NCMA 121: HEALTH ASSESSMENT 2ND

ASSESSMENT OF THE
EARS
SEMESTER
MARCH
AY 2021-2022
08
MIDTERMS LECTURER: MA’AM CORA P. QUINTO 1ST YEAR NURSING

WEEK 8: ASSESSMENT OF THE EARS

INSPECTION
TOPIC ● Angle of Attachment
SUBTOPIC ○ Draw an imaginary line from the top of the helix to
SUB-SUBTOPIC the external canthus of the eye, then draw a line
perpendicular to the ear and note angle of attachment
ASSESSMENT OF THE EARS ● Normal Shape and Presence of Landmarks
○ Helix, antihelix, antitragus, tragus, and lobule
○ Darwinian tubercle is a benign protrusion on upper
part of helix
○ Absence of pits (preauricular sinus or congenital
External auricular fistula), creases (frank's sign or deep
Anatomy crease, an indication that your patient is at risk of
stroke, or at risk of a cardiovascular problem) and
lesions (common cause is the otitis externa or
pseudomonas origiosa)
● Position
○ Helix of ear is level with imaginary line drawn through
inner and outer canthus to occiput. Ears should be
rotated from 0–15 degrees posteriorly
● Condition of Skin
○ Intact, no lesions
○ Note if skin piercings are present
Internal ● Color
Anatomy ○ Consistent with skin color
● Drainage
○ Earwax
○ Cerumen is the only normal drainage

ABNORMAL FINDINGS
● Microtia
○ Ears less than 4 cm vertical height in adults seen in
some genetic disorders
● Macrotia
○ Ears greater than 10 cm vertical height in adults
● Missing or Malformed Landmark
How do we ○ Associated with hearing deficit
Hear? ● Creased Earlobes
○ Associated with heart conditions
● Ear Pits or Sinuses usually located anterior to the
Tragus
○ Associated with internal ear anomalies
● Low - Set ears or Lobes rotated posteriorly more than
15 degrees
○ Associated with mental retardation
HOW DO WE HEAR? ● Drainage
● AIR CONDUCTION is the primary mechanism of hearing ○ Bloody – trauma
- It involves carrying soundwaves through the external ○ Pus – infection
auditory canal to the tympanic membrane. ○ Clear Drainage – spinal fluid, head injury
- The sound vibration cause the tympanic membrane, ● Impacted Cerumen
your mallus, incus, and your stape bones to move ○ Excessive cerumen secretion
thus transmitting the vibration to the inner ear ● Redness
structure ○ Inflammation may indicate infection, fever
● Sound waves through external auditory canal ● Otitis Externa
● Tympanic membrane (TM) ○ Ear pain, especially with movement of the tragus or
● Sound vibrations cause the TM and the malleus pulling of ear lobe
(hammer), incus (anvil), and stapes (stirrup) bones to ○ Redness of external auditory canal or auricle of
move external ear
● Vibrations to inner ear structures
 ○ Inflammation or infection of external ear, often caused
by excessive swimming, chronic irritation, or removal
of cerumen
● Acute Otitis Media
○ Ear pain with reddened TM Palpating the Mastoid
○ Signs of conductive hearing loss
○ Inflammation
○ Infection of middle ear
● Meniere's Disease

Pulling Helix Forward

○ Deviations from normal

○ Chronic, progressive disease of inner ear that leads to - Tenderness of mastoid, helix, tragus or pinna,
permanent hearing loss indicates ear infections
○ Affects proprioception (ability to accurately sense
one’s body position) (awareness of movement and HEARING TESTS
position of the body) ● Whisper Test
○ Characterized by a sensation of fullness or pressure ● Watch Tick Test
in the ears and recurrent episodes of vertigo, tinnitus, ● Weber Test
and hearing loss, lasting from a few minutes to ● Rinne Test
several hours ● Romberg’s Test (Assess the Balance )
○ Person may also experience nausea, vomiting, and
profuse sweating WHISPER TEST
○ Subjective sensation of ear fullness, vertigo, tinnitus ● For LOW – PITCH deficits
○ Disturbance of balance and gait ● Have patient cover opposite ear
● Lesions being tested
○ E.g., skin cancer from sun ● Stand about 1–2 ft behind patient,
● Cysts and whisper
○ May occur when oils are produced in a skin gland ● Note patient’s ability to hear
faster than they can be released from the gland sound
○ Can also occur if the oil gland opening has become ● Normal
blocked and a cyst forms under the skin ○ Patient repeats most words whispered in each ear at
a distance of 1–2 ft.
ASSESSMENT ● Deviations from normal
● Otoscope ○ Inability to repeat words: Low-tone frequency loss.

