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

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

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

4. 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

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

6. 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

7. 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

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

10. 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

11. 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.

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

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

14. 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

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

16. 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

17. 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

18. 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

19. 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.

20. 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

21. 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

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

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

24. 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

25. Age Variations Adolescents
Contacts Sports
Wrestling
Repeated Loud Music

26. 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

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

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

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

30. 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

31. Otitis externa (Swimmer’s ear)

32. Carcinoma