Assessing Ears

Learning Objectives:

 Describe functions and structures of the ears.

 Discuss the risk factors for hearing loss across cultures and ways
to reduce one’s risks.
 Interview a client for an accurate nursing history of hearing and
the ears.
 Perform a physical assessment of the ears and hearing ability
using the correct techniques.
 Correctly use the otoscope to inspect the auditory canal and
tympanic membrane.
 Differentiate between normal and abnormal findings of the ear
and hearing.
Learning Objectives:

 Analyze data from the ear/hearing interview and physical

assessment to formulate valid nursing diagnoses,
collaborative problems, and/or referrals.
 Differentiate between general routine screening versus
skills needed for focused or specialty assessment of the
ear and hearing.
 Document and verbally report accurate assessment
findings of the ear and hearing.
Structure of the Ear

 The ear is the organ of hearing and is also

involved in balance.
 It is supplied by the 8th cranial nerve the
acoustic nerve.
 The structures that form the ear are
encased within the petrous portion of the
temporal bone with the exception of the
auricle (pinna).
Structure and Function

 Theear is the sense organ of hearing and

equilibrium. It consists of 3 distinct parts:
 The external ear
 The middle ear
 The inner ear
The outer ear collects the sound waves and directs them
to the middle ear, which in turn transfers them to the
inner ear, where they are converted into nerve impulses
and transmitted to the hearing area in the cerebral
cortex.
 The tympanic membrane separates the external ear from
the middle ear.
 Both the external ear and the tympanic membrane can be
assessed by direct inspection and by using an otoscope.
 The middle and inner ear cannot be directly inspected.
 Instead, testing hearing acuity and the conduction of
sound assesses these parts of the ear. Before learning
assessment techniques, it is important to understand the
anatomy and physiology of the ear.
EXTERNAL EAR
EXTERNAL EAR
 Composed of the ff. parts:
 The auricle (pinna), and
 The external auditory
canal.
 The auricle (pinna) is the
portion of the external ear
visible without any tools.
 It is composed of a thin plate
of yellow elastic cartilage
covered by tight-fitting skin
and is shaped with hollows,
furrows and ridges that form
an irregular funnel to conduct
sound waves into the external
auditory canal.
 The lobule is the soft
pliable part at the lower
extremity.
 It is composed of
fibrous and adipose
tissue richly supplied
with blood.
External Auditory Meatus
 The external auditory
canal is S shaped in
the adult.
 The outer part of the
canal curves up and
back; the inner part of
the canal curves down
and forward.
External Auditory Meatus(auditory
canal)
 Has Ceruminous glands
and hair follicles.
 Modified sweat glands in
the external ear canal
secrete cerumen, a wax-
like substance that keeps
the tympanic membrane
soft.
 Cerumen has
bacteriostatic properties,
and its sticky consistency
serves as a defense against
foreign bodies.
 Foreign materials, e.g. dust, insects and microbes, are
prevented from reaching the tympanic membrane by wax,
hairs and the curvature of the meatus.

 NOTE! The PINNA DOES NOT PLAY

ANY ROLE IN MAINTAINING THE
BALANCE OF SOUND THAT IS HEARD.
THE MIDDLE EAR
Middle Ear

 Contains the ff:

 Ossicles
 Incus (hammer)
 Incus(anvil)
 Stapes (stirrup)

 Tympanic
membrane
 Eustachian tube
Middle Ear
 The middle ear, or tympanic cavity, is a
small, air-filled chamber in the temporal
bone.
 It is separated from the external ear by the
tympanic membrane (eardrum) and from the
inner ear by a bony partition containing two
openings, the round and oval windows.
 The tympanic membrane, or eardrum, has a
translucent, pearly gray appearance and
serves as a partition stretched across the
inner end of the auditory canal, separating it
from the middle ear.
 The membrane itself is a concave and located
at the end of the auditory canal in a tilted
position such that the top of the membrane is
closer to the auditory meatus than the
bottom.
The Middle Ear

 Ossicles – Transform the acoustic energy into

kinetic energy.
 The ossicles work like levers to mechanically
amplify the sound about 1000x.
 These consist of 3 small bones;
 Malleus (Mallet) – touches the inside of the
membrane
 Stapes (Stirrup) – against the oval window of
the cochlear
 Incus (anvil)
 Eustachian Tube
 Canal that connects the
middle ear with the
nasal cavity.
 This ensures equal air
pressure is maintained
on both sides of the
ear.
This is the reason why when
you have a cold, your hearing
also suffers. Because
eustachian tube gets blocked
and you can’t equalize the
pressure.
THE INNER EAR
Inner Ear
 Inner Ear contains the organs of hearing and balance.
 It has the BONY LABYRINTH and the MEMBRANOUS LABYRINTH
 It contains the ff:
 Vestibule – containing the utricle and saccule
 3 Semicircular canals
 Cochlea
 The inner ear is formed from a network of channels and cavities in the
temporal bone. (the bony labyrinth.)
 The membranous labyrinth lies within the bony labyrinth and is a
network of fluid-filled membranes that lines and fills the bony labyrinth
The Vestibule
 This is the extended part
nearest the middle ear.
 The oval and round
windows are located in its
lateral wall.
 It contains two
membranous sacs, the
utricle and the saccule,
which are important in
balance
Semicircular canals
3 fluid filled tubes
that detect the
movement and
position of the
head.
 The receptors use
this information
to control
balance.
The Inner Ear

