ASSESSING THE EARS AND HEARING

Performance:
1. Prior to performing the procedure, introduce self and verify the client’s identity using agency
protocol. Explain to the client what you are going to do, why it is necessary, and how he or she
can cooperate. Discuss how the results will be used in planning further care or treatments.
2. Perform hand hygiene, apply gloves, and observe other appropriate infection control
procedures.
3. Provide for client privacy.
4. Inquire if the client has any history of the following: family history of hearing problems or loss;
presence of any ear problems; medication history, especially if there are complaints of ringing in
ears; any hearing difficulty: its onset, factors contributing to it, and how it interferes with
activities of daily living; use of a corrective hearing device: when and from whom it was
obtained.
5. Position the client comfortably, seated if possible.
Assessment Normal Findings Deviations from Normal
AURICLES Color same as facial skin. Bluish color of earlobes (e.g.,
6. Inspect the auricles for color, Symmetrical cyanosis); pallor (e.g.,
symmetry of size, and Auricle aligned with outer frostbite); excessive redness
position. To inspect position, canthus of eye, about 10 (inflammation or fever)
not the level at which the degree from vertical. Asymmetry
superior aspect of the auricle Low-set ears (associated with
attaches to the head in a congenital abnormality,
relation to the eye. such as Down syndrome)
7. Palpate the auricles for Mobile, firm, and not tender; Lesions (e.g., cysts); flaky,
texture, elasticity, and areas of pinna recoils after it is folded scaly skin (e.g., seborrhea);
tenderness. tenderness when moved or
 Gently pull the auricle pressed (may indicate
upward, downward, inflammation or infection of
and backward. external ear).
 Fold the pinna forward
(it should recoil).
 Push in on the tragus.
 Applied pressure to the
mastoid process.
EXTERNAL EAR CANAL AND
TYMPANIC MEMBRANE
8. Using an otoscope, inspect the Distal third contains hair Redness and discharge
external ear canal for follicles and glands Scaling
cerumen, skin lesions, pus and Dry cerumen, grayish-tan Excessive cerumen
blood. color; or sticky, wet cerumen obstructing canal
in various shades of brown
9. Inspect the tympanic Pearly gray color, Pink to red, some opacity
membrane for color and gloss. semitransparent Yellow-amber
White
Blue or deep red
GROSS HEARING ACUITY Dull surface
10. Assess client’s response to Normal voice tones audible Normal voice tones not
normal voice tones. If client audible (e.g., requests nurse
has difficulty hearing the to repeat words or
normal voice, proceed with statements, leans toward the
following tests: speaker, turns the head, cups
the ears, or speaks in loud
tone of voice)
a. Perform the watch tick Able to hear ticking in both Unable to hear ticking in one
test. The ticking of a watch ears or both ears
has a higher pitch than the
human voice.
 b. Tuning fork tests

Perform Weber’s test to Sound is heard in both ears or Sound is heard better in
assess bone conduction. is localized at the center of the impaired ear, indicating a
head (Weber negative) bone-conductive hearing loss
or sound is heard better in
ear without a problem,
indicating a sensorineural
disturbance (Weber positive)

Conduct the Rinne test to Air-conducted (AC) hearing is
compare air conduction to greater than bone-conducted
bone conduction (BC) hearing, i.e., AC>BC
(Positive Rinne)
Bone conduction time is
equal to or longer than the air
conduction time, i.e., BC>AC
or BC = AC (negative Rinne;
indicates a conductive
hearing loss.

11. Document findings in the

client record using forms or
checklists supplemented by
narrative notes when
appropriate.
Evaluation:
-Perform a detailed follow up examination of the neurologic system based on findings that deviated
from expected or normal for the client. Relate findings to previous assessment data if available.
- Report significant deviations from normal to the physician.