Clarification Of Ear Disease

Besides ears, nose, nasopharynx and sinuses and teeth, tongue, tonsils, hypopharynx, larynx, salivary glands and temporomandibular joints should be examined, as can be projected from radiating there pain and discomfort to the ears. and to be carried out at the bedside tests of hearing (hearing loss: Physical examination) and the vestibular system: studies of brain nerve functions (cranial nerves Like the cranial nerves are to assess and see table) are also important. The patient is examined with regard to a nystagmus (rhythmic eye movement).

Main symptoms of ear problems are ear pain, hearing loss, otorrhoea, tinnitus and vertigo. Hearing loss is discussed in (see hearing loss). Besides ears, nose, nasopharynx and sinuses and teeth, tongue, tonsils, hypopharynx, larynx, salivary glands and temporomandibular joints should be examined, as can be projected from radiating there pain and discomfort to the ears. and to be carried out at the bedside tests of hearing (hearing loss: Physical examination) and the vestibular system: studies of brain nerve functions (cranial nerves Like the cranial nerves are to assess and see table) are also important. The patient is examined with regard to a nystagmus (rhythmic eye movement). Nystagmus A nystagmus is a rhythmic eye movement, which can have various causes. Vestibular disorders can cause nystagmus due to the connection between the vestibular system and the eye muscles. A vestibular nystagmus not only helps to identify problems with balance, but sometimes when delineate a central from a peripheral vertigo. A vestibular nystagmus is due to the influx of vestibular nerve impulses a slow movement phase and a fast corrective phase of movement that causes a movement in the opposite direction. The direction of nystagmus is defined by the direction of the fast movement, because it is easier to see. There are rotational, vertical or horizontal Nystagmi, which may occur when changing the viewing direction or in certain head movements spontaneously. The inspection to a nystagmus is initially in a supine position of the patient and without eye focusing (a view fixation can be prevented by a lens power of +30 diopters or a Frenzel glasses). The patient is then rotated slowly, first in left, then their right side. Attention is paid to the direction and duration of nystagmus. If so no nystagmus can be seen, the Dix-Hallpike- is (or Barany-) carried out maneuver. In this maneuver, the patient is sitting upright on a stretcher in such a way that his head protruding lying over the end. Did he put down with the help rapidly horizontal, the head should be overstretched and 45 ° backwards rotated 45 degrees to the left. Attention is paid to the direction and duration of nystagmus and the development of a hoax. After righting the patient’s maneuver is repeated, this time with head rotation to the right. If a particular situation or test phase has led to the nystagmus, should be repeated check if it weakens. While having a nystagmus due to a peripheral nerve dysfunction is a latency period of 3-10 s and quickly disappears again, a nystagmus in CNS disorders without latency and mitigate without occurs. An induced nystagmus inhibited as soon as the patient focuses on an object with the eyes when prompted, is the nystagmus based on a peripheral disorder. Since Frenzel glasses prevent visual fixation, they must be removed in order to assess the visual fixation. With intact vestibular nystagmus can be triggered by a caloric irritation of the ear canal. The failure of this attempt or arises regarding the Nystagmusdauer one side difference> 20-25%, a lesion on the side of the weaker reaction is suspected. Quantification of caloric reaction is best done by a formal (computer-aided) electronystagmography. The ability of the vestibular system to respond to a peripheral stimulation can be assessed at the bedside. It should be ensured that with a known perforated eardrum or a chronic infection does not occur to flush the ears in patients. In supine position with the head elevated 30 ° both ears of the patient are washed successively with 3 ml of ice water. Instead of cold can also use 240 ml of warm water (40-44 ° C), care should be taken not to scald the patient with too hot water. Cold water causes a contralateral, warm Wassen out a homolateral nystagmus. As a reminder the English abbreviation COWS you can remember (to the Cold and Warm Opposite to the Same). Tests If history or physical examination at a hearing impairment point or if patients complain of tinnitus or dizziness, they undergo a hearing test audiogram. In nystagmus or modified vestibular a computerized electronystagmography (ENG) can be useful to detect a purely visually perceptible spontaneous, Blickrichtungs- or positional nystagmus of patients. Using the computer-ENG can be quantified for each ear how much the vestibular system responds to the rinsing with hot and cold water at the caloric testing individually; which allows to recognize a unilateral functional weakness the doctor. By different head and body positions, or presentation of visual stimuli individual components of the vestibular system can be investigated. Posturography uses computer-based test equipment for the quantitative evaluation of the patient control of posture and balance. The patient stands on a platform that includes power and motion transducers that detect the occurrence and the magnitude of body sway while the patient tries to stand erect. The test may be carried out under different conditions, u. a. with a stationary or moving platform with a flat or curved surface, with closed or open eyes of the patient; This helps to isolate the contribution of the vestibular system to equilibrium. When imaging methods primarily come CT (with or without contrast agents for the study of the temporal bone) and gadolinium-enhanced cranial MRI used is paying particular attention to the internal auditory canals in the latter to exclude acoustic neuroma. Technical investigations may be indicated even in the ears and / or head trauma, chronic infection, hearing loss, dizziness, facial paralysis or Otalgia unknown cause.

Health Life Media Team

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