Glomerular Filtration and determinants of glomerular filtration .pptx
Β
Examination of ear
1.
2. ο Mental state
ο Consciousness
ο Built and nutrition
ο Attitude and Gait
ο Facies
ο Pallor β palmar creases, mm lips cheeks, conjuctiva,
nail beds
ο Cyanosis β tongue (central), nail bed , tip of nose,
palmar skin
ο Jaundice β sclera, nail bed , ear lobule, tip of nose
ο Skin eruptions β macules ( change in skin colour),
papules , vesicles, pustules (solid projections)
ο Neck nodes
3. ο Pulse β pulse rate, rhythm (regular, irregular)
ο Respiratory rate β fast, slow
ο Temperature β continous ( fluctuates less
than 1 deg), remittent ( fluctuates more than
2 deg), intermittent
ο Blood Pressure
4. ο Examine the affected region
ο Inspection
ο Palpation
ο Movements
ο Measurementsβ
ο LYMPH NODES
ο General Examination- Cranial Nerves,
Respiratory
ο CVS for surgery purpose
5. ο External Ear
ο - Auricle/Pinna
ο - Pre auricular region
ο - Post auricular/Mastoid region
ο EAC
ο TM
ο Middle ear mucosa
ο Eustachian tube
ο Facial nerve and other CN
ο Neck
ο Nose and Throat
8. ο PALPATION
ο Superficial palpation
ο Using fingers (digital palpation) of cartilage and
soft tissue
ο Soft tissue β mobility of skin (lost in malignancy),
thickening, swelling
ο Raised temperature, tenderness
ο Cartilage β defect or loss
ο Deep palpation
ο Tragal tenderness- inflammation
ο Painful movement of pinna β acute otitis externa
10. ο INSPECTION
ο Scar, dermatitis, swelling, fistula
ο Change in mastoid contour
ο Normally β uneven bone, skin over it mobile
ο PALPATION
ο Superficial palpation
ο Skin β mobile
ο Raised temperature
ο Swelling β margins, cystic (sebaceous cyst)
ο Iron out mastoid β smooth surface β
coalescent mastoiditis
11. ο Deep palpation
ο Tenderness β mastoiditis
ο 1. Cymba concha β bony landmark for mastoid
antrum
ο 2. Midpoint of posterior border of mastoid
ο 3. Tip of mastoid
ο NECK EXAMINATION
ο Bezoldβs abscess β pus track along SCM inferiorly
ο Citelliβs abscess β pus track along digastric into
submandibular triangle
ο Lucβs abscess β pus around zygoma
ο IJV as hard cord on palpation along SCM β IJV
thrombosis
12. ο Direct examination
ο Without speculum
ο Size of meatus β atresia/wide/narrow
ο Wide β post op, syphilis, otosclerosis
ο Narrow β congenital atresia, scar due to trauma,
burns tumour - osteoma
ο Content of meatus β wax, discharge, FB, Polyp
ο Digital examination β
ο Adults β pinna pulled upwards, backwards and
laterally, tragus pulled forwards
ο Children β pinna pulled downwards and laterally
13.
14. ο Look for furuncle, swelling
ο Fungal infection (otomycosis) β black β
aspergillus niger, yellow β candida albicans
ο Polyp β probe test β if probe all around β arise
from middle ear
ο Impacted wax β whole EAC occluded
ο Tumours
ο With speculum examination β deep meatus to
straighten the canal
ο Largest speculum which can enter
ο Black coated
ο Introduce in slow rotatory fashion upto cartilage
only
15. ο Cough β vagal irritation
ο Sagging of posterior superior EAC β
cholesteatoma, mastoid abscess, mastoiditis
ο Absence of sensation in post sup EAC β
Hitselbergerβs sign β mass lesion in CP angle
16. ο Normal β pearly white colour, obliquely set,
anterior and posterior malleolar fold (longer)
ο Handle of malleus β whitish bony landmark
ο Umbo
ο Cone of light/light relex β triangular in shape
anterio inferiorly β unreliable landmark
ο Short or lateral process of malleus β small
yellowish prominence β at 12 o clock position -
always present β last landmark to be destroyed
in disease
ο Quadrants β 4 β imaginary line through tip of
umbo, 2 nd vertically along handle of malleus β
ant sup/inf, post sup/inf
17.
18. ο Colour of TM β normal pearly white/greyish
white, red in ASOM, acute myringitis
ο Congestion with yellowish tint β ASOM
ο Diffuse congestion/ localised at handle of
malleus β ASOM
ο Dark grey colour/dull appearance β tubal
occlusion
ο Dull white/thickened cotton like drum β senile
sclerosis, scarring
ο Chalky white appearance β tympanosclerosis
after otitis media
ο Dull lusterless/bulging β secretory otitis media
ο Blue drum β transudative otitis media
ο Dark blue drum - haemotympanum
19. ο TM normally inclined downwards and medially
ο Protrude outwards β bulging drum β acute otitis
media (pus),Haemotympanum (blood),OME with
good ET function (air) β increase length of handle
of malleus, less prominent short process and
malleolar folds, absence of cone of light
ο Pulled inwards β retracted TM- OME with poor ET
function, ET obstruction, atelectasis β shortening
of handle of malleus, more prominent short
process, anterior and post malleolar folds,
distorted cone of light
ο Retraction β attic region (retraction pocket) if
deepens β cholesteatoma sac
20.
21. ο Siegleβs pneumatic speculum/ Valsalva
maneuvre
ο Normal β change in shape of triangular light
reflex/ handle of malleus movement
ο Decreased/absent β ET dysfunction, adhesive
otitis media (fixed), ankylosis of ossicular
chain, SOM
ο Hypermobility β Patulous ET, atrophy of TM
22.
23. ο Perforation β ovoid/ kidney shaped/ round,
small, medium, large, sub total, total,
central/marginal, pars tensa/attic, dry/wet,
single/multiple (TB, measles, wegnerβs
granulomatosis), margins β regular/irregular,
edge of perforation β thick (CSOM)/ thin
(ASOM)
ο Scars
ο Bulla β grey/red/bluish pearls like structures
attached to surface of TM
ο Chalky white patch - tympanosclerosis
24.
25. ο Only through perforation/ if TM thinned out/
semitransparent
ο Middle ear mucosa β oedema/ polyp
ο Granulation tissue
ο Ossicles, ET, round window, oval window
ο FB
ο Fistula
26. ο Posterior rhinoscopy/ Nasopharyngoscopy/
DNE/ Through perforation
ο Valsalva Maneuvre
ο ET catheterisation β check patency of ET
ο Few drops in ear if perforation and bitter
taste in mouth
ο TUNING FORK TESTS
ο Rinneβs
ο Weber
ο ABC
27. ο FISTULA TEST
ο Apply intermittent pressure on tragus/
siegleβs pneumatic speculum β ask patient to
look straight β check for vertigo/ nystagmus
towards opposite side
ο FACIAL NERVE EXAMINATION
ο Paralysis in ASOM, CSOM, Malignant otitis
externa, herpes zoster, tumours and trauma
ο Wrinking of forehead/ closure of eyes/ loss
of naso labial folds/ deviation of angle of
mouth/ cant whistle or blow