1. Chapter 14—Ears Assessment

2. Structure and Function
Function: hearing; sustaining equilibrium
Three distinct portions
External ear: starts developing at sixth week of gestation
External auditory canal; tympanic membrane
Cerumen
Middle ear: dampens volume; has four openings
Bones: malleus, incus, and stapes
Openings: tympanic membrane; cochlear window; oval window; eustachian tube

3. Structure and Function—(cont.)
Three distinct portions—(cont.)
Inner ear: responsible for sound translation to cranial nerve (CN) VIII
Responsible for vestibular function
Maintained in semicircular canals, vestibule
Conduits
Bony labyrinth
Semicircular canals; vestibule; cochlea

4. Structure and Function—(cont.)
Figure 14.2

5. Hearing Complex function External ear channels sound waves thru TM
To inner ear ossicles via oval window, then to cochlea
Which vibrates receptor hair cells of the organ of Corti
Producing electrical impulses for auditory nerve
Then delivers impulses to auditory cortex (in brain)
Which interprets them as sound, assigns meaning
Brainstem locates sound origination

6. Hearing—(cont.) Cochlea interprets two components of sound
Amplitude (volume): change of atmospheric pressure against TM = intensity of sound
Decibels = measurement of amplitude
Frequency (pitch): sound waves
Hertz = number of cycles per second
Normal conversation: 10 to 60 dB and 200 to 5,000 Hz
Sound perceived via
Air conduction; bone conduction

7. Hearing—(cont.)

8. Hearing Difficulties
Conductive hearing loss: sound wave transmission disrupted through external or middle ear
External ear blockage: clear obstruction
Middle ear: investigate for pathology
Conductive loss overcome by increased amplitude
Sensorineural hearing loss: problem from inner ear to auditory cortex
Presbycusis
Tinnitus

9. Vestibular Function Semicircular canals, utricle, saccule
Provide proprioception, equilibrium
Specialized epithelium: sense position
Vertigo: Inflamed labyrinth causes loss of equilibrium.
Ménière disease: vertigo with severe nausea, vomiting
Exacerbation periods often last 24 hours.
Followed by periods of remission

10. Lifespan Considerations: Older Adults
Continual cartilage formation  increasing ear prominence with increasing age
Fine ear hairs become coarser, stiffer.
Sound wave interference  decreased hearing
Cerumen impaction  decreased hearing
Slowing of electrical responses in brain  increased reaction time needed
Cultural considerations
Cerumen differences

11. Question
What transfers the signals into electrical impulses for the auditory nerve? A. Cochlea B. Organ of Corti C. Labyrinth D. Oval window

12. Answer
Rationale: The basal membrane in the cochlea vibrates the receptor hair cells of the organ of Corti, which transfer the signal into electrical impulses for the auditory nerve.

13. Urgent Assessment Outer ear foreign object: otolaryngologist removal
Foul-smelling drainage: immediate attention
Chronically draining ears
Cholesteatoma
Can erode auditory ossicles  significant heading damage
Ear trauma
Hemotympanum (tympanic rupture)

14. Subjective Data Assessment of risk factors Personal history
Medications
Family history
Risk factors

15. Risk Reduction and Health Promotion
Health goals
Patient teaching topics
Most significant: risk assessment for general hearing loss
Protective equipment
Skin cancer prevention
Ear cleaning

16. Common Symptoms Signs/symptoms Hearing loss Vertigo Tinnitus Otalgia
Documentation
Lifespan considerations: older adults
Cultural considerations

17. Objective Data Common and specialty or advanced techniques
Inspection; palpation
Hearing acuity
Otoscopic evaluation
Auditory acuity
Rinne test; Weber test
Equilibrium
Lifespan considerations
Cultural considerations

18. Critical Thinking Common laboratory and diagnostic testing
Diagnostic reasoning: Nursing diagnosis, outcomes, and interventions
Outcomes (partial list)
Patient is free from ear pain.
Patient explains plan to accommodate hearing impairment.
Nursing interventions (partial list)
Turn off TV, radios when communicating.
Close door to muffle loud hallway noise.

19. NCLEX-Style Review Question
The function of the ear is for
hearing and equilibrium.
equilibrium and perforations.
perforations and balance.
balance and equilibrium

20. NCLEX-Style Review Question
The inner ear
contains the malleus, incus, and stapes.
conducts sound waves to the external ear.
translates sound to the nerves and brainstem.
provides the body with proprioception

21. NCLEX-Style Review Question
Cues of hearing loss include which of the following? Choose all that are correct.
Using a loud or monotonous voice
Asking to repeat questions
Concentrating on lip movement
Leaning forward to hear

22. NCLEX-Style Review Question
Risk factors for hearing loss include which of the ­following? Choose all that are correct.
Frequent ear infections
Being current on immunizations
Exposure to smoke
Decreased age

23. NCLEX-Style Review Question
Tinnitus is described as
inability to hear well.
dizziness.
ringing in the ear.
ear pain

24. NCLEX-Style Review Question
Which of the following patients is most likely to have hearing loss?
Caucasian man older than 70 years of age
Hispanic woman older than 50 years of age
Asian man younger than 30 years of age
African American girl younger than 10 years of age

25. NCLEX-Style Review Question
Which of the following differentiates the RN ­assessment from the APRN assessment?
History and risk factors
Symptom analysis
Inspection and palpation
Otoscopic assessment

26. NCLEX-Style Review Question
A nursing diagnosis appropriate for a patient with ear problems is
kinesthetic disturbed perception.
disturbed sensory perception.
sensory perception, gustatory.
olfactory sensory perception

27. NCLEX-Style Review Question
Which of the following is an outcome appropriate for a patient with hearing impairment?
Provide a communication board or picture to assist teaching.
Minimize background noise and close door.
Stand in front of patient and explain procedure.
Patient explains plan to accommodate hearing ­ impairment

28. NCLEX-Style Review Question
Which of the following are appropriate interventions for the patient who is at risk for ear infection? Select all that apply.
Be current on immunizations.
Avoid secondhand smoke.
Clean only external ear.
Have audiogram yearly