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The outer ear channels sound into the ear canal and consists of the pinna, auricles, tragus, lobe, and cerumen (earwax). The middle ear contains the hammer, anvil, and stirrup, which transmit sound vibrations to the cochlea. The cochlea is the hardest bone in the body and can be implanted with electrodes for cochlear implants. The eustachian tube equalizes pressure in the inner ear. The semicircular canals are responsible for balance and coordination. Issues with the ear can cause hearing loss, infections, and dizziness. Doctors specialized in ears, nose, and throat can treat ear and throat problems. Tympanic membrane rupture can cause tinnitus (ringing in the ears). You have the outer ear, the middle ear, and the inner ear. The outer ear is designed to channel sound into the ear canal. It consists of the pinna, which is the whole outer ear, these are the auricles, this is the tragus, this is the lobe, and it sends sound down through the ear canal, the external auditory canal. And you have mucosal, you have, that's mucosal tissue, so you have goblet cells that release a mucosal fluid that bathes that, and that's called cerumen. It's thicker than regular mucus, that's earwax, we call it cerumen. And some people get that impacted, and they think they're going deaf, and then they go to the doctor, and the doctor cleans out the cerumen, all of a sudden I can hear. It's not a hearing problem, it's just impacted earwax. That's why you should never put anything in your ear but your elbow, which means you shouldn't put anything in your ear, period. So the sound travels down and hits the tympanic membrane, that's your eardrum, and then the sound passes into the inner, the middle ear. The middle ear is hollow except for three structures. It has the hammer, the anvil, and the stirrup, Latin, malleus, incus, and stapes. What happens is as the sound hits the tympanic membrane of the eardrum, it causes a vibration, and that vibration translates down through the malleus, incus, and stapes to the cochlea. What happens is the stape acts like a piston, and it goes in and out of that hole, and as it does that, it causes a vibration to the filaments inside the cochlea, stimulating, generating a signal. And that signal is transmitted up the acoustic nerve to the auditory cortex. Now the cochlea is the hardest bone of the body. They figured that out because they can drill into that and do what we call cochlear implants. Some people have infections, irritations, or trauma, and they lose hearing in one ear. So what they do is they drill through the skull into the cochlea, and they put in these electrodes into the ear. And then they wire it to a magnetic disc underneath the skin behind the ears. And then the patient will wear a hearing aid, but the hearing aid doesn't transmit sound into the eardrum. It transmits sound through a wire that magnetically connects to the underlying magnetic disc. So they kind of stick together, and it transmits the signal, and it goes into the cochlea producing that electrical signal that goes up in the ear. I don't know if you've ever seen it, but patients who are deaf and they do cochlear implants and for the first time a parent hears their child, or a child hears their parent, I don't care who you are, it's going to bring a tear to your eye, so I recommend you do it. It's pretty cool. But that's what a cochlear implant is. You'll see it. They'll have a hearing aid, but they'll have a disc behind the ear, and that's a cochlear. So then, my wife had a condition called otosclerosis. It's a buildup of bone on the stapes, and so what happened, it didn't act as a disc and it kind of fused, and she lost hearing in her right ear. So they did what they call a stapectomy and a prosthetic stape application. So they cut the tympanic membrane and reflected it back. They went inside, they cut off the stapes, that's a stapectomy, and they put a prosthetic stape in, and it actually works, and she can hear now, so she's got her hearing back. My wife, I call her the bionic woman, she's a six million dollar woman. She's got a prosthetic stape, she's got metal plates for the wrists, she's just all bionic. What's up? Which part of the ear is closed out? Oh, really? I was just going to get to that. Give me two seconds, I'm going to get to that. Good question. So, this is the middle ear, right, the middle ear only has those structures, but it's hollow. But this is sealed, this is sealed. So what happens to the inner ear when your pressure builds up, right? Do you ever go flying and you get that air pressure in the ear, you've got to pop your ears to get it out? If you don't, it will actually rupture the tympanic membrane. So that's what this tube is for, this is called the eustachian tube. And the eustachian tube equalizes the pressure. So if you go up high and you get that air pressure building up, drink. Chew gum and swallow a drink. Swallowing causes a suction from the eustachian tube and it pulls that, that's why your ears pop when you swallow. So you should drink water if your ear is still up, if you go up high up in altitude. And that's one of the reasons why people, kids, some kids get infections in the ears because they get constricted eustachian tubes. Sometimes their eustachian tube is closed off and it doesn't drain and you get a buildup of pressure in the ear and you get a buildup of bacteria and they get chronic infections that can lead to hearing loss. So they go in and they put in tubes. And that's where they put the tubes in. At the end of the day, your hair, kids get tubes placed. That's where they put them. And sometimes they're temporary tubes and they fall out. And it's just the patient just swallows them, they just fall, you don't even notice it. Or sometimes they have permanent ones, it's like those that have no eustachian tube at all, they put permanent tubes in. The tympanic