ASSESSMENT OF THE HEAD, FACE, NECK AND EYES
Vestibule and semicircular canals w/in
EARS, NOSE, MOUTH, AND THROAT
EARS
- the sensory organs for hearing and maintaining
equilibrium and has three parts:
- external, middle, inner ear
EXTERNAL EAR
- called auricle or pinna
- consists of movable cartilage and skin
- shape serves to funnel sound waves to its
opening, called the external auditory canal
AUDITORY CANAL
- cul-de-sac (tube, vessel, or sac) 2.5-3 cm long in
adults
- terminates at eardrum, or tympanic membrane
- lined w/ glands that secrete ear wax/cerumen
(lubricates and protects ear that is a sticky barrier
to keep foreign bodies from entering and reaching
tympanic membrane)
CARTILAGE
- the outer 1/3 of canal
- a slight s-curve in adult
- inner 2/3 consists of bone covered by thin
sensitive skin
- lymphatic drainage of external ear flows to
parotid, mastoid, and superficial cervical nodes
TYMPANIC MEMBRANE
- separates the external and middle ear
- pearly gray color
- translucent membrane
- oval and slightly concave, pulled in @ its center by
malleus
MALLEUS
- middle ear ossicles
- parts of the malleus show through translucent
drum: umbo, manubrium(handle), and short
process
- PARS FLACCIDA – small, slack, superior section of
TM
- PARS TENSA – remainder of TM, thicker, more
taut
- ANNULUS – outer fibrous rim of TM
MIDDLE EAR
- Tiny air-filled cavity inside temporal bone
- Contains tiny ear bones, auditory ossicles
(malleus, incus, stapes)
- Has several openings:
- Opening to outer ear (TM)
- Opening to inner ear are oval window at the end
of the stapes and round window
- EUSTACHIAN TUBE – connects middle ear w/
nasopharynx and allows passage of air
- Normally closed, opens during swallowing or
yawning
THREE FUNCTIONS OF MIDDLE EAR:
1. Conducts sound vibrations from outer to central
hearing apparatus in inner ear
2. Protects inner ear by reducing amplitude of loud
sounds
3. EUST TUBE. Allows equalization of air pressure on
each side of TM so it doesn’t rupture
INNER EAR
- Contains bony labyrinth, holds sensory organs for
equilibrium and hearing
a.
labyrinth compose the vestibular apparatus
b. Cochlea contains central hearing apparatus
- Functions can be assessed but can’t direct
examine
HEARING
- Auditory system divided into 3 levels:
- PERIPHERAL, BRAINSTEM, CEREBRAL CORTEX
- PERIPHERAL – ear transmits sound and coverts its
vibrations into electrical impulses that can be
analyzed by the brain
- Amplitude : loudness
- FREQUENCY: pitch or # of cycles per sec
Sound waves produce vibrations on TM
- carried by middle ear, dissipated against round
window
- Basilar membrane vibrates @ a point specific to
frequency of sound
- Numerous fibers along basilar are receptor hair
cells of organ CORTI – sensory organ of hearing
- Hair cells bend, they mediate vibration into
electric impulses conducted by auditory portion
of CN 8(vestibulocochlear) to brainstem
Function @ brainstem level is binaural interaction
- Locates direction of sound in space
- How does it work?
- Each ear is actually 1 ½ of total sensory organ
- CN8 sends signals to both sides of brainstem w/c r
sensitive to differences in intensity n timing of
messages from 2 ears
- Cortex – interpret meaning of sound n begin
appropriate response, happens split second
Pathways of hearing
- Normal: air conduction (most efficient)
- Alternate route: bone conduction, bone of skull
vibrate n r transmitted directly to inner ear to CN8
HEARING LOSS
- Anything obstructing transmission of sound
impairs hearing
Conductive hearing loss involves mechanical dysfunction
of external/middle ear
- Partial loss because person is able to hear if
sound amplitude is increased enough to reach
normal nerve elements in inner ear
- May be caused by impact cerumen, foreign
bodies, perforated TM, pus or serum in middle
ear, otosclerosis – decrease mobility of ossicles
Sensorineural hearing loss
- Pathology of inner ear, CN8/auditory areas of
cerebral cortex
 Increase in amplitude may not enable
person to understand words
 May be caused by presbycusis (gradual
nerve degeneration occurs w/ aging,
otoxic drugs w/c affect hair cells in
cochlea
- Mixed hearing loss is combination of conductive n
sensorineural types in same ear
Equilibrium
- Labyrinth in inner ear constantly feeds info to
brain abt body’s position in space
  Works like plumb line to determine - TINNITUS
verticality/depth  Ringing, crackling, buzzing in ears
 Ear’s plumb lines register angle of ur head - VERTIGO
in relation to gravity - SELF-CARE BEHAVIORS
 If inflamed, it feeds wrong info to brain, OBJECTIVE DATA
creating staggering gait n strong spinning - Position: sitting upright w/ head eye lvl
called VERTIGO - If TM intact n no current infection present, clean
ADULTS canal w/ warmed mineral oil n hydrogen peroxide
OTOSCLEROSIS - Do not irrigate if hx suggests perforation/infection
- Common cause of conductive hearing loss in - Equipment: otoscope n tuning forks
young adults 20-40 yrs old Inspecting TM
- Gradual hardening that causes foot plate of - Child under 3: down, back, out
stapes to become fixed in oval window, - Above 3: up, back, out
impending transmission of sound n causing - Avoid touching inner “bony” section cause its
progressive deafness sensitive to pain
AGING ADULTS - Cone=shaped light rel
- Cilia lining ear canal become coarse n stiff
 may cause cerumen to accumulate n oxidize,
reduces hearing
 cerumen is drier bec of atrophy of apocrine
glands
 impacted cerumen is common but reversible
cause of hearing loss in elderly
PRESBYCUSIS
- type of hearing loss that occurs in elderly, even in
people living in quiet environment
 gradual sensorineural caused by nerve
degeneration in inner ear/auditory nerve
 onset occurs in 50s n slowly progresses
 first notice a high freq tone loss
 ability to localize sound is impaired
 accentuated when unfavorable bg noise is present
 auditory reaction time increases after 70; takes
longer to process sensory input n to respond to
OTITIS MEDIA
- obstruction of eustachian tube/nasopharyngeal
secretion into middle ear
- most common in children
- important cause is environmental: children in high
risk grps have multiple pathogens n total bacterial
load is high
- when supine, gravity and sucking tend to draw
nasopharyngeal contents directly into middle ear
 hold baby ipright while feeding
 do not prop bottle/let baby take a bottle to
bed
 encourage breastfeeding
 important side effect: persistence of fluid in
middle ear after treatment; middle ear
effusion can impair hearing, placing child
@risk for delayed cognitive development
CERUMEN
- DRY CERUMEN: gray, flaky, freq forms thin mass
- WET CERUMEN: honey brown to dark brown
moist
- Asian n American Indian have 84% dry cerumen,
blacks have 99% and whites 97% wet cerumen
- Cerumen is not poor hygiene
SUBJECTIVE DATA
- EARACHE
- INFECTIONS
- DISCHARGE
- HEARING LOSS
- ENVIRONMENTAL NOISE