1. Assisting with Eye and Ear Care Lesson 2: The Study of the Ear39
Assisting with Eye and Ear Care
Lesson 2:
The Study of the Ear

2. Lesson Objectives
Upon completion of this lesson, students should be able to …
Define and spell the terms to learn for this chapter.
Name and explain two types of hearing impairment.
Explain procedures to irrigate the ear and instill ear medications.
Explain the procedure to evaluate hearing acuity using an audiometer.

3. Anatomy & Physiology of the Ear3

4. Instruments Used in Ear Examinations
Otoscope
Lighted instrument with a small, disposable speculum inserted into the ear canal to examine the tympanic membrane
Tuning fork
Metal, fork-shaped instrument that produces vibrations when struck
Audiometer
Electronic instrument that measures more precisely the frequencies or the number of fluctuations per second of energy in the form of sound waves

5. Otoscope

6. Turning Fork

7. Audiometer

8. Irrigating the Ear
Necessary to remove impacted cerumen (earwax) or foreign matter from the ear
Patients may be apprehensive about the discomfort of the procedure and it is your responsibility to put them at ease as much as possible

9. Steps to Irrigating the Ear
Check the physician’s orders
Perform hand hygiene
Assemble the equipment
Check the name, concentration, and expiration date of the irrigating solution three times
Identify the patient and explain the procedure
Apply gloves

10. Steps to Irrigating the Ear
Have the patient sit with the affected ear tilted slightly downward
Place a towel over the shoulder and ask the patient to hold the emesis basin
Clean the external ear with a moistened cotton ball
Pour the warmed solution into a sterile basin and fill the syringe with 50 cc (mL) of solution

11. Steps to Irrigating the Ear
For adults, pull the earlobe up and back to straighten the ear canal
For children under three years pull the earlobe down and back to straighten the ear canal
Expel air from the syringe and insert the tip into the ear canal 
Aim the stream of flow toward the roof of the canal

12. Steps to Irrigating the Ear
Repeat until the return from the ear is clear
Remove the basin, dry the outer ear, and remove the towel
Give the patient cotton balls to wipe any external drainage
Instruct the patient about home care if needed

13. Steps to Irrigating the Ear
Ask the patient if he or she has any questions
Dispose of any waste material properly
Perform hand hygiene
Document the procedure, noting the type of drainage and any patient symptoms such as pain or dizziness

14. Instillation of Ear Medication
Commonly performed by medical assistants
Medical assistants may be required to instruct the patient how to administer eardrops
Provide the patient with a printed list of instructions and review the guidelines with them in the office
Ask the patient to demonstrate the steps prior to leaving the office to ensure that he or she understands the procedure

15. Instillation of Ear Medication

16. Steps to Instilling Ear Medication
Check physician’s orders
Perform hand hygiene
Assemble the equipment
Identify patient
Check the medication label three times for the correct name, expiration date, and concentration
If the medication is cold, warm it by rolling between the palms

17. Steps to Instilling Ear Medication
Have the patient tilt the head away from the affected ear or lie down with the affected ear facing up

18. Steps to Instilling Ear Medication
Pull the earlobe up and back for an adult, down and back for a child
Place the dropper in the ear canal without touching the sides of the canal
Instill the appropriate number of eardrops along the side of the canal

19. Steps to Instilling Ear Medication
Instruct the patient to remain in the same position for 3 to 5 minutes
Give instructions for home care if needed – Ask the patient if he or she has any questions

20. Position of the Child’s Ear for an Irrigation

21. Position of the Adult’s Ear for an Irrigation

22. Hearing Loss Conduction hearing loss Due to obstruction of sound waves
Sound waves never reach the organ of Corti
Caused by foreign material or excess cerumen in the external ear canal, calcification of the bones in the middle ear, infection or fluid buildup in the middle ear, or a combination of these problems 22

23. Hearing Loss Sensorineural hearing loss
Nerve damage due to damage of the organ of Corti, or to the auditory nerve
When the sound waves reach the inner ear but are unable to be converted into electrical impulses which are sent to the brain, damage is present
Nerve deafness can be hereditary, or may be due to loud noises or viral infections 23

24. Critical Thinking Question
How can you help minimize the fear a patient may be having due to loss of hearing?

25. Abbreviations for the Ear
AD (aurus dextra) for right ear
AS (aurus sinistra) for left ear
AU (aurus uterque) for both ears are used when charting results involving ears
Although some offices may use the abbreviations, ISMP recommends that complete words be used to avoid errors. 25

26. Steps to Performing Audiometric Tests
Check the physician’s orders
Perform hand hygiene
Prepare the equipment and the examination room – Test the equipment and make sure the power is on
Identify the patient and explain the procedure
Establish signal response patient will give if no automatic button is available; nodding head or holding up a finger are acceptable signals

27. Steps to Performing Audiometric Tests
Have the patient assume a comfortable position
Place headphones over one of the patient’s ears
Begin with low frequency and watch the patient for indication that the sound is heard; push the button to record if the machine does not do it automatically
Gradually increase the frequency until the test is completed in the first ear