membrane is extremely sensitive. Extremely. Extremely. Popping an eardrum is one of the most painful things you can deal with. I can tell you that because what they used to do is they used to, back in the early 1900s, they used to squirt ice water in your ear. And if you didn't jump from that, you were dead. Because that would hurt like hell. Yes? When I was a kid, I used to get really bad ear infections. And I had a perforated eardrum and it was some of the worst. Yeah, perforated eardrum, it hurt a lot. It was so painful. I can remember when I was a kid, I wasn't very bright, I was about 11 maybe, and Roger Moore played James Bond in a movie called Moonraker, and I was just there to see it. Loved, loved James Bond when I was a kid. And I was just drinking a soda and I just wanted to see how far I could stick this straw in my mouth. And I just touched the tympanic membrane and I swear to God, I shot up, you know, to the roof. I mean it was just unbelievable pain. Very, very sensitive. So you can imagine somebody who gets a ruptured eardrum from a blast or something. Hurts like hell. I'm just about to talk about that. So, you asked, and here you are now, balance. What does balance have to do? So we talked about all the structures except this structure right here. What does that remind you of? A neuron. Sorry. No, no, but you've got something goes this way, something goes this way, and something goes this way. And what is it that does that? The gyroscope. The gyroscope. That's how it balances. That's called the semicircular canals. And inside those canals you have these filaments. And how these filaments lay against one another and how they move dictates your balance and coordination. That's what those are. Those are for your balance and coordination. Equilibrium. Ever heard of it? Sometimes patients get infections, they get ear infections, they get colds, and that causes an irritation, inflammation in that, and that can actually throw you off. Patients get dizzy, they get like being drunk all the time, and they vomit. My wife had it for six weeks, and she couldn't get out of bed for six weeks. And you take a medication called meclizine. Now, meclizine is an antiemetic, but it actually has the properties that stop that dizziness or work on that. Some patients can have chronic vertigo. It's a condition called Meniere's disease. And they take meclizine for life. So that's what that structure does. And did you ever spin? Like when you're a kid and you spin and you get dizzy, right? How do skaters, gypsy skaters when they skate, and they kind of spin, looks like they spin like a top, and they just stop and they keep spinning. How do they not get dizzy? Because they can train. They're semicircular canals. They can train those filaments so it doesn't affect them over time. They can adapt to those filaments. Have you ever witnessed cleaning of like an impacted ear? And the stuff they pull out of it. Fungus? I assisted in a procedure once, and I'm like, wow, I had no idea. How much stuff do you know? Well, week one, coming in a couple weeks ago, a 19-year-old came in. They went to see their PCP. PCP sends them to us because they had a cockroach in their ear. That was a cool one to see. Why do you not know? You can. You can hear it. You hear it. It was better because it was alive, too. The cockroach will feed on the saliva, so probably clearly all the wax from the ear. Now, if you ever deal with a child, sometimes kids put things in their nose and put things in their ear. Never try and dig it out. Doctors have an instrument called an otoscope that they can go in and look, and they have special faucets to remove them out. So they're specially designed to do that. But don't go digging them in. Just kind of bandage the ear and take them to the hospital. If you go to a doctor, because you have ear or throat problems, you might see two different types of doctors. You could see an ENT, eyes, ears, nose, and throat specialist, or an otolaryngologist. Somebody handles the throat and the ear. Those are doctors that specialize. Because all those orifices, all those holes are interconnected. So literally a study of one studies the rest. Tympanic membrane rupture or damage to the ear can actually cause ringing in the ear. We call that tinnitus. It's chronic ringing of the ear. I have tinnitus. Ears, military and, you know, firearms and things. Right now my ears are ringing. They're always ringing, constantly. I've gotten used to it. It doesn't bother me. Sometimes at night I get my ears ringing. It's like a phone. It's really loud. Tympanic membrane rupture, inserting two things too far into your ear, kind of like a straw for dumb kids. Kids place foreign objects in their auditory canals. Clear fluid coming from the ear or clear bloody fluid could be the sign of a phase. No fluid should be coming from the ear. Unless you just got out of a pool and you cleaned out your ear. By the way, if your ear gets full of water, do you know how to clear it out? You hop on one foot, turn your head on the side. It clears it every single time. Doesn't the other one? No, you have to do the other side. But you do one side and you're done. This works every single time. And I do it. It works. Facial fractures typically result from blunt impact. Assume that a direct blow to the mouth or nose has caused a facial fracture and a potential cervical spine injury. Look for things like bleeding in the mouth, inability to swallow or talk, acid or loose teeth. Teeth can be voluntarily excised from the mouth. Loose, immovable bone fragments. Facial fractures alone are not an acute emergency unless there is serious bleeding. Yes, you can bleed and become hypovolemic from the amount of blood you can lose from the head. Plastic surgeons can repair face and mouth injuries. Usually they wait about 72 hours for the swelling to go down because if I suture your face with the swelling, you're going to