Pre-Auricular Area: Where & What are you looking for?
-area in front of ear
-Look to see if there are any pits (or holes), tags that are hanging on (excessive skin), sores.
-Look behind ears too
Post-Auricular Area: Where & What are you looking for?
-Back area could be caved in where the mastoid is; there could be a scar, etc.
Auricle: Where & What are you looking for?
-the ear itself
-Look for malformations
In development, there are hillocks. (if they're are not joined together well)
-If one ear is higher/lower or smaller/larger than the other -â†’ developmental problem.
-Can be craniofacial problems or issues with the cochlea.
-Too small/big (check children)
-Cupped shape = too small â†’from craniofacial abnormalities
-Older males tend to have large ears because of excessive cartilage.
-Looking for sores and potential signs skin cancer (e.g. crusty melanomas).
Ear canal: Where & What are you looking for?
-May not have an ear canal, or only have a partial one
-Auricle malformations (cupped, partially developed, etc.)
Ear canal abnormalities
-Necrotizing Otitis Externa
-Carcinomas (or neoplasms; cancer)
-no ear canal
-Can have a partial ear canal, the bone is there but not the cartilage, or vice versa
-white cottage cheese looking
-Drops help return the pH to normal, good for swimmers.
Necrotizing Otitis Externa
-Seen if a patient with otitis externa has a compromised immune system (diabetes or auto immune disorder, HIV positive).
-Causes fungus to become aggressive and starts eating the tissue in the ear b/w cartilage and bone (eats cranial nerves).
-Looks like bloody cottage cheese and lies at the bottom of the ear
Epithelial layer of TM
outside layer of skin
â€¢Can get dry or flakey, especially from swimming
â€¢Grows from the center of tympanic membrane and spreads out.
Fibrous layer of TM
â€¢Fibers crisscross each other
â€¢This is the layer that makes the TM appears more translucent, and not clear.
â€¢Can be stiff or flaccid; opaque or translucent, but not perfectly clear
Landmarks of TM
â€¢Manubrium of the Malleus
â€¢Cone of light
Manubrium of the Malleus
will probably see this 1st; look towards the middle to find the umbo
â€¢Right ear: 1 o'clock
â€¢Left ear: 11 o'clock
-Little white bump at the top of the malleus
-Not attached to the TM, but pushes it out
â€¢Negative Pressure (retraction)
â€¢Fluid or Otitis Media
-Calcium deposits will stick to eardrum on the backside of the TM; means they've had a lot of ear infections
-Could attach to ossicles themselves
-looks like scar tissue and hard to see through
-takes part of the ear canal wall to fix the big hole.
-if TM stays pulled back for a long period of time, the skin will start to peel and fall to the bottom of the E.C.
-Looks like little white lumps or pearls
-Very acidic; eats decaying skin, but can also eat through the TM, ossicles, bone, etc.
-blisters between the fibrous and epithelial layer of eardrum. Like a blood blister, hurts very badly.
-Most common way to get it is trauma (e.g. q-tip) , candling, hot water, etc.
1. To inspect the outer ear
2. To determine if we can see the eardrum and all landmarks look to be normal
3. To give us an idea if we should proceed with testing
1. Bridge (if you don't bridge 1st you will FAIL test)
2. Pull to straighten E.C. (Child: down and back; Adult: up and back)
3. Insert: look while inserting to check if partial atreria
4. Look at eye level: find umbo then follow up malleus, then circle and look around outside edge
5. Reverse: same order but backwards! REMOVE BRIDGE LAST!!!!
What are we looking for ?
If you are performing otoscopy correctly you should see the
â€¢ Tympanic Membrane
â€¢ Pars Flaccida (Membrane of the eardrum)
â€¢ Handle of the Malleus (the first ossicle)
â€¢ Umbo of the Malleus
â€¢ Short process of the Malleus (hard to see for most people)
â€¢ Cone of light
What is considered normal/clear visualization?
â€¢ Need to see the main landmarks (from the previous slide)
â€¢ Having clear visualization of the tympanic membrane is the most important
â€¢ Some cerumen (earwax) is normal as long as you can visualize some part of the eardrum