Professional Documents
Culture Documents
Aims
Recap of basic anatomy
Understand therefore what you are looking for
when looking at the eardrum
Recognise important signs
Recognise what you must not miss
Ear Wax
Wax is not normally present in the inner third of
the ear canal.
So its presence there may indicate inappropriate
use of cotton buds to clean the ears
OR it may be a dried up crust, overlying more
significant pathology such as a perforation or
cholesteatoma (beware!)
Malleus
Normal
The normal tympanic membrane should appear
pearly grey
with a light reflex
generally concave
and you should be able to make out the malleus
Tip:
If you can make out the malleus, then you can figure
out whether something is worth worrying over by
noting its relation to it. Its simple really. More
later.
Another normal
Some people like to be real
fancy and label the individual
parts.
There is another EASIER way you can figure out whether something is in the anterior or posterior segment.
When youre looking down an earhole, just figure out whether the lesion is at the face end of the patient or not.
If it is, it is anterior easy peasy lemon squeezy!
The clever ones amongst you will have figured out that the picture above is in fact the right ear drum.
Perforations
Bubbles (glue ear, resolving infection)
White patches (tympanosclerosis or cholesteatoma)
Granulations
Red lesion at tip of malleus (glomus tumour)
Grommets/FBs
Bubbles
You may see bubbles
behind the drum. This
represents a resolving
middle ear effusion, as air
gradually re-enters the
middle ear. In this image,
the bubbles appear much
larger
Glomus Tumour
This small blurry red lesion at the
tip of the malleus handle is a
vascular lesion called a glomus
tumour. This might cause pulsatile
tinnitus, but is rare.
Im showing you this lesion
because you need to look out for
it. Its rare but needs surgical
treatment.
If you were thinking of a clear red
bulge sticking out towards you,
think again.
Once seen, like in this pic, youre
unlikely to forget it.
Glomus tumour
This red bulge in the canal
is another glomus tumour
(glomus jugulare). this is
the tip of a much larger
lesion involving the
temporal bone.
But remember, not all of
them will be as clear as
this.
Other abnormalities
presence of fluid levels and
bubbles
Otitis media+effusion-Glue
ear
Features
Dull retracted TM
May show air-fluid level
Conductive hearing loss(whisper test, Rinne/weber
tests)
Notes
Common in children; often after AOM and can
persist for weeks
Reduced hearing noticed by parents/teacher
Unsteadiness- child falling over
80% clear at 8 weeks
Eustachian Tube
Dysfunction
Eustachian Tube
Dysfunction
Features
Retracted eardrum you can see the bones
clearly
Notes
My ears have been popping for two weeks and
occasionally hurt.
Treatment includes pinching your nose and
blowing - this forces air up the tube and pops the
ear drum back into place.
1.
Cholesteatoma
These are nasty!
They need referral.
In this pic:
Eardum is clearly retracted:
margin is very clear + drum
looks sunken + you can
make out some structures
underneath (dunno what
they are though).
And there is that ugly
crusty yellowy thing in the
attic region. Remember,
attic = serious
Cholesteatoma
Features
Pearl shaped sac or disc yellow in colour
Retracted ear drum (so you can see the anatomy easily)
Notes
Must not miss this one!
The problem occurs when the dead cells accumulate in the
middle ear and can not be expelled.
Typically an infection occurs with intermittent drainage from
the ear.
As this ball of dead cells accumulates it produces enzymes
which cause the destruction of bone.
Discharge with foul odor, a full feeling or pressure in the ear,
hearing loss.
Tympanosclerosis
These are white patches common in the
elderly and usually safe.
In this picture, you should have notice
the eardrum is retracted:
Malleus clearly visible
Margin clearly visible
Looks sunken
Do you know which ear it is?
Yep, the right ear.
Tympanosclerosis
Features
White patches on the eardrum
Nothing else really
Notes
Deposition of calcium into the drum itself in
response to trauma or infection
This is not normally of any consequence unless it is
severe, which can lead to a mild conductive
hearing loss.
More on UNSAFE
Inspect the attic region (the small area of drum
between lateral process of the malleus and the
roof of the ext aud canal immediately above it)
1. Any defect or apparent perforation in the attic
must be considered unsafe (?cholesteatoma)
2. A posterior perforation where the posterior
margin of the drum is also unsafe. This are often
linear rather than oval.
3. Any perforation involving the drum margin is also
unsafe
SAFE
Source
Cholesteatoma
Mucosa
Odour
Foul
Inoffensive
Amount
Can be profuse
Nature
Purulent
Mucopurulent
Useadditionalfeaturesthatmaybepresenttohelpyou!
If you cant tell whether it is anterior, posterior, inferior or in the attic, go back to slide 13
Monolayer (healed
perforation)
Granulations
Granulations like this are
often associated with
underlying disease,
particularly if they arise in
the attic.
Grommets
Just because you can see a grommet in the ear
does not mean it is working.
The hole in the middle should be clear of debris.
Grommet
This grommet is in the
correct position but is
covered in infective
granulation and blocked
up. This will not be doing
any good and may be
responsible for a chronic
discharge. Note also the
extensive
tympanosclerosis on the
drum.