have a really bad scar because I can't line it up properly. So they'll wait until the swelling goes down. Swelling can be very extreme in the first 24 hours. Dental injuries can be traumatic to the patient. Bleeding will occur whenever a tooth is bound to this place in the socket. What you do is you take a 4x4 or maybe roller gauze and you put it in the socket and have the patient bite down. Don't let them swallow it, but have them bite down. Perform suction if needed. Cracked, loose teeth can become an airway obstruction. So try and have the patient not talk if you can avoid it. If a tooth has evolved from the socket, you want to take it to the hospital within two hours. If they re-implanted, it usually can take as long as it's not damaged. Don't touch it by the root. Touch it by the crown. Don't touch the roots. You've got to store it so it doesn't dry out. You can put it in milk, sterile water, or patient spit. We don't carry milk. And I'm not about to open a bottle of sterile water and put a tooth in it. So the easiest thing to do is have them take a cup or something and spit. Even if it's blood soaked spit, have them spit in it and put the tooth right in that. And then have them hold it and take it to the hospital. And they will implant them. UMass, St. D's, they can implant them. You may encounter an object impaled in the patient's cheek. As long as you can tamp it out on both sides, I can put a gauze pad inside and outside, I can remove it and put it in. That's okay. That's the only other time you can remove an impaled object. The neck contains many structures vulnerable to blunt injury. The upper airway, oesophagus, the carotid and jugular veins, thyroid, carotid and the upper part of the trachea. We kind of talked about these already. Any crush injury to the upper part of the neck is likely to involve the larynx or the trachea. Signs and symptoms might be loss of voice, difficulty swallowing, kind of a hoarse voice. You can develop fatal airway obstructions with swelling or the trachea becomes fractured. If you break that cartilage. And sometimes the air can leak into the tissues of the skin and even into the mediastinum. And that can produce a pneumomediastinum and that subcutaneous emphysema. That's what they talk about there. Characteristic crackling sensation produced by the presence of air when you palpate. It's usually right around this area here. That's a sign of an impending pneumothorax. You said it all. Complete airway obstruction can develop rapidly. Call ALS. Patients should be intubated and you've got to put a collar on them because any movement of the head can make that worse. You can receive any kind of penetrating injury. It can cause profuse bleeding to lacerations of the great blood vessels in the neck. Blood can stop that bleeding and put a sealed dressing on it. Put an occlusive dressing right on the neck. Patients can exsanguinate within minutes from carotid artery and jugular venous lacerations. Direct pressure will control the bleeding. Blood trauma to the larynx can be caused by an unrestrained driver strikes the steering wheel with their neck or snowmobile rider clotheslines. Larynx can become crushed against the cervical spine resulting in soft tissue injury fractures or even separation of the fascia. All the tubes of your body are under tension. They're kind of stretched a little bit to include your esophagus and trachea. You can take a fracture to the neck that can separate the trachea. What does it do when it breaks off? It retracts right down into your thorax and you're dead because there's no way you can breathe. It seals right up. That's you too. Penetrating or impaled objects in the larynx should not be removed unless they interfere with CPR. So I guess unless I can't ventilate, we will stabilize it in place. Signs of larynx injury. Respiratory distress, hoarseness, pain, difficulty swallowing. There's the dysphagia, cyanosis, tail skin, sputum in the wounds. You look at the wounds and you see bubbling from air but you also see sputum from like the trachea, you know, coughing up sputum. Subcutaneous emphysema, bruising in the neck, a hematoma. And let me tell you what. You have large blood vessels. You develop a hematoma. It can be huge on the neck to the point as you put a collar on. You may have to loosen the collar or else the patient will choke. Provide oxygen, a ventilation, cervical spine with a collar. So which of the following statements regarding the Adam's apple is false? False. A. It is superior to the cranioid cartilage. The cranioid cartilage is here. The thyroid cartilage is above it or superior. The globe of the eye is also called the... The eyeball. The globe. That's why they call it the globe. It looks like a globe. When a person is looking at an object up close, the pupil should... Like a microscope, they're going to constrict. Actually, as I look at things close, my eyes are going to abductive turn in. Remember the abdicens? They're going to abductive turn in and then I'm going to focus. My pupils are going to constrict. Like a... Like a... For a chemical burn to the eye, the empty should... Avoid contamination of the opposite eye. I don't want to infect the other eye. Which of the following signs is least indicative of a head injury? Pain. Pain. That's what we expect to see. Shine a bright light in your eye and the pupil is constricted. That's what we want to see. The purpose of the eustachian tube is to... Equalize the pressure in the middle ear. Equalize the pressure in the middle ear. When caring for patients based on time, the empty should be most concerned with... That's always. Unless steam safety BSI, it's the only thing that comes before your lip. Unless it's arterial bleed. The presence of subcutaneous emphysema following trauma to the face and throat is suggestive of... The presence of subcutaneous emphysema following trauma to the face and throat is suggestive of...