○ A flashlight type viewer WATCH - TICK TEST

used to visualize the ● For HIGH – PITCH Deficits
eardrum and external ear ● Have patient cover opposite ear being tested
canal ● Hold ticking watch within 5 inches from ear
● Note patient’s ability to hear sound
● Normal
● Palpation ○ Patient hears tick of a watch in each ear at a distance
○ Palpate for consistency and tenderness of 5 inches
○ Always palpate tragus, helix, and mastoid process for ● Deviations from normal
tenderness prior to otoscopic exam ○ Inability to hear watch ticking: High-tone frequency
○ Normal loss
- Soft and pliable, nontender
- Structures should be nontender, with no nodules WEBER TEST
or swelling ● Perform if the client reports diminished or lost
○ How to do it? hearing in one ear
● This test helps to evaluate the conduction of
sound waves through bone to help
distinguish between
Palpating the Ear ○ CONDUCTIVE HEARING
- sound waves transmitted by the
external and the middle ear
○ SENSORINEURAL HEARING
- sound waves transmitted by the
middle ear
● Hold tuning fork by stem
Palpating the Tragus ● Tap tuning fork prongs on palm of your hand
● Place vibrating tuning fork in the middle of the patient’s ● Deviations from normal
forehead or on the top of patient’s head ○ AC to BC ratios that differ markedly in each ear –
● Note patient’s ability to hear sound; note lateralization of UNILATERAL HEARING DEFICIT
sound ○ CONDUCTIVE HEARING LOSS
● Normal ■ AC less than twice BC
○ Vibrations should be felt or heard equally in both ears. ■ BC sound is heard longer than or equally as long
○ Negative lateralization. as AC sound (BC ≥ AC), possibly due to
● Deviations from normal ● ear wax, impacted cerumen
○ Lateralization of vibrations ● otitis media (middle ear infection)
■ Conductive hearing loss ● serous otitis media (allergies)
● lateralization of sound to the poor ear ● damage to the ossicles of the middle ear
○ the client “hears” the sound in the poor ● fluid in middle ear
ear the good ear is distracted by ● eustachian tube dysfunction
background noise and conducted air ● perforated eardrum
which the poor ear has trouble hearing ● benign tumors
thus the poor ear receives most of the ● infection in the ear canal (external otitis)
sound conducted by bone vibration ● presence of a foreign body
○ occurs when there is a problem ○ SENSORINEURAL HEARING LOSS
conducting sound waves ■ the most common type of permanent hearing loss
■ Sensorineural hearing loss ■ finding will also be AC > BC
● lateralization of sound to the good ear ■ damage to inner ear (cochlea) or damage to the
○ the client “hears” the sound in the good nerve pathways between the inner ear and brain
ear ■ decreases a client’s ability to hear faint sounds or
○ there is a limited perception of the even loud may be muffled
sound due to nerve damage in the poor ■ possibly due to
ear ● ototoxic drugs
○ making sound seem louder in the ● genetic hearing loss
unaffected ear ● aging
○ root cause lies in the inner ear or ● head trauma
sensory organ ● malformation of the inner ear
● loud noise exposure
● 90% of reported hearing loss is sensorineural hearing loss
ROMBERG’S TEST
RINNE TEST ● Test the client's equilibrium / inner
ear vestibular function
○ Ask the client to stand with feet
together, arms at side, and
eyes open, then with the eyes
closed
○ Stand close by in case patient
loses balance
○ Note patient’s ability to
maintain balance
○ Patient stands with feet together and eyes closed
■ When performing this test, put your arms around
the client without touching him or her to prevent
falls
● Normal
the tuning fork base is placed after which the prongs are
first on the mastoid process moved to the front of the ○ Client maintains position for 20 seconds without
external auditory canal swaying or minimal swaying
○ Maintains balance
○ Negative Romberg
● Compares air and bone conduction sounds ● Deviations from normal
○ Strike a tuning fork ○ Client moves feet apart to prevent falls or starts to fall
○ Place the base of the vibrating tuning fork on the from loss of balance
client’s mastoid process ■ may indicate a vestibular disorder
○ Ask the client to tell you when the sound is no longer ○ Loss of balance
heard ■ inner ear disorder
○ Without striking the tuning fork, move the prongs of ■ cerebellar damage
the tuning fork in front of ear (external auditory canal) ■ ingestion of intoxicants
○ Continue to note the length of time until patient no
longer hears sound
○ Ask the client to tell you if the sound is audible after
the fork is removed
● Normal
○ Air conduction (AC) sound is normally twice as long
for bone conduction or normally heard longer
(AC>BC)
○ The ratio of AC to BC is similar in both ears