28. Steps to Performing Audiometric Tests

29. Steps to Performing Audiometric Tests
Proceed to the other ear and repeat the entire procedure
Remove the head phones
Clean the equipment following the manufacturer’s instructions
Perform hand hygiene
Document the procedure appropriately

30. Procedures and Diagnostic Tests Related to the Ear
Audiogram:
A chart that shows the faintest sounds a patient can hear during audiometry testing
Audiometric test:
A test of hearing ability by determining the lowest and highest intensity and frequencies that a person can distinguish
The patient may sit in a soundproof booth and receive sounds through earphones as the technician decreases and changes the volume and tones

31. Procedures and Diagnostic Tests Related to the Ear
Electrocochleography:
A recording of the electrical activity produced when the cochlea is stimulated

32. Falling Test A test used to observe balance and equilibrium
The patient is observed standing on one foot, then with one foot in front of the other, and then walking forward with eyes open
The same test is conducted with the patient’s eyes closed

33. Falling Test
Swaying and falling with the eyes closed can indicate an ear and equilibrium malfunction

34. Procedures and Diagnostic Tests Related to the Ear
Mastoid antrotomy:
Surgical opening made in the cavity within the mastoid process to alleviate pressure from infection and allow for drainage
Mastoid X-ray:
An X-ray taken of the mastoid bone to determine infection, which can be an extension of a middle ear infection

35. Procedures and Diagnostic Tests Related to the Ear
Myringoplasty:
Surgical reconstruction of the eardrum
Otoplasty:
Corrective surgery to change the size of the external ear or pinna
The surgery can either enlarge or decrease the size of the pinna

36. Myringotomy
Surgical puncture of the eardrum with removal of fluid and pus from the middle ear
It is used to eliminate a persistent ear infection and excessive pressure on the tympanic membrane
A tube is placed in the tympanic membrane to allow drainage of the middle ear cavity

37. Otoscopy
The use of a lighted instrument to examine the external auditory canal and the middle ear

38. Procedures and Diagnostic Tests Related to the Ear
Stapedectomy:
Removal of the stapes bone to treat otosclerosis (hardening of the bone)
A prosthesis or artificial stapes is implanted
Tympanoplasty:
Another term for the surgical reconstruction of the eardrum

39. Rinne and Weber Tuning Fork Tests
Tests assess both nerve and bone conduction of sound
Rhine test
Examiner places the base of the vibrating fork against the patient’s mastoid bone and in front of the auditory meatus (air conduction)
Weber test
Tuning fork is placed on the center of the forehead
Both test hearing but in very different ways

40. Tympanometry
A diagnostic test used to measure the ability of the tympanic membrane to move, thereby estimating the pressure in the middle ear
If the middle ear is filled with fluid the tympanic membrane will be more rigid
A printout of the results is produced for the physician to evaluate

41. Electronystagmograph (ENG)
Special examination that evaluates balance through measurement of the movement of the eyes
Used to evaluate patients with vertigo (a false sense of spinning or motion that can cause dizziness) and other disorders that affect hearing and vision
Electrodes are placed above and below the eye to record electrical activity

42. Electronystagmograph (ENG)
By measuring electrical changes in the electrical field in the eye, an ENG can detect nystagmus (involuntary rapid eye movement) in response to stimuli

43. Anatomy of the Upper Airway

44. Examination of the Nose and Throat
Part of a physical examination and is considered routine in most offices
The physician uses a nasal speculum to inspect the mucous lining of the nose for signs of irritation and infection
Includes use of a tongue depressor to examine the throat for signs of infection, enlarged tonsils, and abnormalities of the tongue or oral cavity

45. Examination of the Nose and Throat
Nasal speculum and pharyngeal mirror.

46. Signs and Symptoms of Nasal Problems
Nosebleeds or epistaxis
Reduced sense of smell
Congestion
Allergic rhinitis – an inflammation of the lining of the nose

47. Steps to Instilling Nasal Medication
Check physician’s orders
Perform hand hygiene
Assemble the equipment
Identify the patient and explain the procedure
Position the patient with head lower than the shoulders to instill medication into the ethmoid and sphenoid sinuses

48. Steps to Instilling Nasal Medication
To instill medication into the maxillary and frontal sinuses, have the patient assume the same back-lying position with the head turned toward the side to be treated
Place patient in a supine position with a pillow under the neck to lower the head below the shoulders
Make the patient as comfortable as possible

49. Steps to Instilling Nasal Medication
Check the medication three times for correct name, dosage and expiration date
Draw the medication into a dropper and hold it over the center of the affected nostril, taking care not to touch the dropper to the inside of the nostril
Administer the medication
Repeat in the other nostril if ordered

50. Steps to Instilling Nasal Medication
Tell the patient to stay in that position for 5 minutes to prevent medication from running out of nostril
Provide tissues for the patient to wipe the excess from the skin
Discard the dropper in the biohazard waste container, recap the medication, and return it to the storage place
Clean the area and remove gloves

51. Steps to Instilling Nasal Medication
Provide home instruction if needed
Verify patient understanding
Perform hand hygiene
Document the procedure in patient’s record

52. Questions? 52