Health Assessment
Week 8
Ears
Chapter 16
The ear is a sensory organ for hearing and maintaining equilibrium.
The ear has three parts:
1. External (auricle/pinna) – funnels sound waves into its opening, the external auditory
canal which terminates at the eardrum/tympanic membrane. Lined with cerumen (ear
wax) that lubricates and protects the ear.
2. Middle – tiny, air-filled cavity inside the temporal bone. Contains the malleus, incus and
stapes. Connects the ear to the nasopharynx via the Eustachian tubes. Functions: (A)
conduct should vibrations from the out ear to the central hearing apparatus in the inner
ear (B) protects the inner ear by reducing the amplitude of loud sounds (C) Eustachian
tubes allow equalization of air pressure on each side of the eardrum so that the
membrane does not rupture (during altitude changes during flying)
3. Inner – embedded in bone. Contains the bony labyrinth which holds the sensory organs
for equilibrium and hearing. Cochlea contains the central hearing apparatus.
Responsible for equilibrium.
Hearing involves THREE auditory system levels:
1. Peripheral – ear transmits sounds and converts its vibrations into electrical impulses
which can be analyzed by the brain
2. Brainstem – binaural interaction enables a person to locate the direction of a sound as
well as identifying the sound. CN VIII from each ear sends signals to both sides of the
brain stem.
3. Cerebral cortex – interpret the meaning of the sound and being the appropriate
response
Pathways of Hearing
Air conduction – the most efficient pathway. Occurs through the air by the ear.
Bone conduction – occurs through vibrations picked up the ear’s specialized nervous
system, the skull bones vibrate. CN VIII transmits these vibrations.
Hearing Loss
Conductive hearing loss – involves a mechanical dysfunction of the external or middle
ear. Partial loss because the person is able to hear is sound amplitude is increased
enough to reach normal nerve elements in the inner ear. Can be caused by impacted
cerumen, foreign bodies, perforated eardrums, pus or serum in the middle ear or
otosclerosis (decrease in mobility of the ossicles/hardening that causes the footplate of
the stapes to become fixed in the oval window which impedes transmission of sound
and causes progressive deafness) which is common cause for hearing loss in adults ages
20-40.
Sensorineural hearing loss – or perceived loss: pathology of the inner ear, CN VIII or the
auditory areas of the cerebral cortex. Can be causes be presbycusis (gradual nerve
degeneration what occurs with aging), ototoxic medications which affect the hair cells in
the cochlea.
Mixed loss – a combination of conductive and sensorineural types in the same ear
Hearing loss is the third-most prevalent chronic condition in older adults
Equilibrium
The three semicircular canals, or labyrinth, in the inner ear constantly feed information to the
brain about the body's position in space. They work like plumb lines to determine verticality or
depth. The plumb lines of the ear register the angle of your head in relation to gravity. If the
labyrinth ever becomes inflamed, it feeds the wrong information to the brain, creating a
staggering gait and a strong, spinning, whirling sensation called vertigo.
Older Adults
Cilia lining the ear canal become coarse and stuff which may cause a decrease in hearing
because it impedes sound waves travelling toward the eardrum
Impacted cerumen in common is aging adults (~57%). Cerumenolytics are wax-softening
agents that expedite removal with electric or manual irrigators
Presbycusis is a type of hearing loss that occurs with aging caused by nerve
degeneration
Hearing tests should be done every three years starting at age 2
Those over 65 should see an audiologist annually
Otitis Media
Middle ear infection
Results from obstruction of the eustachian tube or of passage of nasopharyngeal
secretions into the middle ear
Most common illness in children
Size and Shape
Ears should be of equal size bilaterally, no swelling or thickening.
Microtia: ears smaller than 4cm vertically
Macrotia: ears larger than 10cm vertically
Skin condition
Consistent with facial skin
Intact with no lumps or lesions
Darwin’s tubercle – small painless nodule of the helix, not significant
External Auditory Meatus
Atresia: absence or closure of the ear canal
Tympanic Membrane
Shiny and translucent with early grey colouration
Flat and slightly pulled in at the center
Test Hearing Acuity
Pure Tone Audiometer
A precise quantitative measure of hearing by assessing the person’s ability to hear
sounds of varying frequency
Battery-powered, handheld instrument
Whispered Voice Test
Stand arm’s length behind patient
Test one ear at a time
Move head about 2 feet from patient’s ear
Whisper three random letters and numbers
The patient will repeat the three words if they can
Tuning Fork Test
Used to measure air conduction and bone conduction hearing
Weber and Rinne tests
Weber –
Rinne –
Romberg Test
Assessment of the ability of the vestibular apparatus in the inner ear to help maintain
standing balance
Also assessed intactness of the cerebellum and proprioception
Abnormal Findings Seen on Otoscopy
Appearance of Eardrum Indicates Suggested Condition
Yellow-amber colour Serum or pus Serous otitis media or chronic otitis media
Prominent landmarks Retraction of Negative pressure in middle ear from obstruction of
eardrum eustachian tube
Air/fluid level or air bubbles Serous fluid Serous otitis media
Abnormal Findings Seen on Otoscopy
Appearance of Eardrum Indicates Suggested Condition
Absence or distortion of light Bulging of eardrum Acute otitis media
reflex
Bright red colour Infection in middle Acute purulent otitis media
ear
Blue or dark red colour Blood behind Trauma, skull fracture
eardrum
Dark, oval areas Perforation Eardrum rupture
White, dense areas Scarring Sequelae of infections
Diminished or absence of Thickened eardrum Chronic otitis media
landmarks
Black or white dots on eardrum Colony of growth Fungal infection
or canal