 Cochlea is a spiral shaped organ with a fluid filled

duct running through the center.
 The movement of the fluid stimulates the Organ
of Corti.
 The fluid moves differently depending on the
frequency of the sounds.
 The lower the frequency the further into the
cochlea the wave penetrates.
ASSESSMENT
Health History

 Hearing Loss
 Excessive Cerumen
Common Chief Complaints

 Ear
Hearing loss
Otorrhea
Otalgia
Tinnitus
Evaluation of Chief Complaint

 Quality
 Associated Manifestations
 Aggravating Factors
 Alleviating Factors
 Frequency
 Timing
Past Health History
 Medical
 Otitis media or externa

 Surgical
 Tympanostomy tubes

 Medications
 Antibiotics
 Antihistamines
 Steroids
 Chemotherapy
 Immunosuppresive drugs
Past Health History
 Injuries and accidents
 Foreign bodies
 Trauma
 Sports injuries
 Special needs
 Use of assistive devices (hearing aids)
 Speech disorders

 Childhood illnesses
 Frequent tonsillitis or ear infections
Past Health History
 Social History
 Alcohol use
 Drug use
 Tobacco use
 Sexual practices
 Work and home environment
 Hobbies and leisure activities
 Stress
 Health Maintenance Activities
 Sleep
 Diet
 Use of safety devices
 Health check-ups
General Approach to Assessment

 Greet the patient

 Explain assessment techniques
 Quiet, well-lit environment
 Sitting position
 Compare right to left
 Systematic approach
Equipment

 Otoscope
 Tuning fork in
256, 512 and
1024 Hz
Assessment of the Ear

 Examination consists of 3 parts:

 1. Auditory screening
 2. Inspection and palpation of external ear
 3. Otoscopic assessment
Take history of:

 Ear Aches
 Infections
 Discharge
 Hearing loss
 Environmental noise
 Tinnitus
 Vertigo
 Self care
Auditory Screening

 Voice-whisper test and Vestibular apparatus

 Normal findings: able to repeat words whispered at a
distance of 2 feet.

 Tuning fork tests

 Weber Test
 Rinne Test
 Determine whether hearing loss is conductive or
sensorineural.
Voice Whisper and balance test
 Test hearing acuity: Conversational speech note
behavioral response to conversational speech (lip reading,
frowning, straining forward, turning to catch sounds asks
you to repeat, misunderstands your questions)

 Voice test: Test one ear at time cover opposite ear, shield
lips 1 to 2 feet whisper 2 syllable words have patient
repeat

 Romberg Test: (Vestibule Apparatus) test stand with feet

together and arms at sides, close eyes should hold
position for 20 seconds without loosing balance.
Tuning Fork Test

 Weber test: Place vibrating tuning fork midline

on the skull ask if tone is equal bilaterally or
better in one ear.

 Rinne test: Have patient signal when the

vibrating tuning fork can no longer be heard place
fork near the ear canal should still hear sound
AC>BC
Otoscopic Examination

 Otoscopic exam external canal- color, redness,

swelling for cerumen, discharge, foreign bodies,
lesions.

 Tympanic membrane – normal is shiny

translucent with pearl-gray color, flat slightly
pullet in at center flutters with swelling
membrane should be intact.
2 types of hearing disorder

 SENSORINEURAL
 Auditory Nerve problem

 CONDUCTIVE
 Problem with sound passing through the inner
ear.
Normal Findings

 Weber test
 Normal finding: Able to hear sound equally in both
ears
 Abnormal finding: sound is heard laterally.
 Rinne test
 Normal finding: Air conduction>Bone conduction
(RINNE’s POSITIVE)
 Abnormal finding: Bone conduction>Air conduction
(RINNE’s NEGATIVE)
 External Ear

 Inspection
 Note position, size, color,
and shape color

 Palpation
 Auricle
 Tragus
 Mastoid bone
 TMJ
 Normal findings
 Flesh in color
 Positioned centrally and in proportion to the
head
 Noforeign bodies, redness, drainage,
deformities, nodules, or lesions.
 Abnormal findings
 Pale, red, cyanotic
 Small-size or large-size ears
 Purulent drainage
 Clear or bloody discharge
 Hematoma behind ear over mastoid
 Pain or tenderness on palpation
Otoscopic assessment

 Inspect both ears

 External ear canal:
 Tympanic membrane
 Pullauricle upward and backward to straighten the
auditory canal (adult)
 Pull auricle down and back.
Disorders of the Ears
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