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Parts of the ear practice test5/25/2023 ![]() If multiple attempts of removal are unsuccessful, referral to an otolaryngologist is warranted. There are three options for intervention: irrigation, cerumenolytic agents, manual removal. Cerumen removal should occur if the examiner cannot visualize the entire TM. The diagnosis of cerumen impaction can be made by direct visualization through an otoscope. In the presence of any of these symptoms, removal is indicated. Ĭerumen impaction refers to a buildup of cerumen that causes symptoms such as hearing loss, ear fullness, itching, otalgia, tinnitus, cough, or rarely imbalance. Other causes of decreased TM mobility are tympanosclerosis, TM retraction, and TM perforation. Recent clinical practice guidelines report that AOM should not receive a diagnosis without evidence of middle ear effusion shown by pneumatic otoscopy. Therefore, pneumatic otoscopy aids in the diagnosis of acute otitis media (AOM) and otitis media with effusion (OME). The most common cause of decreased TM mobility is middle ear effusion. A normal TM will respond by concaving into the middle ear cavity. With an adequate seal, air enters the EAC and increases pressure. Pneumatic otoscopy helps determine the mobility of the TM. The TM is normally gray-colored, and its translucency allows for visualization of the incus and stapes, though the degree of translucency can vary from patient to patient. The cone of light originates at the umbo and extends anteriorly (this allows the viewer to determine a right from left ear based solely on an otoscopic view). The cone of light, handle of malleus, umbo, pars tensa, and pars flaccida make up the normal landmarks. ![]() When inspecting the TM, the examiner takes note of color, bulging, perforation, and the presence or absence of normal landmarks. The TM separates the external ear from the middle ear. Įxaminers inspect the EAC for cerumen impaction, foreign objects, canal edema, erythema, and otorrhea. It is essential to use a fully charged otoscope, as low light may produce a yellow tint on the TM, which is subject to misinterpretation as middle ear effusion. For neonates, the examiner pulls the pinna posteriorly and inferiorly. ![]() For adults and older children, the pinna is gently retracted in a posterior and cephalad vector. The EAC travels in a “sigmoid” fashion therefore, the recommendation is to manipulate the pinna to allow for proper visualization of the TM. The fifth finger rests on the patient's head to stabilize the otoscope. The otoscope is held with three fingers, like a pen, between the thumb, first, and second fingers. To inspect the right ear, the examiner holds the otoscope with their right hand and the ear with his left.
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