Download Inspect and palpate

Ears
Chapter 15
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 15: Ears

Structure and Function

Subjective Data—Health History Questions

Objective Data—Physical Exam

Abnormal Findings
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 15-2
Chapter 15: Ears
Structure and Function
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External ear
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External auditory canal
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Tympanic membrane
Middle ear
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Malleus, incus, and stapes
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Eustachian tube
Inner ear

Vestibule and semicircular canals

Cochlea
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 15-3
Chapter 15: Ears
Structure and Function
(cont.)

Hearing

Levels of auditory system
• Peripheral
• Brainstem
• Cerebral cortex

Pathways of hearing
• Air conduction
• Bone conduction
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 15-4
Chapter 15: Ears
Structure and Function
(cont.)


Hearing loss
• Conductive
• Sensorineural (perceptive)
Equilibrium
• Vertigo
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Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 15-5
Chapter 15: Ears
Structure and Function
(cont.)
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
Developmental Care
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Infants and children
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The adult

The aging adult
Cross-cultural Care
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Otitis media

Cerumen

Hearing loss
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 15-6
Chapter 15: Ears
Subjective Data—
Health History Questions

Earaches

Infections

Discharge

Hearing loss
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 15-7
Chapter 15: Ears
Subjective Data—
Health History Questions
(cont.)

Environmental noise

Tinnitus

Vertigo

Self-care behaviors
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 15-8
Chapter 15: Ears
Subjective Data—
Health History Questions
(cont.)
Additional history for infants and children

Ear infections

Hearing loss

Trauma
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 15-9
Chapter 15: Ears
Objective Data—Physical Exam
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
Preparation

Position

Cleaning the ear canal
Equipment

Otoscope with bright light

Pneumatic bulb attachment
(sometimes needed with infants or young children)

Tuning forks in 512 and 1024 Hz
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 15-10
Chapter 15: Ears
Objective Data—Physical Exam
(cont.)
External Ear—Inspect and palpate

Size and shape

Skin condition

Tenderness

External auditory meatus
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 15-11
Chapter 15: Ears
Objective Data—Physical Exam
(cont.)
Otoscopic examination



Position of head and ear
Method of holding and inserting
otoscope
External canal

Color
 Swelling
 Lesions
 Discharge

Tympanic membrane

Color and characteristics
 Position
 Integrity of membrane
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 15-12
Chapter 15: Ears
Objective Data—Physical Exam
(cont.)
Test hearing acuity



Conversational speech
Whispered voice test
Tuning fork tests
• Weber test
• Rinne test
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 15-13
Chapter 15: Ears
Objective Data—Physical Exam
(cont.)
Vestibular apparatus

Romberg test

Developmental Care

Infants and young children
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 15-14
Chapter 15: Ears
Sample Charting
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 15-15
Chapter 15: Ears
Sample Charting
(cont.)
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 15-16
Chapter 15: Ears
Sample Charting
(cont.)
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 15-17
Chapter 15: Ears
Abnormal Findings
Abnormalities of the External Ear

Frostbite

Otitis externa (“swimmer’s ear”)

Brachial remnant and ear deformity

Cerebrospinal fluid otorrhea
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 15-18
Chapter 15: Ears
Abnormal Findings
Lumps and Lesions on
the External Ear

Darwin’s tubercle
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Sebaceous cyst

Tophi
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Chondrodermatitis nodularis helicis

Keloid

Carcinoma
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 15-19
Chapter 15: Ears
Abnormal Findings
for Advanced Practice
Abnormalities in the Ear Canal

Excessive cerumen

Otitis externa

Osteoma

Foreign body

Exostosis

Furuncle

Polyp
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 15-20
Chapter 15: Ears
Abnormal Findings
Abnormalities of
the Tympanic Membrane
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Retracted drum
Otitis media with effusion (OME)
Acute (purulent) otitis media
Perforation
Insertion of tympanostomy tubes
Cholesteatoma
Scarred drum
Blue drum (hemotympanum)
Bullous myringitis
Fungal infection (otomycosis)
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 15-21
Chapter 15: Ears
Abnormal Findings
Tuning Fork Tests


Conductive hearing loss

Results with Weber test

Results with Rinne test
Sensorineural hearing loss

Results with Weber test

Results with Rinne test
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 15-22