3.

Organs of Corti - end organ for hearing, transforms mechanical

AUDITORY SYSTEM energy into neural activity.
Ear’s main function is hearing, but it also plays a major role in
maintaining one’s equilibrium or balance. Risk Factors:
1. Infectious Disease with ear sequelae (Mumps, Measles, Meningitis)
2. Surgery
3. Allergy
4. Medication - antibiotics usually are ototoxic
5. Dietary habits - Polysaturated fats
6. Family Hx

Assessment: Subjective
1. Chief complaint - COLDSPA;
2. Other symptoms - Diminished hearing, tinnitus, itchiness.
3. Past History of Ear Disorders
4. Family Health History
5. Lifestyle and Health Practices - people who are living near the
airport. Subjected to high decibels of sounds from airplane taking
off and landing. Also, people who use earphones with LOUD
sounds.

Assessment: Objective
External Ear
Inspection & Palpation
Size and Shape
N: equal with no swelling or thickening (4-10cm)
AbN: Microtia - smaller than 4cm vertically
larger than 10cm vertically, Edema
External Ear
If baby’s auricle is evidently lower than the outer canthus of eye =
1. Auricle (Pinna) — detect sound waves and directs vibration into the
Down Syndrome
external auditory canal
2. External Auditory Canal (Ear Canal) — is comprised of Stratified
SKIN CONDITION
Squamous Epithelial cells equipped with Cilia. “S” Shaped and has a
N: consistent with facial color
length of 2.5cm.
AbN: redness; enlarged lymph nodes - inflamed.
It contains, hair follicles, sebaceous and ceruminous glands and has
crusting (indicative of premature keratinization
ability to secrete dark brown substance called Cerumen. (Every other
replacement of corpus corneum)
week ang cleaning) Ear has its own cleaning mechanism.
red-blue discoloration - frost bite.
tophi, keloid, carcinoma
Middle Ear
1. Tympanic Membrane - normal color is pearly gray, shiny,
TENDERNESS
translucent. Separates external ear to the middle ear. Function is it
Move pinna and push on tragus
conducts sound vibrations from external ear to the ossicles (3
N: firm with no pain
bones)
AbN: painful = otitis media
pain on mastoid = mastoiditis
Normally it has 3 layers (outer, fibrous middle, inner mucosa)
Darwin’s Tubercle congenital; thickening on the helix.
• Pars Tensa - complete 3 layers
• Pars Flaccida - absence of fibrous middle layer making it more
Abnormalities of the External Ear
vulnerable.
1. Frost bite — flaking/drying of ears due to cold environment
2. Otitis Externa - infection of the external ear
2. Ossicles - 3 smallest bones of the body.
3. Tophi - deposits of monosodium urate crystals; risk factors people
o Malleus (Hummer) - largest; attached to the tympanic membrane.
with elevated uric acid.
Would vibrate when sound is present and transmit sound to
4. Carcinoma
stirrup.
5. Cauliflower - risk for boxers due to consistent trauma
o Incus (Anvil) - middle part;
6. Keloids
o Stapes (Stirrup) - inner most; attached to the cochlea.
Remember:
Eustachian Tube - 1mm wide, 35mm long. Connects middle ear to the
Adult - Pull Pinna UP-BACK
nasopharyngeal cavity; Normally closed but open when yawns,
Infant: Pull Straight down
swallow, Valsalva to drain normal and abnormal secretion of the middle
ear and equalize pressure.
Middle Ear
Inspection through otoscope
In case of colds - where in the secretions would occlude this eustachian
- note for color, amount of cerumen, discharges
tube; Secretions can go up to the middle ear, infecting tympanic
- note for color and nodules in the canal
membrane (Otitis Media). If tympanic membrane perforates, pus
leakage can occur (Luga). If not corrected it may to a permanent hearing
Abnormal: malodorous., sticky yellow discharge, reddened, swollen
loss.
canal. Note for bloody purulent discharge, bloody or watery discharge
(CSF leak), impacted cerumen blocking the external canal and
Inner Ear - housed deep within the temporal bone.
exostoses (cartilage cap bony projection arising from any of the bones
Cochlea and Semicircular canals housed inside bony labyrinth that
that develops from a cartilage) and polyps.
surrounds and protects the membranous labyrinth filled with perilymph.
Inspection of Tympanic Membrane through otoscope
Membranous Labyrinth — has fluids called endolymph.
Normal: Pearly gray, shiny, translucent; no bulging or retraction
1. Semicircular canals - contains sensory receptors that detect rational
concave, smooth, intact; Cone-shape at 5 o’ clock —Right Ear
movement
7 o’ clock — Left Ear.
2. Utricle & Saccule - linear movements
Abnormal: red bulging eardrum with distorted or absent light reflex, D. Chief Complaints
yellowish, bulging membrane with bubbles behind, Bluish or Dark Red o Ear pain
color, White spots, Perforations, prominent/absent landmarks. o Hearing Loss
o Vertigo
Upon inspection: o Tinnitus
o Perforated o Drainage
o Blue Drum (hymotympanum) o Infection
o With Tymanostomy Tube o N/V

