loss will cause what to occur in the bone to air ratio. • Hear bone longer than ear

45. Define true vertigo. • True vertigo is a sense of “spinning” that occurs as a result of a lesion of the vestibular pathway

46. What anatomical structure are associated with vertigo? • labyrinth in the inner ear, • the vestibular nerve and nucleus, • cerebellum • parietal cortex

47. Describe the symptoms and implications of Central Vertigo. • Central causes can include disorders of the posterior cranial fossa which are considered medical emergencies. • Associated symptoms include • diplopia, • dysarthria, • incoordination, • and episodes of unconsciousness

48. What test can be performed to test for either central or peripheral vertigo? • The Nylan-Barany or Dix-Hallpikemaneuver • Vertical nystagmus that occurs immediately and does not adapt with repetition is highly associated with central causes of vertigo.