Clinical Examination of the Ear Equipment for Ear Examination Both indirect and direct light sources are used1. Bull’s eye lamp-indirect light source.2. Head mirror.3. Head light-direct light source.4. Ear specula of various sizes-The largest speculum which can be conveniently inserted into the ear canal should be used.5. Siegel’s pneumatic speculum.6. Tuning fork-256, 512, 1024 Hz


When sound signal strikes the tympanic membrane, the vibration is transmitted to the stapes footplate through a chain of ossicles. The movements of the stapes causes pressure changes in the labyrinthine fluids which move the basilar membrane. This stimulates the hair cells of the organ of corti which acts as a transducer. MECHANISMS OF HEARING


“Otology is almost unique even ill the later part of the 20th century in not being able to explain at least a few of its diseases ill biochemical terms”– Ruben 1975. Ear is divided into three parts:1. External ear2. Middle ear3. Inner earIt consists of pinna and external auditory canal. Pinna develops from six tubercles

Embryology of the Ear

EAR DEVELOPMENT Ear has a very complex source of development. The sound conductive apparatus develops from the branchial apparatus whereas the sound perceptive apparatus develops from the ectodermal otocyst (pars otica). Because of this dual source of origin the developmental anomaly that produced commonly affects either the sound conductive system which includes anomaly of the

Systemic lupus erythematosis

Systemic lupus erythematosis is one of the important autoimmune disorders which involve various systems in the body including kidneys. Its exact etiology is not known but genetic factors and abnormal immune responses have a role to play. Circulating immune complexes composed of a variety of endogenous antigens along with auto antibodies. DNA form major component of

Immune Hemolytic Anemia

Auto Immune Hemolytic Anemia are acquired disorders where auto-antibodies develop against one’s own red blood cells and haemolysis results from their increased destruction. Auto immune haemolytic anemia are divided into warm or cold types depending which temperature the antibody binds itself to the red cell. Warm auto immune anemia occurs at all ages though more in

Goodpasture‘s syndrome

Goodpasture‘s syndrome constitutes triad of glomerulonephritis, Pulmonaty hemorrhage and antibody to basement membrane antigens. Its etiology is unknown. It affects people at any age. Patient generally presents with cough, breathing difficulty and haemoptysis. Anti-GBH antibodies react with an antigen in the glomerular basement membrane producing necrotizing glomerulonephritis. Rapidly progressive renal failure may occur. Circulating antibodies to

Autoimmune myasthenia gravis

Myasthenia gravis is an acquired auto immune disorder of the myoneural junction resulting from attack of antibodies to acetylcholine receptors. The antibodies originate in thymus, reaching skeletal neuro muscular junctions via blood stream. The antibodies cause complement mediated damage at the neuro muscular junction producing functional blockage at the antibody binding sites. Autoimmune myasthenia gravis

Autoimmune Hepatitis Chronic Active

Autoimmune hepatitis (AIH) is a disease characterized by irresolving inflammation of the liver, a predominant pen portal. Hepatitis which generally involves young women who are well nourished with moon facies, acne, amenorrhea hirsuties, pigmentation and abdominal striae. Onset is insidious and patient may be asymptomatic for number of years. Patient is mildly jaundiced with hepatosplenomegaly.

Autoimmune disorders or diseases

Autoimmune disorders – An agent capable of stimulating immune response is known as antigen. It may be a protein, polysaccharide or a complex lipid. There are two kinds of immune responses. Humoral immune response involved in the production of antibodies and cellular immunity in which incompetent cells react directly against the foreign material. T and

Connective Tissue Disorders

Connective Tissue Disorders are a group of disorders which are characterized by arthralgia, arthritis, myositis, raynauds phenomenon and skin lesions. There is multi system involvement with fibrinoid degeneration of connective tissue. Most Connective Tissue Disorders are common in women and these include systemic lupus erythematosis and Sjogren’s syndrome while in men vasculatides are more common. Characteristic features

Ankylosing spondylitis (marie-strupell disease)

It is a chronic progressive inflammatory disorder of unknown etiology, distinguished by the involvement of sacroiliac joints, synovial and spinal joints and the adjacent soft tissues. There may be associated involvement of peripheral joints and extra-articular structures. It is often referred to as rheumatoid spondylitis (Bambo spine). The disease is characterized by long intermittent course

Polyarteritis nodosa

Polyarteritis nodosa is an uncommon connective tissue disorder, characterized by involvement of small and medium sized arteries. There is necrotizing vasculitis with polymorphonuclear infiltration, necrosis and aneursymal dilatation of the vessel wall. The involvement of vessels is widespread and involves major organs except pulmonary vessels. It is a rare disease which commonly manifests in adult age,

Disease modifying anti rheumatic drugs (DMARDS)

It is now agreed that Disease modifying anti rheumatic drugs (DMARDS) should be started early in disease i.e. within 3-6 months of onset of symptoms when patient has persistent polyarticular synovitis, joint deformity and reduction in functional capacity. Traditionally patients are put on Disease modifying anti rheumatic drugs (DMARDS) when they fail to respond to

Gonococcal Meningococcal arthritis

Gonococcal arthritis  is an important form of arthritis which involves young adults of either sex who indulge in sexual abuse. About 2-5% of those suffering from gonorrhoea develop this complication. Clinically patient presents with fever, mild inflammatory asymmetrical polyarthritis with migratory joint paths. There is painful tenosynovitis. The joints mainly affected include knee, shoulder, wrist


Diphtheritic neuropathy is the commonest complication of diphtheria and generally occurs during childhood. Diphtheria toxin is neurotoxic and results in segmental demyelination. Earliest symptom is paralysis of soft palate which occurs within a few days of the illness. It leads to hasal character of voice and regurgitation of fluids through the nose. There is loss of

Diabetic Neuropathy (autonomic, asymmetric, Mono neuritis, Cranial)

Diabetic Neuropathy – Diabetics can develop neuropathy which is classified into symmetrical and asymmetrical forms. Neuropathy in diabetics occurs in those with long standing disease with poor control of hypeiglycemia and is related to severity of diabetes. Diabetic neuropathy can be classified as: (a) Symmetric 1. Diffuse distal primarily sensory polyneuropathy 2. Autonomic neuropathy 3.

Basilar invagination

Basilar invagination means invagination of upper part of the vertebral column into the posterior fossa along with the rim of the foramen magnum. As a result the upper part of cervical cord is stretched over the protecting odontoid peg. Clinically patient has low hairline, short neck and signs and symptoms of lower cranial nerve and cervico

Subacute sclerosing panencephalitis (SSPE)

Subacute sclerosing panencephalitis (SSPE) is a disease of young children and adults caused by measles virus or a virus very closely related to it. The disease is more frequent in boys as compared to girls and generally starts in patients below the age of 10. It has insidious onset with a slowly progressive course spread over

Occupational dystonia (writers cramp)

Occupational dystonia is one form of focal dystonia where dystonic postures and movements occur while performing a specific act. The most important example is writers cramp. It is because of the habitual use of one set of muscles and their repetitive use. The symptoms are local pain in the muscle concerned, local spasm and loss of

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