Unit # 7 B

Assessment of
Ears

Presented by:
Kaneez Fatima
Sajida Sharif
 Learning
Objectives
• Identify the structures and functions of the Ear
• Discuss how the nurse focus and prioritize
subjective /objective data collection.
- pt safety issues
• Identify normal and abnormal findings
• Identify teaching opportunities for health promotion and
risk reduction r/t the ear system
• Demonstrate application of the knowledge:
• like Nurse & Act like Nurse:
• Pulling it ALL together:
• Reflection and critical thinking
Ear Anatomy
• Sensory organ of the body
• Used for hearing and maintaining
equilibrium
• Composed of 3 sections
– External ear
– Middle ear
– Internal ear
Structure and Function
• External ear
– External auditory canal
– Tympanic membrane
• Middle ear
– Malleus (hammer), incus (anvil), and stapes
(stirrup)
– Eustachian tube
• Inner ear
– Vestibule
– Vestibule and semi circular canals
– Cochlea
– Frequency range of 20–20,000 Hz
– Decibel range 0–140
Conti….
Cont…
Conti….
 Structure and
• Hearing
Function
– Levels of auditory system
– Peripheral; The peripheral auditory system consists of the outer,
the middle, and the inner ear, which are responsible for capturing and
analyzing sound signals and converting them into information that can
be experienced as an auditory percept. ‫ تصور‬,‫ گمان‬,‫احساس‬.

– Brainstem; The auditory pathway conveys the special sense of hearing.

Information travels from the receptors in the organ of Corti of the inner ear( an
inner ear organ located within the cochlea that contributes to audition) to the
central nervous system, carried by the vestibulocochlear nerve (CN VIII).

– Cerebral cortex; The information is decoded and integrated by each

relay nucleus in the pathway and finally projected to the auditory cortex.
• Pathways of hearing

– Air conduction
– Bone conduction
Cont…
Middle Ear
Anatomy
Inner Ear
Anatomy
 Structure and
Function

• Hearing loss
–Conductive
–
Sensorineural
(perceptive)

• Equilibrium
–Vertigo
Structure and Function
• Developmental Care
– Infants and children
– The adult
– The aging adult
• Cross-Cultural Care
– Otitis media
– Cerumen
– Hearing loss
 Equipmen
t
• Otoscope
• Nasal speculum
• Penlight
• Tuning fork in 256 , 512 and
1024 Hz
• Tongue blade
• Watch
• Gauze square
• Cotton-tipped applicators
Assessment of the Ears

• Subjective Data-
– Hx. Earaches
– Infections
– Discharge (otorrhea)
– Hearing loss
– Environmental noise
– Tinnitus
– Vertigo
 Assessment of the Ears

•Objective data:
•Inspect and palpate external ear:
•Note color, lesions, tenderness,
discharge
•If S/S of ear infection, inspect
unaffected ear first to avoid
transferring infected material.
Inspect/Palpate
Ear
Otitis
Externa
Keloid
scar
Otoscopic
Examination
1. Ask the client to sit comfortably with the back
straight and the head tilted slightly away from you
toward his or her opposite shoulder.
2. Choose the largest speculum that fits comfortably
into the client’s ear canal (usually 5 mm in the
adult) and attach it to the otoscope. Holding the
instrument in your dominant hand, turn the light on
the otoscope to “on.”
3. Use the thumb and fingers of your opposite hand
to grasp the client’s auricle firmly but gently. Pull
out, up, and back to straighten the external auditory
canal. Do not alter this positioning at any time
during the otoscope examination.
 Conti….

4. Grasp the handle of the otoscope between your

thumb and fingers and hold the instrument up or
down.
5. Position the hand holding the otoscope against
the client’s head or face. This position prevents
forceful insertion of the instrument and helps
to steady your hand throughout the
examination, which is especially helpful if the
client makes any unexpected movements.
 Conti….
6. Insert the speculum gently down and forward
into the ear canal (approximately 0.5 inch). As
you insert the otoscope, be careful not to touch
either side of the inner portion of the canal
wall. This area is bony and covered by a thin,
sensitive layer of epithelium. Any pressure will
cause the client pain.

