Head & Neck - Session 6
Note: This session is very poorly phrased in parts.
1
Max.
Mark
What structure separates the external ear from the middle ear?
The Tympanic Membrane (x1)
Actual
Mark
1
2
Max.
Mark
What structure joins the middle ear to the nasopharynx?
The Pharyngotympanic Tube/The Eustachian Tube (x1)
Actual
Mark
1
3
Fill in the boxes
Max.
Mark
Actual
Mark
(x1 for each correct red box)
3
4
What type of cartilage makes up the Auricle of the ear?
Max.
Mark
Irregularly shaped plate of elastic cartilage covered by thick skin
(x1)
Actual
Mark
1
5
Max.
Mark
What structure guards the entrance to the ear canal?
Tragus (x1)
Actual
Mark
1
6
Describe what the Lobule of the ear is comprised of
Max.
Mark
Fibrous Tissue (x1)
Fat
Blood Vessels (x1)
Actual
Mark
(1 mark for 1 or 2 correct answers, 2 marks for all three)
2
7
Max.
Mark
Describe the arterial blood supply to the Auricle of the ear and
what vessel they branch from
Posterior Auricular (x1)
Superficial Temporal (x1)
External Carotid (x1)
Actual
Mark
3
8
Max.
Mark
2
Describe what nerve supplies sensory innervation anterior to
the canal into the ear, and what cranial nerve it is a branch of.
Auriculotemporal Nerve (x1)
Branch of the Mandibular Nerve (CN V3) (x1)
Actual
Mark
9
Max.
Mark
Describe what nerve supplies sensory innervation to the rest
of the Auricle
Great Auricular Nerve (x1)
Actual
Mark
1
10
Max.
Mark
What is the entrance into the ear actually called?
The External Acoustic Meatus (x1)
Actual
Mark
1
11
Describe the composition of the ear canal
Max.
Mark
Cartilaginous tube lateral 1/3rd (x1)
Bony Canal medial 2/3rds (x1)
Actual
Mark
2
12
Max.
Mark
What bone does the ear canal lie in?
The Temporal Bone (x1)
Actual
Mark
1
13
Max.
Mark
What is the ear canal lined by and what is its function?
Lined by skin secreting Cerumen (x1) which offers protection (x1)
Actual
Mark
2
14
Max.
Mark
1
How is ear wax formed?
The discarded cells of the skin together with the cerumen (x1)
Actual
Mark
15
Max.
Mark
What shape is the ear canal? As a result, what has to be done
in an ear exam in an adult to achieve a good internal view?
Sigmoid shaped (x1)
Needs to be pulled upwards (x1) and backwards (x1)
Actual
Mark
3
16
Max.
Mark
What has to be done in an ear exam in a child to achieve a
good internal view?
Pull the canal downwards (x1) and back (x1)
Actual
Mark
2
17
Max.
Mark
Describe the features of the Tympanic Membrane that allows
visualisation of some structures within the middle ear
Shallow cone with medially pointing apex
~1cm diameter
Thin, Oval. Semi-transparent, Pearly-grey membrane
Actual
Mark
(any 2 from above)
2
18
Max.
Mark
What can be seen around the periphery of the Tympanic
Membrane?
Blood vessels (x1)
Actual
Mark
1
19
Max.
Mark
4
What is the sensory supply of the external surface of the
Tympanic membrane? What cranial nerves have they
branched off?
Auriculotemporal branch (x1) of Mandibular Nerve (x1)
Auricular Branch (x1) of the Vagus Nerve (x1)
Actual
Mark
20
Max.
Mark
What is the sensory supply of the internal surface of the
Tympanic Cavity?
Glossopharyngeal Nerve (x1)
Actual
Mark
1
21
Describe the Arnold’s Cough reflex and why it happens
Max.
Mark
Stimulation of the Auricular Branch of the Vagus Nerve (x1) with a
cotton bud (x1) causes a cough reflex (x1)
Actual
Mark
3
22
Max.
Mark
What is the clinical significance of bulging of the membrane in
the Tympanic Cavity?
Pus or fluid in middle ear (x1)
Actual
Mark
1
23
Max.
Mark
What is the clinical significance of a retracted membrane in
the Tympanic Cavity?
Intratympanic cavity pressure reduces (x1)
Obstruction of the Eustachian tube (x1)
Actual
Mark
2
24
When might the Tympanic Membrane perforate?
Max.
Mark
Trauma (x1)
Infection (x1)
Actual
Mark
2
25
Max.
Mark
1
What is the name of dense, white plaques on the Tympanic
Cavity?
Tympanosclerosis (x1)
Actual
Mark
26
Define the middle ear
Max.
Mark
The narrow air filled chamber (x1) in the petrous part (x1) of the
Temporal bone (x1)
Actual
Mark
3
27
Name the two parts of the middle ear
Max.
