Ears and Nose Assessment
Hearing Pathways
- Hearing disorders of the external and middle ear cause conductive hearing loss
- External ear: causes include cerumen impaction, infection (otitis media), trauma, squamous cell
carcinoma, and benign Bony growth such as exostosis or osteoma
- middle ear disorders: otitis media, congenital conditions, cholesteatomas, otosclerosis,
tympanosclerosis, tumors, and perforations of the tympanic membrane
- disorders of the inner ear: cause sensorineural hearing loss from congenital and hereditary conditions,
presbycusis, viral infections such as rubella or cytomegalovirus, Meniere disease, noise exposure,
ototoxic drugs, and acoustic neuromas
Common or Concerning Symptoms
1. Hearing Loss
a. May be congenital – from single gene mutations
b. Conductive Loss : problems in the external/ middle ear ( noisy environments may help )
c. SENSORINEURAL LOSS: resulting from problems in the inner ear, the cochlear nerve, or
its central connections to the brain
i. Those with this type of hearing loss have issues with understanding speech, often
complaining that people mumble
ii. Noisy environments make hearing worse
d. Medications known to cause permanent hearing loss:
i. aminoglycosides i.e gentamicin
ii. chemotherapeutic agents i.e cisplatin and carboplatin
iii. temporary damage to hearing may be caused by aspirin, and said, quinine, and loop
diuretics ( furosemide)
2. Earache and ear discharge
a. pain occurs in the external canal and otitis externa ( inflammation of the external ear canal)
and deeper within the ear in otitis media(infection of the middle ear)
b. pain in the ear can also be referred to from other structures in the mouth, throat, or neck
c. note: acute otitis externa and acute or chronic otitis media with perforation usually presents
with yellow- green discharge
3. Ringing in the ears (tinnitus)
a. a common symptom, increasing in frequency with age.
b. When tinnitus is associated with fluctuating hearing loss and Vertigo suspect Meniere’s
disease
4. Dizziness and Vertigo
a. Vertigo: the sensation of true rotational movement of the patient or the surroundings
i. points directly to problems in the labyrinths of the inner ear, peripheral lesions of the
CN VII , or lesions in its central pathways or nuclei in the brain
ii. represents a vestibular disease- usually from peripheral causes in the inner ear
1. Peripheral Causes: Benign positional Vertigo, labyrinthitis, vestibular neuritis,
and Meniere’s disease
2. Central Neurological Causes: ataxia, diplopia, and dysarthria signal central
neurological causes in the cerebellum or brainstem
, a. Cerebral Vascular disease or posterior fossa tumor (consider vestibular
migraine)
b. S/s: weak in the legs, faint points to presyncope from arrythmias,
orthostatic hypotension, or vasovagal stimulation
5. Nasal Discharge (rhinorrhea) and nasal congestion
a. Viral infections, allergic rhinitis ( hay fever), and vasomotor rhinitis ( itching favors an
allergic cause)
b. Seasonal onset or environmental triggers suggests ALLERGIC RHINITIS
i. Drug- induced rhinitis: excessive use of topical decongestants or intranasal use of
cocaine
ii. Acute bacterial sinitus (rhinosinusitis): mostly unlikely unit viral symptoms persist
more than 7 days; both purulent drainage / facial pain should be present for diagnosis
c. Inquire about medications/drugs, particularly oral contraceptives, alcohol, and cocaine
d. With these symptoms: consider a deviated nasal septum, nasal polyp, foreign body,
granulomatous disease, or carcinoma
6. Nosebleed (epistaxis)
a. Local causes: nose picking, inflammation, drying/ crusting of nasal mucosa, tumors, and
foreign bodies
b. Anticoagulants, NSAIDs, vascular malformations, and coagulotherapies can contribute to
epistaxis
Auricle
- Otitis Externa: inflammation of the ear canal, but not in otitis media (inflammation of the middle ear)
o Tenderness behind the ear occurs in otitis media and mastoiditis
- Otitis media can occasionally progress to acute mastoiditis, which presents with postauricular swelling,
flatulence, erythema, and significant tenderness
o Bullous Myringitis: common sequela presenting with painful hemorrhagic vesicles on the
tympanic membrane
THIS REQUIRES urgent, often surgical, management by otolaryngologist
- Nontender nodular swellings covered by normal
skin deep in the ear canals suggest osteomas or exostoses
- Nonmalignant overgrowths, which may obscure the tympanic
membrane
- Acute otitis externa: the canal is often swollen, narrowed, moist,
erythematous or pale, and tender.