Degree of Hearing loss Diagnostic Exams

§ Normal: -15 to 25 decibels Non-invasive
§ Mild: 26 to 40 decibels Test of Aural Structure - to check for structural deformities
§ Moderate: 41 to 60 decibels 1. CT, Ear MRI
§ Severe: 61 to 80 decibels
§ Profound: 81 and above Test of Auditory Function
1. Audiometry
Type of Hearing Loss
1. Conductive — mechanical dysfunction of the external ear Test for Vestibular Function
Causes: 1. Electronystagmography - test that looks on eye movement to see
• Fluids in the Middle Ear (colds/allergy) how well the 2 nerves in the brain are working. Vestibulocochlear
• Ear infection (Otitis Media) and Oculomotor nerves are involved.
• Perforated TM 2. Platform Posturography aka Computerized Dynamic Posturography
• Poor eustachian tube function - quantifying body’s balance
• Impacted Cerumen 3. Rotary Chair Assessment (Harmonic Acceleration) - determine
• Swimmer’s ear (Otitix Externa) whether or not dizziness maybe due to disorder of the inner ear or
• Foreign body in the ear canal brain and particularly to determine whether or not both ears are
• Malformation of the ear (otosclerosis) impared at the same time.
2. Sensorineural or Perceptive - damage in the inner ear, CN VIII & Betahistidine - drug of choice for headache.
auditory areas in the cerebral cortex.
Causes: Invasive
Ototoxic Meds 1. Arteriography - dye is injected to visualize occlusion, mass formation
Old Age (presbycusis) etc.
Head Trauma
Familial History of hearing loss Laboratory Test
Malformation of the inner ear 1. CBC (WBC) - infection
Prolonged exposure to loud noise 2. Ear Culture - if not responding to treatment (determine if gram + or
-
3. Mixed Hearing Loss - damage in the outer and or middle and in the 3. Tests for presence of CSF
inner ear (cochlea) or auditory nerve. Tissue specimen - suspect if there’s any malignancy.
Hearing and Equilibrium Test
1. Whisper Test - stand 1-2 ft away so client can’t read your lips.
2. Tuning Fork tests
• Weber Test - distinguish between conductive or sensorineural
hearing loss; strike a 512 hz tuning fork softly, place fork in the
middle of the client’s head; This test determines if the pt has
diminished or lost hearing in one ear.

ASK if sound is heard centrally of toward one side.

Negative Weber Test - sound is perceived in both ears. NORMAL.

Abnormal:
Sound is perceived to affected ear - unilateral conductive loss
Sound is perceived to unaffected ear - sensorineural loss

• Rinne Test - compares air and bone conduction hearing. Strike again
512 hz tuning fork softly and place it on the mastoid area. Ask client
to tell when the sound is no longer heard.
Note time interval and immediately move tuning fork to the auditory
meatus.
Normal hearing clients: note air conduction twice as long as bone
conduction.
Conductive hearing loss - bone conduction sound is heard longer than
or equally as long as air.
Sensorineural hearing loss - air conduction is longer than bone
conduction in the affected ear, but less than 2:1 ratio.

3. Romberg Test - to test equilibrium.

Stand with arms at side and feet together. Perform initially with eyes
open and then closed. Stand close to the client to prevent falls.

Normal: client should maintain position for 20 seconds with only

minimal swaying.