Mark
Tympanic Cavity proper (x1) is the space directly internal to the
tympanic membrane
Actual
Mark
Epitympanic Recess (x1) is the space superior to the membrane
2
28
Max.
Mark
The space directly internal to the tympanic membrane has two
connections to other structures in the region, the
Nasopharynx and the Mastoid Air Cells. What is the name of
these connections, and where can these connections be found
in relation to the space directly internal to the tympanic
membrane?
Anteromedially – Nasopharynx (x1) connected by the Eustachian
Tube (x1)
Actual
Mark
Posterolaterally – Mastoid Air cells (x1) through the Mastoid
Antrum (x1)
4
29
Max.
Mark
The Middle Ear is lined by what?
Mucous Membrane (x1)
Actual
Mark
1
30
Max.
Mark
2
The pharyngotympanic tube is usually closed. When does it
open and what causes it to open?
Opens during swallowing (x1) due to pull of the attached palate
muscles (x1)
Actual
Mark
31
Max.
Mark
What are the contents of the middle ear?
Auditory Ossicles (x1)
Stapedius and Tensor Tympani muscles (x1)
Chorda Tympani Nerve (x1)
Tympanic Plexus (x1)
Actual
Mark
4
32
Max.
Mark
What type of connection can be found where the Ossicles
articulate?
Synovial joints (x1)
Actual
Mark
1
33
What is the function of the Ossicles?
Max.
Mark
Serve to relay the vibrations encountered by the tympanic
membrane to the internal ear (x1)
Amplify and concentrate sound energy to the oval window (x1)
Actual
Mark
2
34
Label the red boxes
Max.
Mark
Actual
Mark
Top Left: Incus (x1)
Bottom Left: Malleus (x1)
Right: Stapes (x1)
3
35
Max.
Mark
Where does the Tensor Tympani insert? What is its action?
What is its function?
Handle of the malleus (x1)
Tenses the tympanic membrane, reducing the amplitude of its
oscillations (x1)
Prevents damage t the inner ear when exposed to loud sounds (x1)
Actual
Mark
3
36
Max.
Mark
What is the action of Stapedius? What is its function? What is
innervated by?
Pulls the stapes posteriorly and tilts its base in the oval window (x1)
which tightens the anular ligament and reduces the oscillatory
range (x1)
Prevents excess stapes movement (x1)
Nerve to Stapedius, which arises from the Facial Nerve (x1)
Actual
Mark
4
37
Max.
Mark
The middle ear has an intimate association with an important
nerve. What is this nerve? Where does it lie? Why is this
association clinically important?
Nerve lies in the Facial Canal (x1) Separated rom the middle ear by
a very thin bony prominence (x1)
Infection of the middle ear may lead to a facial nerve lesion (x1)
Actual
Mark
3
38
What is the Inner Ear?
Max.
Mark
A series of channels (x1) hollowed out of the petrous temporal
bone (Bony Labyrinth) (x1), surrounding the Membranous Labyrinth
(x1)
Actual
Mark
3
39
Max.
Mark
3
What is contained within the Vestibule of the inner ear? What
movements are these structures sensitive to?
Utricle (x1) and Saccule (x1)
Sensitive to rotational acceleration and static pull of gravity (x1)
Actual
Mark
40
Max.
Mark
What inner ear structures communicate with the Vestibule?
What do they contain?
Semi-circular ducts and canals (x1)
Contains receptors that respond to Rotational Acceleration in three
different planes (x1)
Actual
Mark
2
41
What is the name of this overall structure (Boxed in red in the
top left)? Label the other two boxes. What is the function of
the structure labeled by top right box?
Top Left: Cochlea (x1)
Middle: Cochlear Duct (x1)
Top right: Organ of Corti (x1)
Max.
Mark
3
Actual
Mark
42
What is shown? Describe how it gets this appearance and
what will happen if it is not treated
Max.
Mark
Actual
Mark
Boxers Ear/Cauliflower Ear (x1)
Trauma resulting in blooding resulting in an Auricular Haematoma
(x1)
Localised collection of blood forms between the perichondrium and
the auricular cartilage (x1) which causes distortion of the contours
of the auricle
If not aspirated, fibrosis develops in the overlying skin, forming a
deformed auricle (x1)
4
43
Max.
Mark
What are some congenital pinna deformities?
Antihelix deformity
Pinna malformation
Pre-auricular pit
Pre-auricular skin tag
(x1) for every 2 correct answers
2
Actual
Mark
44
Max.
Mark
What is Acute Otitis Externa? Who does it most often develop
in? What are some symptoms?
Infection/Inflammation of the external acoustic meatus (x1)
Often develops in swimmers who do not dry their meatus after
swimming (x1)
Itching and pain in external ear (x1), Pulling the auricle or applying
pressure on the tragus increases pain (x1)
Actual
Mark
4
45
Max.
Mark
What is Otitis Media? Why is it often secondary to upper
respiratory tract infections? Why is it more common in
children?