7. Move your head in close to the otoscope

and position your eye to look through the lens.
 Otoscopic Examination
• Insert otoscope and examine ear canal
noting: redness, swelling, lesions,
discharge or foreign bodies

• Inspection of Tympanic Membrane normally TM

- Pearly gray, shiny, translucent

• Flat, slightly pulled in at center

• Skin intact, no redness/ discharge

• Canal- clear, no obstructions

Site of holding the ear
Objective Data—Physical Exam
• 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
–
Objective Data—Physical Exam

• Test hearing acuity

– Conversational
speech
– Whispered voice test
– Tuning fork tests
– Weber test
– Rinne test
 Objective Data—Physical
Exam
• Vestibular apparatus
(cont.)

– Romberg test
•stand with feet together and arms at
sides, close eyes should hold
position for 20 seconds without
loosing balance
– Developmental Care
– Infants and young children
Ear Drum (light reflex)
ght cone (Reflex) Tympanic membrane
• Normal findings:
– Tympanic membrane is pearly gray
with well-defined landmarks
– Light reflex present at 5 o’clock in
right ear and 7 o’clock in left ear
– Tympanic membrane moves when
patient blows against resistance
– No redness, swelling, tenderness,
lesions, drainage, foreign bodies
Normal TM
Otomycosis: Fungal Infection
Cerumen obstructing TM
Retraction of
TM
Perforated
membrane
Infection-red, bulging TM with
Otitis Media
 Hearing •Conductive
•SENSORINEURAL
Lossof sound
•Transmission •Transmission of sound waves
through the external & middle ear
waves in the inner ear is
is referred to as “Conductive
referred to as
“Sensorineural Hearing”
•Mechanical dysfunction of
hearing”.
external /middle ear
•Pathology of inner ear, •Examples include:
CNVIII, temporal lobe of impacted Cerumen, foreign
brain body, pus or
perforated TM,
•Example: presbycus- • Otosclerosis; is a term
gradual nerve derived from oto, meaning “of the ear,”
and sclerosis, meaning “abnormal
degeneration( gradual loss of hardening of body tissue.” The
condition is caused by abnormal bone
 Lateralization
Lateralization;
is the perception by an individual that a sound
is being heard on one side due to a timing and
intensity difference, when in fact the sound
was presented bilaterally. This is a normal
phenomenon that occurs in everyone, but it
can be more pronounced in people with
hearing loss. ‫پس منظر‬
‫ایک فرد کا یہ تاثر ہے کہ وقت اور شدت کے فرق کی وجہ‬
‫ جب کہ حقیقت میں‬،‫سے آواز ایک طرف سنائی دے رہی ہے‬
‫آواز کو دو طرفہ طور پر پیش کیا گیا تھا۔ یہ ایک عام‬
‫ لیکن یہ سننے سے‬،‫رجحان ہے جو ہر کسی میں پایا جاتا ہے‬
‫محروم لوگوں میں زیادہ واضح ہو سکتا ہے۔‬
Pathways of Hearing
 Cochlea
The cochlea is a fluid-filled, spiral-shaped
cavity found in the inner ear that plays a
vital role in the sense of hearing and
participates in the process of auditory
transduction. Sound waves are transduced
into electrical impulses that the brain can
interpret as individual sound frequencies.
‫ سرپل نما گہا ہے جو‬،‫کوکلیا ایک سیال سے بھرا ہوا‬
‫اندرونی کان میں پایا جاتا ہے جو سماعت کے احساس‬
‫میں اہم کردار ادا کرتا ہے اور سمعی نقل و حمل کے‬
‫عمل میں حصہ لیتا ہے۔ صوتی لہروں کو برقی تحریکوں‬
‫میں تبدیل کیا جاتا ہے جسے دماغ انفرادی آواز کی تعدد‬
‫سے تعبیر کر سکتا ہے‬
Causes of Hearing Loss
Hearing loss due to middle ear
causes

• Otitis media:
is inflammation or infection located in the middle ear.
Otitis media can occur as a result of a cold, sore throat,
or respiratory infection.
• Serous otitis media:
(SOM) is a common inflammatory process of the
middle ear, frequent in early childhood.

