The Assessment of Ears Inspect and Palpate External Ear Otoscopic Examination Inspect ear canal and tympanic membrane Test Hearing Acuity

The Ear Sensory organ for hearing and maintaining equilibrium Consists of movable cartilage and skin Contains 3 parts External Ear Middle Ear Inner Ear

Serves to funnel sound waves Auricle, Pinna or Helix External Auditory Canal Cerumen Ends at the Tympanic Membrane

Hearing function of auditory system divided into 3 levels Peripheral Brainstem Cerebral Cortex Middle Ear: Conducts sound vibrations from the outer ear to the central hearing apparatus in the inner ear It protects the inner ear by reducing loud sound It’s eustachian tube allows equalization of air pressure so that the TM does not rupture Air filled cavity inside the temporal bone Eustachian tube Transmits Sound by Bones or Auditory ossicles Malleus Incus Stapes Inner ear: Contains the bony labyrinth which holds the sensory organs Vestibule Semicircular canals Cochlea Responsible for Equilibrium

Pearly gray color Cone of light Landmarks Malleus Manubrium of Malleus Pars Tensa Pars Flaccida Umbo Annulus

Pathways of Hearing Air Conduction- transmission of sound through ear canal. Bone Conduction- transmission of sound through the bones of the ear. NORMAL AC to BC ratio 2:1

Hearing Loss Conductive Hearing Loss- caused by interference of air conduction of sound (outer to inner ear) due to change in outer or middle ear. Sensorineural Hearing Loss- structural changes or disorders of inner ear or auditory nerve. Damage to Organ of Corti- cranial nerve stimulation impaired Mixed Hearing Loss

Health History- Subjective Data for Ear Exam Pain-Otalgia Infections Discharge-Otorrhea Hearing Loss Presbycusis Nonverbal cues to loss? Environmental Noise Tinnitus Vertigo

And More Subjective Information Past Medical History Chronic Ear Infections Ear Surgery or Injury Perforation Family History Hearing Loss Congenital Birth Defects Meniere’s Disease

More Subjective Information Present Health status Chronic Diseases Medications Hearing Aids Self care behaviors ASA can cause tinnitus and hearing loss Rapid infusion of Lasix can cause hearing loss.

Health Promotion & Protection Patterns Protection from Noise Routine Hearing Screening & Exams Cleaning of Ears Foreign Bodies in the Ear Canal

Equipment & Examining Techniques Otoscope Speculum to fit ear canal Positioning the speculum Pneumatic bulb attachment Tuning Fork

Objective - Physical Exam Inspect Outer Ear Size Shape Alignment Color Darwin’s Tubercle Palpation Helix/Auricle/Pinna Tragus Mastoid process Preauricular and Postauricular Lymph nodes

Physical Exam of External Canal External Auditory Canal Swelling Pain with exam Discharge Foreign Body Cerumen Color Irritation

Exam of the Tympanic Membrane USE OSTOSCOPE Position for adults versus children Normal Color Shiny pearly gray and translucent Cone of light reflex in the antero-inferior quadrant (Right 5 o’clock, Left 7 o’clock) Pars Tensa, Pars Flaccida Annulus Malleus Umbo Manubrium Short Process of Malleus Adults up and back Children under 3 down

Exam of the Tympanic Membrane Eardrum is flat, slightly pulled in the center Flutters with Valsalva or Insufflation Abnormalities Red, Inflamed, Yellow, Purulent Bulging or Retracted Decreased mobility Absent Landmarks Air/fluid levels Scarring

Testing Hearing Acuity – Cranial Nerve VIII 1. Whisper Test or Voice Test 2. Finger-Rubbing Test 3. Weber Test 4. Rinne Test 5. Audiometry Exam Normal AC to BC ratio = 2:1

Rinne/Weber Tests Rinne Test- strike tuning fork& place base on client’s mastoid process--- count number of sec., the client can hear tone, when client no longer hears the tone quickly invert tuning fork (vibrating section) in front of ear & count the number of sec. until vibration no longer heard. Conductive loss - AC=BC (or longer)AC<BC in affected ear. Sensorineural hearing loss-air conduction longer than bone conduction, less than normal ratio 2:1or normal ratio but is hearing is reduced. - client hears poorly both ways. Test lateralization of sounds, strike tuning fork & place base in the middle of forehead. Normal-equal in both ears. Abnormal – hear better in one ear. Conductive hearing loss- lateralization of sound to deaf ear (sound transmits through bone instead of air). Sensorineural hearing loss- lateralization of sound to better ear. Poor ear unable to perceive the sound.

Evaluate Vestibular Function Test Acoustic/Vestibular-Cochlear Nerve (Cranial Nerve VIII) Romberg Test-balance Client should face you with feet together, arms at side, eyes open, then eyes closed for 20 seconds. Normal Findings are to maintain balance without stepping sideways Abnormal Findings are stepping sideways or widening the base of support

Developmental considerations Infants/Children EAC shorter & eustachian tubes wider More prone to infection Inner ear develops during the first trimester of pregnancy Startles to loud noise External ear birth defects Parental Smoking Smoking increases risk for OM

Risk for Hearing Impairment: Infants Low Birth Weight Congenital Infection Perinatal Asphyxia High risk birth problems Chronic OM

Racial Groups Highest Risk for Hearing Impairment Native Americans Alaskan Natives Pacific Islanders

Behavioral Clues for Hearing Impairment Should startle to sound at birth 6-8 month turns to sound and should babble Inattentive in conversation Reacts to movement more than sound Facial expression is strained or puzzled Asks to repeat statements Confuses words that sound alike Speech problem Shy and withdrawn Complains of earaches Hears better when it is quiet or without background noise

Age Variations Adolescents Contacts Sports Wrestling Repeated Loud Music

Age Variations Elderly Decrease in sebaceous glands Increased cerumen production (accumulation/drier) Hair Cells in Organ of Corti degenerate after age 50 Bones of ossicle become fixed Types of hearing Loss Sensorineural - Presbycusis Conductive

Common Conditions of the Ear Associated with Hearing Loss Otosclerosis Presbycusis Cerumen Cholesteatoma Tinnitus Meniere’s Disease

Common Ear Conditions Otitis Media Otitis Externa Myringitis Mastoiditis Tumor Abscess Hematoma

Acute Otitis Media Bacterial/Viral Infection of Middle Ear Red, bulging TM Fever, Ear Pain Conductive Hearing Loss Common in Children

Serous Otitis Media Accumulation of Serous Fluid in the Middle Ear TM may be retracted, yellow, with air bubbles C/O Crackling or popping sound when yawning or swallowing Conductive Hearing Loss Associated with Allergies, Infection, Enlarged lymphoid tissue

Otitis externa (Swimmer’s ear)

Carcinoma