Download NUR 248 CH 15 EARS 2015

The Assessment of Ears
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Inspect and
Palpate External
Ear
Otoscopic
Examination
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Inspect ear canal
and tympanic
membrane
Test Hearing
Acuity
The Ear
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Sensory organ for hearing and
maintaining equilibrium
Consists of movable cartilage and
skin
Contains 3 parts
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External Ear
Middle Ear
Inner Ear
Pathways of Hearing
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Air Conduction- transmission of
sound through ear canal.
Bone Conduction- transmission of
sound through the bones of the ear.
NORMAL AC to BC ratio 2:1
Hearing Loss
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Conductive Hearing Loss- caused by
interference of air conduction of sound
(outer to inner ear) due to change in
outer or middle ear.
Sensorineural Hearing Loss- structural
changes or disorders of inner ear or
auditory nerve. Damage to Organ of
Corti- cranial nerve stimulation impaired
Mixed Hearing Loss
Health History- Subjective Data for Ear
Exam
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Pain-Otalgia
Infections
Discharge-Otorrhea
Hearing Loss
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Presbycusis
Nonverbal cues to loss?
Environmental Noise
Tinnitus
Vertigo
And More Subjective Information
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Past Medical History
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Chronic Ear Infections
Ear Surgery or Injury
Perforation
Family History
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Hearing Loss
Congenital Birth Defects
Meniere’s Disease
More Subjective Information
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Present Health status
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Chronic Diseases
Medications
Hearing Aids
Self care behaviors
Health Promotion & Protection Patterns
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Protection from Noise
Routine Hearing Screening & Exams
Cleaning of Ears
Foreign Bodies in the Ear Canal
Equipment & Examining Techniques
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Otoscope
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Speculum to fit ear canal
Positioning the speculum
Pneumatic bulb attachment
Tuning Fork
Objective - Physical Exam
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Inspect Outer Ear
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Size
Shape
Alignment
Color
Darwin’s Tubercle
Palpation
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Helix/Auricle/Pinna
Tragus
Mastoid process
Preauricular and Postauricular Lymph nodes
Physical Exam of External Canal
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External Auditory Canal
 Swelling
 Pain with exam
 Discharge
 Foreign Body
 Cerumen
 Color
 Irritation
Exam of the Tympanic Membrane
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USE OSTOSCOPE
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Position for adults versus children
Normal Color Shiny pearly gray and
translucent
Cone of light reflex in the antero-inferior
quadrant (Right 5 o’clock, Left 7 o’clock)
Pars Tensa, Pars Flaccida
Annulus
Malleus
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Umbo
Manubrium
Short Process of Malleus
Exam of the Tympanic Membrane
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Eardrum is flat, slightly pulled in the
center
Flutters with Valsalva or Insufflation
Abnormalities
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Red, Inflamed, Yellow, Purulent
Bulging or Retracted
Decreased mobility
Absent Landmarks
Air/fluid levels
Scarring
Testing Hearing Acuity – Cranial
Nerve VIII
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1.
2.
3.
4.
5.
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Normal AC to BC ratio = 2:1
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Whisper Test or Voice Test
Finger-Rubbing Test
Weber Test
Rinne Test
Audiometry Exam
Rinne/Weber Tests
Evaluate Vestibular Function
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Test Acoustic/Vestibular-Cochlear Nerve
(Cranial Nerve VIII)
Romberg Test-balance
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Client should face you with feet together,
arms at side, eyes open, then eyes closed
for 20 seconds.
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Normal Findings are to maintain balance
without stepping sideways
Abnormal Findings are stepping sideways or
widening the base of support
Developmental considerations
Infants/Children
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Infants
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EAC shorter &
eustachian tubes
wider
More prone to
infection
Inner ear develops
during the first
trimester of
pregnancy
Startles to loud
noise
External ear birth
defects
Parental Smoking
Risk for Hearing Impairment:
Infants
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Low Birth Weight
Congenital Infection
Perinatal Asphyxia
High risk birth problems
Chronic OM
Racial Groups Highest Risk for Hearing
Impairment
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Native Americans
Alaskan Natives
Pacific Islanders
Behavioral Clues for Hearing
Impairment
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Should startle to sound at birth
6-8 month turns to sound and should babble
Inattentive in conversation
Reacts to movement more than sound
Facial expression is strained or puzzled
Asks to repeat statements
Confuses words that sound alike
Speech problem
Shy and withdrawn
Complains of earaches
Hears better when it is quiet or without
background noise
Age Variations Adolescents
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Contacts Sports
Wrestling
Repeated Loud Music
Age Variations Elderly
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Decrease in sebaceous glands
Increased cerumen production
(accumulation/drier)
Hair Cells in Organ of Corti
degenerate after age 50
Bones of ossicle become fixed
Types of hearing Loss
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Sensorineural - Presbycusis
Conductive
Common Conditions of the Ear
Associated with Hearing Loss
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Otosclerosis
Presbycusis
Cerumen
Cholesteatoma
Tinnitus
Meniere’s Disease
Common Ear Conditions
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Otitis Media
Otitis Externa
Myringitis
Mastoiditis
Tumor
Abscess
Hematoma
Acute Otitis Media
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Bacterial/Viral
Infection of Middle
Ear
Red, bulging TM
Fever, Ear Pain
Conductive Hearing
Loss
Common in
Children
Serous Otitis Media
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Accumulation of Serous
Fluid in the Middle Ear
TM may be retracted,
yellow, with air bubbles
C/O Crackling or
popping sound when
yawning or swallowing
Conductive Hearing
Loss
Associated with
Allergies, Infection,
Enlarged lymphoid
tissue
Otitis externa (Swimmer’s ear)
Carcinoma