- Chronic otitis externa: the skin of the canal is often thickened, red and itchy
Hearing Pathways
- Hearing disorders of the external and middle ear cause conductive hearing loss
- External ear: causes include cerumen impaction, infection (otitis media), trauma, squamous cell
carcinoma, and benign Bony growth such as exostosis or osteoma
- middle ear disorders: otitis media, congenital conditions, cholesteatomas, otosclerosis,
tympanosclerosis, tumors, and perforations of the tympanic membrane
- disorders of the inner ear: cause sensorineural hearing loss from congenital and hereditary conditions,
presbycusis, viral infections such as rubella or cytomegalovirus, Meniere disease, noise exposure,
ototoxic drugs, and acoustic neuromas
Common or Concerning Symptoms
1. Hearing Loss
a. May be congenital – from single gene mutations
b. Conductive Loss : problems in the external/ middle ear ( noisy environments may help )
c. SENSORINEURAL LOSS: resulting from problems in the inner ear, the cochlear nerve, or
its central connections to the brain
i. Those with this type of hearing loss have issues with understanding speech, often
complaining that people mumble
ii. Noisy environments make hearing worse
d. Medications known to cause permanent hearing loss:
i. aminoglycosides i.e gentamicin
ii. chemotherapeutic agents i.e cisplatin and carboplatin
iii. temporary damage to hearing may be caused by aspirin, and said, quinine, and loop
diuretics ( furosemide)
2. Earache and ear discharge
a. pain occurs in the external canal and otitis externa ( inflammation of the external ear canal)
and deeper within the ear in otitis media(infection of the middle ear)
b. pain in the ear can also be referred to from other structures in the mouth, throat, or neck
c. note: acute otitis externa and acute or chronic otitis media with perforation usually presents
with yellow- green discharge
3. Ringing in the ears (tinnitus)
a. a common symptom, increasing in frequency with age.
b. When tinnitus is associated with fluctuating hearing loss and Vertigo suspect Meniere’s
disease
4. Dizziness and Vertigo
a. Vertigo: the sensation of true rotational movement of the patient or the surroundings
i. points directly to problems in the labyrinths of the inner ear, peripheral lesions of the
CN VII , or lesions in its central pathways or nuclei in the brain
ii. represents a vestibular disease- usually from peripheral causes in the inner ear
1. Peripheral Causes: Benign positional Vertigo, labyrinthitis, vestibular neuritis,
and Meniere’s disease
2. Central Neurological Causes: ataxia, diplopia, and dysarthria signal central
neurological causes in the cerebellum or brainstem
, a. Cerebral Vascular disease or posterior fossa tumor (consider vestibular
migraine)
b. S/s: weak in the legs, faint points to presyncope from arrythmias,
orthostatic hypotension, or vasovagal stimulation
5. Nasal Discharge (rhinorrhea) and nasal congestion
a. Viral infections, allergic rhinitis ( hay fever), and vasomotor rhinitis ( itching favors an
allergic cause)
b. Seasonal onset or environmental triggers suggests ALLERGIC RHINITIS
i. Drug- induced rhinitis: excessive use of topical decongestants or intranasal use of
cocaine
ii. Acute bacterial sinitus (rhinosinusitis): mostly unlikely unit viral symptoms persist
more than 7 days; both purulent drainage / facial pain should be present for diagnosis
c. Inquire about medications/drugs, particularly oral contraceptives, alcohol, and cocaine
d. With these symptoms: consider a deviated nasal septum, nasal polyp, foreign body,
granulomatous disease, or carcinoma
6. Nosebleed (epistaxis)
a. Local causes: nose picking, inflammation, drying/ crusting of nasal mucosa, tumors, and
foreign bodies
b. Anticoagulants, NSAIDs, vascular malformations, and coagulotherapies can contribute to
epistaxis
Auricle
- Otitis Externa: inflammation of the ear canal, but not in otitis media (inflammation of the middle ear)
o Tenderness behind the ear occurs in otitis media and mastoiditis
- Otitis media can occasionally progress to acute mastoiditis, which presents with postauricular swelling,
flatulence, erythema, and significant tenderness
o Bullous Myringitis: common sequela presenting with painful hemorrhagic vesicles on the
tympanic membrane
THIS REQUIRES urgent, often surgical, management by otolaryngologist
- Nontender nodular swellings covered by normal
skin deep in the ear canals suggest osteomas or exostoses
- Nonmalignant overgrowths, which may obscure the tympanic
membrane
- Acute otitis externa: the canal is often swollen, narrowed, moist,
erythematous or pale, and tender.
- Chronic otitis externa: the skin of the canal is often thickened, red and itchy
