1. ENT: Ears
Module 7 OSCE Revision

2. Anatomy

3. Ear Anatomy : Outer Ear

4. Ear Anatomy: Inner Ear

5. Otoscopy

6. Normal Tympanic Membrane
Otoscopy
Normal Tympanic Membrane
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 1/5th – Pars Flaccida
Lower 4/5th- Pars Tensa
Handle of Malleus – downwards and backwards
Light Reflex
Right or Left Ear drum?

7. Diagrammatic representation of normal otoscope

8. Otoscope Quiz

9. Wax (cerumen) impaction
Description?
Complications?
Tx?
pale-yellow, golden yellow wax, darker = greater consistency,
Removal with syrninging, blunt hook, softening with sodium bicarbonate ear drops 3 times a day or hydrogen peroxide

10. AOM with effusion (Glue Ear)
Description?
Complications?
Tx?
Distortion of the drum, prominent blood vessels in the upper half, dullness in the lower half, bulging of the upper half of the drum, outline of the malleus obscured
Complications:
Acute recurrence of infection, perforation of TM, thinning of TM, retraction pocket may form
Tx: watchful waiting period of 3-6months, hearing airds/grommet insertion
Bonus Question: What would a Tympanogram look like for this copndition?

11. Otitis Media (serous) Description? Complications? Tx?
Ear drum has lost its lustre, visible effusion, fluid meniscus defining the upper margin,
Treatment is aural toilet with topical steroid ear drops,

12. Central Perforation of Ear Drum
Description?
Complications?
Tx?
Long standing central perforation with the formation of scar tissue and calcified plaques,
Complications: infection, hearing loss, tinnitus, dizziness, facial paralysis, treatment: myringoplasty

13. Grommet Insertion Description? Indications? Complications?
Indicated in AOM or COM in children
Removal 12 months later
Complications: infection leading to otorrhea, chronic perforation of TM

14. Audiograms

15. Understanding the Audiogram
Volume : vertical axis represents volume (loudness) measured in decibels (dB).
Pitch: horizontal axis represents frequency (pitch) which is measured in hertz (Hz).
0 dB 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 dB.

16. Different sensitivities of the Audiogram
Noticed by family and friends, between 21dB and 40dB
Difficulty following speech, 41dB and 70dB
Unable to hear speech, traffic unless its loud, 71dB to -95dB
Greater than 95dB, unable to hear most sounds unless very loud

17. Diagrammatic representation of the Audiogram
Speech Banana

18. Normal Audiogram Right ear air conduction = O bone conduction = [ or Δ
Left Ear
air conduction = X bone conduction = ] or triangle Δ.

19. AUDIOGRAM QUIZ

20. Right sided, conductive deafness
Conductive or Sensorineural ?
Right or Left Ear?
Mild/Moderate/Severe/Profound?
Causes?
Management?

21. Bilateral mild sensorineural hearing loss
Conductive or Sensorineural ?
Right or Left Ear?
Mild/Moderate/Severe/Profound?
Causes?
Management?

22. Bilateral Moderate Sensorineural Hearing Loss
Conductive or Sensorineural ?
Right or Left Ear?
Mild/Moderate/Severe/Profound?
Causes?
Management?

23. Presbyacusis right sided
Conductive or Sensorineural ?
Right or Left Ear?
Mild/Moderate/Severe/Profound?
Causes?
Management?

24. Presbyacusis, left sided
Conductive or Sensorineural ?
Right or Left Ear?
Mild/Moderate/Severe/Profound?
Causes?
Management?

25. Hearing Loss due to Meniere’s
Conductive or Sensorineural ?
Right or Left Ear?
Mild/Moderate/Severe/Profound?
Causes?
Management?

26. An extra audiogram quiz:
/audiotutorial2/AudiogramTutorial2.h tm

27. Tympanometry

28. 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)
• A pattern that
corresponds to various disorders
Vertical – Compliance (can also give indication of Ear Canal Volume)
Horizontal – Pressure in daPa
Shaded area – normal tymanogram would fall into this area

29. 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.

30. 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)

31. Different patterns of a tympanogram
Type C Peak compliance significantly below 0, less than – 200 indicating negative pressure (sub- atmopsheric) within the middle ear space, suggest Eustachian Tube Dysfunction or middle ear fluid

32. GOOD luck 