1. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 50 Chapter 50 Assessment of the Ear and Hearing

2. 2 Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Anatomy & Physiology

3. 3 Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Middle & Inner Ear

4. 4 Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Tympanic Membrane

5. 5 Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Middle Ear

6. 6 Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Otoscope

7. 7 Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Assessment Techniques  Patient history  Family history (including genetic risk)  Occupational history  Drug history

8. 8 Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Weber & Rinne Tests

9. 9 Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Diagnostic Assessment  Laboratory tests  CT, MRI  Audiometry (pure-tone, speech)  Tympanometry  Auditory brainstem-evoked response  Electronystagmography (ENG)  Caloric testing  Dix-Hallpike test for vertigo

10. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Chapter 50 Audience Response System Questions 10

11. 11 Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Question 1 The patient with a long history of heart failure is at risk for developing hearing loss if: A. There is a genetic predisposition to developing hearing loss. B. Heart failure alters tissue perfusion, which may affect hearing. C. The patient uses topical medications, which may be ototoxic. D. The patient has received multiple doses of furosemide.

12. 12 Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Question 2 What is a priority nursing intervention when providing care to a patient with hearing loss? A. Providing a safe environment B. Providing written information regarding medications and disease processes C. Ensuring that the patient can directly visualize you when you provide instructions D. Having the patient repeat instructions to evaluate additional teaching needs

13. 13 Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Question 3 During the physical assessment, the nurse notices that the patient’s right external ear is deformed. What should the nurse do? A. Ask the patient about hearing deficits. B. Ask the patient about kidney or urinary tract problems. C. Speak in a lower-toned voice and ensure good visual contact with the patient. D. Ask the patient to provide information about his or her hearing.