Lecture No. 1. Study of the ear. Otolaryngological examination. Ear anomalies

1. Examination of the ear. Otolaryngological examination

External examination reveals deformity of the auricle, swelling, hyperemia in the area of ​​the mastoid process, discharge from the ear, impaired facial expressions in case of damage to the facial nerve, enlarged lymph nodes in the area of ​​the tragus, mastoid process, below the auricle, postoperative scars, condition of the entrance to the external auditory canal .

On palpation, soreness, volume and consistency of tissue in places of inflammation and pathological changes are noted.

Otoscopy is performed using a frontal reflector and an ear funnel.

The reflector is aimed at the membrane so that the light beam does not change its position when the left eye is closed and opened.

To examine the right ear, the ear funnel is gently inserted with the right hand into the initial section of the cartilaginous part of the auditory canal, and the auricle is slightly pulled back with the left hand (with otoscopy of the left ear, vice versa) upwards and backwards in adults, and downwards in young children. This straightens the ear canal and the membrane becomes visible.

For better visibility of the membrane, it is advisable for an inexperienced doctor to remove secretions in the ear canal (sulfur, epidermal crusts, dried pus) using an ear cotton holder or Voyachek's attic probe.

In the auditory canal, the presence of secretions (pus, blood), swelling of its walls in the cartilaginous or bone part, narrowings are noted.

During otoscopy, attention is drawn to the identification points of the tympanic membrane - the handle of the malleus, its short process, the light cone, the anterior and posterior malleus folds. The color of the membrane is noted (normally pearly gray, and with otitis media - a different degree of hyperemia).

The position of the membrane is determined (retracted, bulging) and mobility using an optical funnel or an impedance meter. In the presence of perforation, its size, shape, nature of the edges (in chronic otitis media, cicatricial edges) and localization by quadrants (anterosuperior, anteroinferior, posterior superior and posterior inferior) are noted. There are rim and marginal perforations. With the first of them, the membrane tissue is preserved near the tympanic ring, and the second reaches the bone.

The color, smell (of rotten cheese with cholesteatoma), consistency, degree of discharge from the middle ear, the state of the mucous membrane of the tympanic cavity during perforations are characterized. With marginal perforations, primarily in the shrapnel part of the membrane, probing is performed using the Voyachek attic probe to determine bone caries and cholesteatoma. After a thorough toilet of the ear canal and tympanic cavity, otoscopy data can be better evaluated. Discharge from the ear is subjected to bacteriological examination in order to determine the pathogen and its sensitivity to antibiotics.

2. Anomalies in the development of the ear

Congenital malformations of the auricle are determined visually by cosmetic defects - macrotia (increase in size), microtia (decrease in size) and protrusion of the auricles.

These defects are corrected by operations. When the ears are protruding, an oval skin flap is removed from the behind-the-ear fold.

During the suturing of the wound, the auricle is pulled up to the edge of the skin of the mastoid process.

Macrotia and microtia are eliminated with the help of plastic surgery.

Other deformities of the auricle include the ear of the satyr (a conch elongated upwards in the form of a point), Darwin's tubercle (a protrusion on the curl), the ear of the macaque (smoothness of the curls), etc.

In the region of the ascending part of the curl, above the tragus, there are congenital fistulas due to non-closure of the first gill slit. A yellow viscous liquid or pus may come from them.

When the fistula is blocked, the skin around the fistula becomes inflamed, and cysts may develop. In the surgical treatment of malformations of the external ear, plastic auricle prostheses are sometimes used.

Atresia (fusion) of the external auditory canal may be accompanied by underdevelopment of the middle and inner ear in the form of a lack of auditory ossicles, bone fusions of the middle and inner ear with deafness or hearing loss.

Atresias are membranous-cartilaginous and bone, partial and complete. 22% of patients do not perceive whispered and colloquial speech or feel it at the auricle, and 30% - at a distance of 1-2 m.

Conductive hearing loss is noted at the level of 40-60 dB, with normal bone conduction, with an air-bone interval of 30-40 dB.

80% of individuals have a severe degree of hearing loss, and 14,8% have deafness. The main group consists of patients with II and III degrees of hearing loss, with very severe forms of dysgenesis - with IV degree.

With the help of radiography of the temporal bones according to Schüller, Mayer, Stenvers, magnetic resonance imaging and computed tomography, changes in the middle and inner ear are revealed.

The most informative is computed tomography, which allows you to identify the structure of the atresia of the auditory canal, the state of the tympanic cavity, auditory ossicles, the number of cochlear coils, etc.

A contrast radiography of the auditory tube is performed to determine its patency. Carry out a thorough audio-logical examination.

Bilateral hearing loss and deafness in children lead to a violation of the development of speech and mental abilities. The fate of such children directly depends on the possibilities of surgical and deaf-pedagogical correction of hearing and speech, so they need to be operated on earlier, at the age of 3–5 years, and in case of unilateral pathology, after 10–14 years.

Surgical treatment consists of creating a stable external auditory canal using the type of radical ear surgery with tympanoplasty, which involves revision of the auditory ossicles, labyrinthine windows, auditory tube, and the creation of a tympanic cavity with a neotympanic membrane. When indicated, any variant of tympanoplasty, stapedoplasty or fenestration of the horizontal semicircular canal is performed. In each case, the operation is individual and complex, so it is advisable to conduct examination and treatment of patients, especially children with ear malformations, hearing loss, in qualified otolaryngology or maxillofacial surgery clinics (auricular plastic surgery).

Authors: Drozdov A.A., Drozdova M.V.

>> Forward: Diseases of the external ear (Furuncle of the external auditory canal. Diffuse purulent external otitis media. Perichondritis of the external ear. Exostoses of the external auditory canal)

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