Ear Assessment

Ear Assessment

• Ear:
– Sense organ of hearing and
equilibrium consisting of:
• External, middle, inner ear
• Tympanic membrane
 Ear Assessment
• Otoscope used to inspect external ear
• Middle and inner ear
– Cannot be directly inspected
– Assessed by testing
• Hearing acuity
• Conduction of sound
 Ear Assessment

• Introduction
– Understanding required
• Normal structure and function;
components of PE
– Outcome of required knowledge
• Differentiate normal from abnormal;
accuracy in assessment
 Ear Assessment
• External ear structures
– Auricle (pinna)
– External auditory canal
– Modified sweat glands (cerumen)
– Tympanic membrane
 Ear Assessment

• Tympanic
membrane
landmarks
– Handle and short
process of the
malleus
– Umbo
– Cone of light
– Pars flaccida and
– Pars tensa
 Ear Assessment

• Middle ear structures

– Tympanic cavity
– Windows (round and oval)
– Auditory ossicles (transmit sound
waves):
• Malleus, Incus, Stapes
 Ear Assessment

• Inner ear structures

– Bony labyrinth (cochlea, vestibule,
semicircular canals)
– Membranous labyrinth
– Inner cochlear duct
• Spiral Organ of Corti –sensory organ for
hearing, sense also position and head
movements to help maintain both static
and dynamic equilibrium.
 Ear Assessment

• Inner ear innervation

– Acoustic or Vestibulocochlear
Nerve (Cranial VIII)
• Hearing pathways
– Sound vibrates through air are
Collected and funneled through
external ear and cause the eardrum
to vibrate.
Ear Assessment

• Hearing pathways, continued

– Eardrum vibrations cause malleus,
incus, and then stapes to vibrate
– Stapes vibration opens oval window
– Sound waves pass to fluid of inner ear
– Fluid movement stimulates hair cells of
Spiral Organ of Corti
– Spiral Organ of Corti initiates impulses
that travel to brain by way of acoustic
nerve (Cranial VIII)
Ear Assessment

• Hearing pathways, continued

– Conductive hearing =
transmission of sound through
external and middle ear
– Perceptive/sensorineural
hearing = transmission of sound
waves in inner ear
 Health Assessment
• Collecting Subjective Data
– Interview approach (COLDSPA)
– Collecting subjective data
• History of current health problem, past
health, family
• Lifestyle and health practices
 Health Assessment

• History of Present Patient Concerns

– Changes in Hearing
• Presbycusis
– Other symptoms
• Ear drainage
• Ear pain , and accompanying signs and symptoms
• Ringing or crackling in the ears.
• Spinning (Vertigo)
Health Assessment

• Past Health History

– Past problems with ear infection,
earache or trauma.
– Past treatment
• Family Health History
– History of hearing lost
Health Assessment

• Work or live in an area with frequent or

continuous loud noise.
• Swimming, protection
• Affect ability to care for yourself, work,
socializing
• Last hearing examination
• Ear care.
Hearing loss
Risk reduction teaching tips
Risk Factors
• Generic predisposition
• Congenital anomalies • Avoid loud noises or sustained
• Preauricular tag loud reverberation
• Otitis media • Wear ear protection when
• Fluid in inner ear exposed to loud noises
• Loud noises • Obtain treatment for otitis media
• Micronutrients deficiencies • Seek for recurrent sinusitis
• Ototoxic medications which can lead to otitis media
• Age • Eat a varied, well-balanced diet
• Trauma to eardrum • Have any hearing loss
• Otosclerosis dizziness, and tinnitus evaluated
• Trauma to the eardrum as soon as possible.
• Viral infection • Avoid medications associated
• Menieres disease with ototoxicity, if possible
• Impacted Cerumen
• Acoustic neuroma of the auditoy nerve
• Brain diseasese
• Child of mother who contracted rubella while
pregnant
• In utero developmental problems that affect
hearing
PHYSICAL EXAMINATION
 Inspection and Palpation
Assessment procedure Normal finding Abnormal findings
Inspect the auricle, Ears are equal in size Ears are smaller than 4
tragus and lobule. Note bilaterally (4-10 cm). The cm or larger than 10 cm
for size, shape and auricle aligns with the
position corner of each eye and Malaligned or low-set
within a 10-degree angle ears may be seen with
of vertical postition. genito urinary disorderd
or chromosomal defect
Continue inspecting the Skin smooth and no Infection
auricle, tragus and lesion, lumps or nodules. Thopi
lobule. Note for lesions, Color is consistent with Blocked sebaceous
discoloration and facial color. gland
discharge. No discharge should be Skin cancer
present. Otitis externa
Darwin’s tubercle may be frostbite
seen which is clinically
insignificant
Palpate the auricle and Normally the auricle, Otitis externa, post
mastoid process tragus and mastoid auricular cyst
process are not tender Mastoiditis
Otitis media
Inspection and Palpation
 Internal Ear:Small
Inspect the
Otoscopic
external
amount of
auditory canal. Note any
•Foul smelling, sticky,
odorless cerumen is the yellow discharge – otitis

