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ANATOMI

External

Middle

InnerEAR

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Ears examination

(Inspect and Palpate)

The External Ear

1).Size and shape :

bilaterally equal size , no swelling , thickening2).Skin condition :

intact , no lump or lesion

3).Tenderness :

move the pinna and push the tragus

4).The external auditory meatus :

size / swelling / redness / discharge

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The Otoscopic Examination

Using the Otoscope :

a. choose the largest speculum

b. head toward the opposite shoulder

c. pull adult ear : pinna upper and back

pull infant and child (

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d. hold the otoscope : upside down

* The External Canal:redness / swelling / lesion / foreign body / discharge

* Tympanic Membrane:

color / character / perforation

shiny , translucent , pearl-gray color

Cone-sh aped light reflex

visible : Umbo, Manubrium, short process

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Tuning Fork Test :

Weber test :

.place a vibrating tuning fork in the midline skull

.the same sound in both ears

Rinne test :

.compares air conduction ( AC ) and bone conduction ( BC )

.mastoid near ear cana

.AC : BC 2 : 1 or AC > BC

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Hearing loss Webber test Rinne test

Conductive loss lateralisasi to CHL ACBC

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Diagnostic Evaluation Audiogram

Puretones

air

bone

Speech

Immitance

Diagnostic imaging

CT scan

MRI

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Classification of Hearing Loss

Conductive

SensorineuralMixed

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External auditory canal

Eardrum

Middle ear

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External Auditory Canal Cerumen (wax)

impaction

Stenosis (narrowing)

Infection

Surgery

Skin disorders

Congenital

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Tympanic Membrane

(Eardrum)

Perforation (hole)

Retraction Tympanosclerosis

(stiffness)

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Middle Ear Absence of ossicles

(middle ear bones)

Stiffness of ossicles

OtosclerosisTympanosclerosis

Dislocation of ossicles

(trauma)

Cholesteatoma

Tumors

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250 500 1000 2000 4000 8000

010

2030

405060

7080

90100110120

d

BHL(ANSI,1969)

125 12,000

-10

O OO O O

O

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