Infection/Inflammation of the middle ear (x1)
Infection travels via the Eustachian tube (x1)
More common in children as their Eustachian tube is shorter and
more horizontal (x1) making it easier for organisms to travel up it
and harder for fluid to drain away (x1)
Actual
Mark
4
46
Max.
Mark
What might inflammation of the lining of the tympanic cavity
cause?
Partial or complete blockage of the Pharyngotympanic tube (x1)
Actual
Mark
1
47
Max.
Mark
4
How might one perforate their Tympanic Membrane? What
could it cause? What is the difference in healing in Minor and
Large ruptures?
Infection, Trauma, Excessive Pressure (x1)
May cause middle ear deafness (x1)
Minor ruptures heal spontaneously (x1)
Large ruptures require surgical repair (x1)
Actual
Mark
48
Max.
Mark
What is Mastoiditis? What is it a result of? What clinical sign
might indicate mastoiditis?
Infections of the mastoid antrum and mastoid air cells (x1)
Results from otitis media (x1)
Causes inflammation of the mastoid process, so a swelling behind
the ear can be located (x1)
Actual
Mark
3
49
Max.
Mark
Where might infection in mastoiditis spread to in children?
How? What could this cause?
Might spread superiorly into the middle cranial fossa (x1) through
the petrosquamous fissure in children (x1)
Osteomyelitis (x1)
Actual
Mark
3
50
Max.
Mark
When the eustachian tube is occluded, where does residual air
in the tympanic cavity (middle ear) go? Why?
Absorbed into mucosal blood vessels (x1)
Lower pressure in the tympanic cavity (x1)
Retraction of the tympanic membrane (x1)
Actual
Mark
3
51
Max.
Mark
What does interference with the free movement of the
tympanic cavity membrane affect?
Hearing (x1)
Actual
Mark
1
52
Max.
Mark
1
Adenoidal hypertrophy can block the opening to the tube in
the Nasopharynx. What age group are most at risk of this?
Children 3-8 (x1)
Epstein-Barr Virus
Actual
Mark
53
Max.
Mark
How can the Stapedius muscle be paralysed? What are the
consequences of this?
Lesion of the facial nerve (x1)
Loss of protective action against loud noises (x1)
Hyperacusis (x1)
Actual
Mark
3
54
Max.
Mark
How is motion sickness caused?
Discordance between vestibular and visual stimulation (x1)
Actual
Mark
1
55
Max.
Mark
Injuries of the peripheral auditory system cause three major
symptoms. What are they?
Hearing loss – Usually conductive (x1)
Vertigo – When the injury involved the semicircular ducts (x1)
Tinnitus – Buzzing or ringing (x1)
Actual
Mark
3
56
Max.
Mark
3
What does conductive hearing loss result from? How do
people with this type of hearing loss speak? What treatments
are available?
Results from anything in the external or middle ear that interferes
with the conduction of sound or movement of the oval or round
windows (x1)
Usually speak with a soft voice (x1)
May be improved surgically or by use of a hearing device (x1)
Actual
Mark
57
Max.
Mark
What does sensorineural hearing loss result from? What
treatments are available and how do they work?
Results in defects in the pathway from the cochlea to the brain (x1)
(Defects of cochlea, cochlear nerve, brainstem defects)
Cochlear implants (x1)
External microphone transmitting to an implanted receiver that
sends electronic impulses to the cochlea, stimulating the cochlear
nerve (x1)
Actual
Mark
3
58
Max.
Mark
What is Meniere Syndrome? What are some symptoms?
Blockage of cochlear aqueduct (x1)
Recurrent attacks of tinnitus, hearing loss and vertigo (x1)
Accompanied by a sense of pressure in the ear, distortion of sound
and sensitivity to noise (x1)
Actual
Mark
3
59
Max.
Mark
What is Cholesteatoma? How is it caused? How can middle
ear structures become damaged?
Blockage of the eustachian tube (x1) leads to negative middle ear
pressure (x1)
Negative pressure leads to retraction pockets (x1)
Dead skin cells accumulate in pockets (x1)
Necrotic mass of dead skin – Cholesteatoma (x1)
Erosion of middle ear structures and bone by lytic enzymes (x1)
Actual
Mark
5
60
Max.
Mark
3
What is otalgia? What cause it?
Ear pain (x1)
Infection/Inflammation around the ear (x1)
Pain from teeth, pharynx or cervical spine commonly referred to ear
(x1)
Actual
Mark
61
What is Pruritus? What may it result from?
Max.
Mark
Itching of the ear (x1)
May result from primary discharge of external ear or middle ear
discharge (x1)
Actual
Mark
2
62
What is Otorrhea? What does it indicate?
Max.
Mark
Discharge from the ear (x1)
Indicates acute or chronic infection (x1)
If blood/CSF – associated with skull fracture (x1)
3
Actual
Mark