Examination
discharge along with the
only discharge present.
color and consistency of
externa or impacted
Cerumen may be yellow, foreign body.
cerumen. orange, red brown, gray •Bloody purulent
or black and soft and discharge – otitis media
moist, dry, flaky or even w/ ruptured tympanic
hard membrane
•Blood or watery
discharge – skull trauma
•Impacted cerumen
Observe the color and Canal walls should be •Reddened swollen
consistency of the ear pink and smooth without canal – otitis externa
canal walls and inspect nodules. •Exostoses
the character of any •polyps
nodules
 Internal the
Inspect Ear:TMOtoscopic
should be acute otitis
pearly gray, media
Examination
tympanic
shiny and Serous otitis
membrane
translucent with media
no bulging or Bluish or dark
retraction. redcolor
Its is slightly White spots
concave, Perforations
smooth, and Prominent land
intact. marks
Normal Findings on Physical
Examination

Copyright
Inspection of ear canal
 Hearing and Equilibrium
Test

• Perform the Weber’s

test
• Normal
– Vibrations are heard
equally well in both ears
• Abnormal findings
– Conductive hearing loss
– clients reports
lateralization of sound to
the poor ear.
– Sensorineural –
lateralization on the
good ear
• Perform Rinne’s test
• Normal
– Air conduction is heard
longer than the bone
conduction.
• Abnormal
– With CHL bone sound is
heard longer than or
equally as long as air
conduction
– With SHL air conduction
sound is heard longer
than bone conduction
• Perform romberg’s sign
– Test s client’s equilibrium
– Normal
• Clients maintain position for 20 seconds
without swaying or minimal swaying
– Abnormal
• Clients move feet apart top avoid falling or
start to fall from loss of balance. This may
indicate vestibular disorders.
Abnormality of the External Ear
• A tophus (Latin: "stone", plural tophi)
is a deposit of monosodium urate
crystals in people with longstanding
high levels of uric acid in the blood. ...
 Abnormality of the External Ear
• Post auricular cyst • Malignant lesion
 Abnormality of the External Ear
• Otitis externa (also
known as "External
otitis," and
"Swimmer's ear")
is an inflammation
of the outer ear
and ear canal.
 Abnormality of the External Ear
• Impacted ear
 Abnormality of the External Ear

• An exostosis
plural: exostoses)
is the formation of
new bone on the
surface of a bone.
 Abnormalities Of The Tympanic Membrane

• Acute otitis media (AOM) is

most often purely viral and self-
limited, as is its usual
accompanying viral URI (upper
respiratory infection). There is
congestion of the ears and
perhaps mild discomfort and
popping, but the symptoms
resolve with the underlying URI.
If the middle ear, which is
normally sterile, becomes
contaminated with bacteria, pus
and pressure in the middle ear
can result, and this is called
acute bacterial otitis media.
Viral acute otitis media can lead
to bacterial otitis media in a very
short time, especially in
children, but it usually does not
 Abnormalities Of The Tympanic Membrane

• Serous otitis media • Blue/ dark red tympanic

membrane
 Abnormalities Of The Tympanic Membrane

• Perforated tympanic • Ruptured tympanic

membrane membrane
 Ear Assessment
• Validation and Documentation of Findings
– Subjective Data
– Objective Data
 Ear Assessment
• Analysis of Data
– Wellness nursing diagnosis example
• Opportunity to enhance auditory
integrity
– Risk nursing diagnosis example
• Risk for injury related to poor hearing
ability
 Ear Assessment
• Analysis of Data
– Actual nursing diagnosis example
• Acute pain related to infection of
middle ear
– Collaborative problem example
• PC: Otitis media, acute