1. The Ears
Dr. Zyad Saleh

2. Concerning symptoms of the ear are:
Subjective Data
Concerning symptoms of the ear are:
Hearing loss
Earache (otalgia)
Discharge (otorrhea)
Tinnitus
Vertigo
During data collection, the examiner should be alert to signs of hearing loss such as inappropriate answers, frequent requests for repetition, etc.

3. Otitis media: medical term for middle ear infection
Earache
Otitis media: medical term for middle ear infection
Surat otoscope lal otitis media
ear pain
fever
drainage from the ear (occurs from a ruptured ear drum)
a feeling of fullness or pressure in the ear
hearing loss
balance problems (vertigo)

4. Otitis externa: inflammation of the outer ear and ear canal.

5. Subjective Data
Drainage (otorrhea)  infection.
Purulent, bloody drainage  infection of the external ear (external otitis).
Purulent drainage associated with pain and a popping sensation  otitis media with perforation of the tympanic membrane.

6. Subjective Data
Earache (otalgia)
 ear infections, cerumen blockage, sinus infections, or teeth and gum problems.

7. Tinnitus: ringing, roaring or crackling  no external stimulus
 excessive earwax buildup, high blood pressure, or certain ototoxic medications
Staggering gait: meshye mutarane7a

8. It is important to distinguish vertigo from dizziness
Vertigo: refers to perception of rotating or spinning. (an inner-ear problem.)
It is termed subjective vertigo when clients feel that they are spinning around
objective vertigo when clients feel that the room is spinning around them..
It is important to distinguish vertigo from dizziness
Staggering gait: meshye mutarane7a

9. Congenital hearing loss Removal of cerumen Ear surgery Trauma
Past history:
Congenital hearing loss
Removal of cerumen
Ear surgery
Trauma
Infection
Exposed to hazardous noise levels
Describe any past treatments
Rubella: 7osbe almaneye, syphilis: zuhri

10. live in an area with frequent or continuous loud noise
Family history:
Hearing loss
Lifestyle habits:
live in an area with frequent or continuous loud noise
time spent in swimming or in water  Otitis externa
hearing loss affected ability to care
hearing loss affected socializing
last hearing examination
wear a hearing aid
care for ears
Smoking is irritating, and can cause otitis media

11. Objective Data
Inspect and palpate the external ear:

12. Objective Data
Inspect and palpate the external ear:
Size and shape and ear alignment: ears are equal size bilaterally with no swelling or thickening
Skin Condition: skin color is consistent with facial skin color, skin intact, with no lump or lesions.
Enlarged preauricular and postauricular lymph nodes—infection
Redness, swelling, or itching—otitis externa

13. Objective Data
Palpate the auricle and mastoid process
A painful auricle or tragus  otitis externa
Tenderness over the mastoid process  mastoiditis.
Tenderness behind the ear  otitis media.

14. Objective Data
Inspect the external auditory canal. (Note any discharge along with the color and consistency of cerumen)

15. Objective Data
Inspect the external auditory canal.
External auditory meatus:
A small amount of odorless cerumen
appearance-color varies from yellow to brown or black;
moist and waxy to dry. Any other discharge? Inflammation?

16. Objective Data
Inspect the external auditory canal.
Observe the color and consistency of the ear canal walls and inspect the character of any nodules.
The canal walls should be pink and smooth, without nodules.

17. Objective Data
Inspect the external auditory canal.
(abnormal)
Reddened, swollen canals
Foul-smelling, sticky, yellow discharge— otitis externa
Bloody, purulent discharge—otitis media
Blood or watery drainage (cerebrospinal fluid)—skull trauma

18. Inspect the eardrum (tympanic membrane):
Color: shiny and translucent with a pearl-gray color.
no bulging or retraction.
slightly concave, smooth, and intact.
Cone-shaped light reflex.

19. Inspect the eardrum:
Red, bulging eardrum and distorted, diminished, or absent light reflex—acute otitis media
Yellowish, bulging membrane with bubbles behind—serous otitis media
Bluish or dark red color—blood behind the eardrum from skull trauma
Perforations—trauma from infection

20. Hearing and Equilibrium Tests:
Whisper-Voice test.
ask pt to close her other ear, stand behind the pt, whisper softly toward unoccluded ear, increase intensity of sound if necessary.
Able to correctly repeat the two-syllable word as whispered.
 hearing loss

21. #testing of ear and bone conduction is done if the patient has problems in hearing…
Weber test:
evaluate the conduction of sound waves through bone to help distinguish between conductive hearing (sound waves transmitted by the external and middle ear) and sensorineural hearing (sound waves transmitted by the inner ear).

22. #testing of ear and bone conduction is done if the patient has problems in hearing…
Weber test:
Vibrations are heard equally well in both ears. No lateralization of sound to either ear.

23. Weber test:
With conductive hearing loss, the client reports lateralization of sound to the poor ear  the poor ear receives most of the sound conducted by bone vibration.
With sensorineural hearing loss, the client reports lateralization of sound to the good ear  nerve damage in the bad ear

24. Rinne’ test: compare air conduction (AC) with bone conduction (BC)
Rinne’ test: compare air conduction (AC) with bone conduction (BC). Place vibrating tuning fork on the mastoid bone, when the pt can no longer hear the sound, quickly place the fork close to the ear, and ask if the sound can be heard again.
Air conduction sound is normally heard longer than bone conduction sound (AC > BC).

25. Conductive hearing loss: BC=AC, or BC>AC.
Sensorineural hearing loss: AC>BC.

26. Romberg test: Test-assesses the ability of the vestibular apparatus in the inner ear to help maintain standing balance.

27. Romberg test:.
Ask patient to stand up with feet together. When stable have pt close eyes wait about 20 seconds; slight swaying may occur.
Positive Romberg’s –loss of balance that occurs when closing eyes.