1. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Ears Chapter 15

2. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 15: Ears Slide 15-2  Structure and Function  Subjective Data—Health History Questions  Objective Data—Physical Exam  Abnormal Findings

3. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 15: Ears Slide 15-3 Structure and Function  External ear  External auditory canal  Tympanic membrane  Middle ear  Malleus, incus, and stapes  Eustachian tube  Inner ear  Vestibule and semicircular canals  Cochlea

4. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 15: Ears Slide 15-4 Structure and Function (cont.)  Hearing  Levels of auditory system Peripheral Peripheral Brainstem Brainstem Cerebral cortex Cerebral cortex  Pathways of hearing Air conduction Air conduction Bone conduction Bone conduction

5. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 15: Ears Slide 15-5 Structure and Function (cont.)  Hearing loss Conductive Conductive Sensorineural (perceptive) Sensorineural (perceptive)  Equilibrium Vertigo Vertigo

6. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 15: Ears Slide 15-6 Structure and Function (cont.)  Developmental Care  Infants and children  The adult  The aging adult  Cross-cultural Care  Otitis media  Cerumen  Hearing loss

7. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 15: Ears Slide 15-7 Subjective Data— Health History Questions  Earaches  Infections  Discharge  Hearing loss

8. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 15: Ears Slide 15-8 Subjective Data— Health History Questions (cont.)  Environmental noise  Tinnitus  Vertigo  Self-care behaviors

9. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 15: Ears Slide 15-9 Subjective Data— Health History Questions (cont.) Additional history for infants and children  Ear infections  Hearing loss  Trauma

10. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 15: Ears Slide 15-10 Objective Data—Physical Exam  Preparation  Position  Cleaning the ear canal  Equipment  Otoscope with bright light  Pneumatic bulb attachment (sometimes needed with infants or young children)  Tuning forks in 512 and 1024 Hz

11. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 15: Ears Slide 15-11 External Ear—Inspect and palpate  Size and shape  Skin condition  Tenderness  External auditory meatus Objective Data—Physical Exam (cont.)

12. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 15: Ears Slide 15-12 Objective Data—Physical Exam (cont.) Otoscopic examination  Position of head and ear  Method of holding and inserting otoscope  External canal  Color  Swelling  Lesions  Discharge  Tympanic membrane  Color and characteristics  Position  Integrity of membrane

13. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 15: Ears Slide 15-13 Objective Data—Physical Exam (cont.) Test hearing acuity  Conversational speech  Whispered voice test  Tuning fork tests Weber test Weber test Rinne test Rinne test

14. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 15: Ears Slide 15-14 Objective Data—Physical Exam (cont.) Vestibular apparatus  Romberg test  Developmental Care  Infants and young children

15. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 15: Ears Slide 15-15 Sample Charting

16. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 15: Ears Slide 15-16 Sample Charting (cont.)

17. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 15: Ears Slide 15-17 Sample Charting (cont.)

18. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 15: Ears Slide 15-18 Abnormal Findings Abnormalities of the External Ear  Frostbite  Otitis externa (“swimmer’s ear”)  Brachial remnant and ear deformity  Cerebrospinal fluid otorrhea

19. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 15: Ears Slide 15-19 Abnormal Findings Lumps and Lesions on the External Ear  Darwin’s tubercle  Sebaceous cyst  Tophi  Chondrodermatitis nodularis helicis  Keloid  Carcinoma

20. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 15: Ears Slide 15-20 Abnormal Findings for Advanced Practice Abnormalities in the Ear Canal  Excessive cerumen  Otitis externa  Osteoma  Foreign body  Exostosis  Furuncle  Polyp

21. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 15: Ears Slide 15-21 Abnormal Findings Abnormalities of the Tympanic Membrane  Retracted drum  Otitis media with effusion (OME)  Acute (purulent) otitis media  Perforation  Insertion of tympanostomy tubes  Cholesteatoma  Scarred drum  Blue drum (hemotympanum)  Bullous myringitis  Fungal infection (otomycosis)

22. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 15: Ears Slide 15-22 Abnormal Findings Tuning Fork Tests  Conductive hearing loss  Results with Weber test  Results with Rinne test  Sensorineural hearing loss  Results with Weber test  Results with Rinne test