Jarvis Chapter 15

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Jarvis: Physical Examination & Health Assessment, 6th Edition

Chapter 15: Ears
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This section discusses key points about the structure and function of the
ears.
The ear is the sensory organ for hearing and maintaining equilibrium.
It has three parts: the external, middle, and inner ear.
The external ear (or auricle or pinna) has six landmarks: the helix,
antihelix, external auditory meatus, tragus, antitragus, and lobule.
The translucent, pearly gray, tympanic membrane (or eardrum)
separates the external and middle ear. Otoscopic inspection of this
membrane reveals several features:
o A prominent cone of light is visible.
o The malleus pulls at the center of the ear, causing it to appear oval
and slightly concave.
o Almost in the center, the umbo is where the first ossicle is
attached.
o The pars flaccida is the small, slack, superior section of the
membrane.
o The pars tensa is the remainder of the membrane. It is thicker and
more taut.
The middle ear is a small air-filled cavity inside the temporal bone. It
contains tiny ear bones: the malleus, incus, and stapes. The middle ear
has three functions:
o It conducts sound vibrations from the outer ear to the central
hearing apparatus in the inner ear.
o It protects the inner ear by reducing the amplitude of loud
sounds.
Elsevier items and derived items 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of
Elsevier Inc.
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o And its eustachian tube allows equalization of air pressure on

each side of the tympanic membrane.
The inner ear contains the bony labyrinth, which holds the sensory
organs for equilibrium and hearing. In the labyrinth, the vestibule and
semicircular canals compose the vestibular apparatus, and the cochlea
contains the central hearing apparatus. Although the inner ear is not
accessible to direct examination, you can assess its function.
Hearing involves the auditory system at the peripheral level,
brainstem, and cerebral cortex. The ear transmits sound and converts
its vibrations into electrical impulses, which the brain analyzes. Anything
that obstructs sound transmission impairs hearing. Hearing loss may
be conductive, sensorineural, or mixed.
o Conductive hearing loss involves a mechanical dysfunction of the
external or middle ear. If the sound amplitude is increased enough,
the person can hear. Cerumen buildup and otosclerosis may cause
conductive hearing loss.
o Sensorineural or perceptive hearing loss indicates a pathologic
condition of cranial nerve eight. Presbycusis, an age-related
gradual degeneration of the nerve, may be the cause.
o Mixed hearing loss results from conductive and sensorineural
causes.
At different developmental stages, anatomic differences alter hearing.
o In infants, the eustachian tube is relatively short and wide and is
more horizontal than it is in an adult. This allows pathogens to
migrate to the middle ear from the nasopharynx. Also, the lumen is
easily occluded.
o In adults younger than age 40, otosclerosis is a common cause of
conductive hearing loss.
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o In aging adults, hearing acuity may be decreased because of the

coarse and stiff cilia lining the ear, impacted cerumen, and nerve
degeneration in the inner ear.
This section presents critical points about subjective and objective
assessments of the ears.
To obtain subjective data, ask questions that investigate
these topics:
o Earaches,
o Ear infections,
o Discharge from the ears,
o Hearing loss,
o Environmental noise,
o Tinnitus,
o Vertigo,
o And self-care behaviors.
To obtain objective data, first inspect and palpate the external ear.
o Note the size and shape of the auricle and the ear position and
alignment on the head. Observe the skin condition, including
color and any lumps or lesions.
o Check for movement of the auricle, and palpate the pinna, tragus,
and mastoid process to detect tenderness.
o Evaluate the external auditory meatus, noting its size and any
swelling, redness, discharge, cerumen, lesions, or foreign bodies.
Next perform an otoscopic examination.
o Inspect the external canal, again looking for any cerumen,
discharge, foreign bodies, or lesions. Also check the canal wall for
redness or swelling.
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o With the otoscope, inspect the tympanic membrane. Observe its

color and characteristics. Note its position, which may be flat,
bulging, or retracted. Also assess the integrity of the membrane.
Then test hearing acuity. First, note the patients behavioral response to
conversational speech.
o If indicated, perform the whispered voice test. If needed, perform
tuning fork tests to measure hearing by air conduction or by bone
conduction.
To assess the vestibular apparatus, perform the Romberg test, which
evaluates standing balance.
Based on the patients developmental stage, adjust your assessment
technique or expected findings. For example, for a child, use different
tests to assess hearing acuity. In an older adult, expect the tympanic
membrane to appear whiter, more opaque, and duller than in a
younger adult.
During the ear assessment, incorporate health promotion. For instance,
teach young people about the risk of hearing loss with digital music
players and earbuds, and suggest ways to prevent hearing loss from the
overuse of these devices.
Elsevier Inc.

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Key Points Print

Jarvis: Physical Examination & Health Assessment, 6th Edition

Key Points Print

o And its eustachian tube allows equalization of air pressure on

Key Points Print

o In aging adults, hearing acuity may be decreased because of the

Key Points Print

o With the otoscope, inspect the tympanic membrane. Observe its

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