• Otosclerosis:
is a medical condition in which there is an abnormal bone
growth inside the ear. It is one of the common reasons of the
hearing loss in young .
Hearing loss due to inner ear causes

• Ménière's disease :is a disorder of the inner ear

that causes severe dizziness (vertigo), ringing in the
ears (tinnitus), hearing loss, and a feeling of fullness
or congestion in the ear.
• Exposure to noise :high levels of noise can cause
permanent hearing loss.
• Presbycusis: refers to bilateral age-related hearing
loss.
• Oto” means ear. “Toxicity” means poisoning
• Ototoxicity is inner ear damage that develops as a
side effect of taking certain medications. It can cause
problems related to hearing and balance, functions
your inner ear controls.
• Drugs that cause ototoxicity:
 Hearing
Acuity
•Without Audiometry, other tests are
crude (hearing aid ) measures.

•Whisper test:
•Test one ear at a time
•Press on tragus
•Whisper words from 1-2 ft. away
•Person should be able to repeat back the
words
 Weber Test
•Weber test- valuable when person
reports hearing better with one ear.

•Strike tuning fork and place on midline of

skull

•Tone should be equally loud bilaterally

•Person should hear the tone by bone

conduction (BC)
Conti…
Conti…
Conti…
 Rinne Test
• Strike and place tuning fork on mastoid
process (Sound heard via bone conduction = BC)
• Instruct person to signal when sound stops.
• Quickly reposition fork in front of ear close to
ear canal . (sound heard via air conduction = AC)
• Instruct person to signal when sound stops.
• Normally sound is heard twice as long by AC
by BC.
• Recorded as AC > BC
Conti….
Sample Charting

•Subjective
• States hearing is good.
• No earaches,
• NO infections, discharge,
• NO hearing loss,
• tinnitus or vertigo
Sample Charting
• Objective
• Pinna - skin intact with no masses, lesions,
tenderness, or discharge.
• Otoscope- external canals are clear with no
redness, swelling, lesions, foreign body, or
discharge. Both tympanic membranes are pearly
gray, with light reflex and landmarks intact, no
perforations.
• Hearing- whispered words heard bilaterally,
Weber test: tone heard midline without
lateralization. Rinne test: AC> BC and =
bilaterally.
 Sample Nursing
• Diagnoses
Wellness Diagnoses
• Readiness for enhanced communication r a t e d t o use of
hearing aid as evidence based (AEB)…
• Risk Diagnoses
• Risk for injury r/t hearing impairment
• Risk for loneliness r/t hearing loss

• Actual Diagnoses
• Disturbed Sensory Perception: Auditory r/t
conductive or sensorineural hearing loss AEB…
• Acute pain r/t infection of external or middle ear AEB….
• Impaired social interaction r/t inability to
interact effectively with others secondary to hearing
loss AEB…..
• Disturbed body image r/t concern over appearance
and
 Summary
• Assessment of the ear includes:
1.Inspection & palpation of external ear
2.Otoscopic exam including ear canal
and tympanic membrane
3.Testing hearing acuity
4.Sample documentation
 References
1. Bickley, L. S., Szilagyi, P. G., & Bates, B.
(2007). Bates' guide to physical examination
and history taking (11th Edi). Philadelphia:
Lippincott Williams & Wilkins. Chapter
No.06 & 07 p.n 171-250

2. Weber, Kelley's. (2007). Health Assessment in

Nursing, 3rd Ed: North American Edition.
Lippincott Williams & Wilkins. Chapter
No.14 &15 p.n 239-294