Pediatric Nursing Q 174

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When performing a physical examination on an infant, the nurse in charge notes abnormally low-set ears. This finding is associated with:

  

     A. Otogenous tetanus

     B. Tracheoesophageal fistula

     C. Congenital heart defects

     D. Renal anomalies

    

    

Correct Answer: D. Renal anomalies

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Normally the top of the ear aligns with an imaginary line drawn across the inner and outer canthus of the eye. Ears set below this line are associated with renal anomalies or mental retardation. This is due to the observation that auricular malformations often are associated with specific MCA syndromes that have high incidences of renal anomalies.

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Option A: Otogenic tetanus is a subtype of cephalic tetanus, usually limited to the muscles and nerves of the head and neck, but can also progress to a more generalized form. It usually is the result of tetanus spores gaining entry into the middle ear of otitis media through a tympanic membrane perforation.

Option B: TEF is most commonly associated with other congenital anomalies, particularly cardiac defects. Esophageal atresia (EA) is a related congenital malformation with a similar presentation to TEF and can occur with or without the presence of a fistula.

Option C: Low-set ears do not have congenital heart defects. Many cases of CHD are multifactorial and result from a combination of genetic predisposition and environmental risk factors. CCHD is usually isolated and sporadic, but it can also be associated with genetic syndromes. Approximately 15% to 20% of infants with CCHD are related to known chromosomal abnormalities, most of these are aneuploidies (trisomy 21, 13, and 18 and Turner syndrome).

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