1. Assessment of the Ear and Hearing
Chapter 50
Assessment of the Ear and Hearing
Marion Kreisel RN, MSN
Adult Health NU230
Fall 2011

2. Anatomy and Physiology
Review of the structure of:
External ear
Middle ear
Inner ear

3. Internal Ear

4. Internal Ear— Tympanic Membrane

5. Middle Ear

6. Otoscope
pressure bulb for injecting air into external cana; to test mobility of the ear drum

7. Tympanic Membrane

8. Copyright © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Hearing
Copyright © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

9. Ear and Hearing Changes Associated with Aging
Drier, impacted cerumen
Loss of tympanic membrane elasticity
Decreased bony ossicle movement
Degenerative changes of cochlea
Disturbed vestibular function
Diminished hearing acuity
Decreased ability to hear high-frequency sounds

10. Assessment Techniques
Patient history
Family history and genetic risk
Current health problems:
Hyperacusis
Tinnitus
Vertigo

11. Physical Assessment External ear and mastoid assessment
Otoscopic assessment

12. Auditory Assessment
Conductive hearing loss resulting from any physical obstruction of sound wave transmission
Sensorineural hearing loss resulting from a defect in the cochlea, the eighth cranial nerve, or the brain
Mixed conductive-sensorineural hearing loss, a profound hearing loss

13. Tests Voice test Watch test Audioscopy Weber tuning fork test
Rinne tuning fork test

14. Weber Tuning Fork Test

15. Rinne Tuning Fork Test

16. Diagnostic Assessment
Laboratory tests
Computed tomography
Magnetic resonance imaging
Auditory brainstem-evoked response
Electronystagmography
Caloric testing
Dix-Hallpike test for vertigo

17. Audiometry Frequency is the highness or lowness of tones.
Intensity is expressed in decibels.
Threshold is the lowest level of intensity at which pure tones and speech are heard.
Pure tones are generated by an audiometer to determine hearing acuity.

18. Audiogram

19. Speech Audiometry Speech reception threshold
Speech discrimination testing
Tympanometry

20. Chapter 50
NCLEX TIME

21. Question 1
A history of which of these conditions will increase the patient’s risk for developing hearing loss?
Diabetes mellitus
Down syndrome
Cardiac disease
Turner’s syndrome
Answer: B
Rationale: 70% of people with Down syndrome develop hearing loss in adulthood. No evidence has shown that diabetes mellitus, cardiac disease, or Turner’s syndrome increases a patient’s risk for also developing hearing loss.

22. Question 2
What is the most important measurable aspect of human hearing?
The ability to detect high-frequency sounds
The ability to distinguish highness or lowness of tones
The ability to understand speech
The ability to tolerate loud sounds
Answer: C
Rationale: The ability to understand speech is the most important measurable aspect of human hearing. Speech discrimination testing assesses understanding of speech. A hearing loss may decrease sensitivity to sound and impair understanding of what is being said.

23. Question 3
The patient with a long history of heart failure is at risk for developing hearing loss if:
There is a genetic predisposition to develop hearing loss.
Heart failure alters tissue perfusion, which may affect hearing.
The patient uses topical medications, which may be ototoxic.
The patient has received multiple doses of furosemide.
Answer: D
Rationale: The patient who has a history of heart failure will likely be using large amounts of diuretics, most commonly furosemide, which has been shown to be ototoxic. The patient who has a history of heart failure may use topical medications, but there is no evidence that any of them are ototoxic. It is true that heart failure affects tissue perfusion, which can affect comprehension of what is heard.

24. Question 4
What is a priority nursing intervention when providing care to a patient with hearing loss?
Provide a safe environment.
Provide written information regarding medications and disease processes.
Ensure that the patient can directly visualize you when you provide instructions.
Have the patient repeat instructions to evaluate additional teaching needs.
Answer: C
Rationale: A patient with hearing loss will use other senses like sight to help interpret communication; the nurse should sit in adequate light and face the patient to allow him or her to see you speak. Safety concerns are also a priority intervention because the patient may not hear warning sounds such as alarms in the room. Written information and assessment of patient comprehension augments all teaching interventions completed by a nurse.

25. Question 5
During the physical assessment, the nurse notices that the patient’s right external ear is deformed. The nurse
should:
Ask the patient about hearing deficits.
Ask the patient about renal or urinary tract problems.
Speak in a lower-toned voice and ensure good visual contact with the patient.
Ask the patient to provide information about his hearing.
Answer: B
Rational: The external ear develops in the embryo at the same time as the kidneys and urinary tract develop. Thus any person with a defect of the external ear should be examined for possible problems of the renal and urinary systems.