ASSESSING EARS

STRUCTURE AND FUNCTION

 The ear is the sense organ of hearing and equilibrium. It consists of three
distinct parts: the external ear, the middle ear, and the inner ear.
 External ear and tympanic membrane (eardrum) can be assessed by
inspection and using otoscope.
Middle and inner ear cannot be directly inspected. Instead, test hearing
acuity and the conduction of sound.
 COLLECTING SUBJECTIVE DATA

 Gather data from the client about the current level of hearing and ear
health as well as past and family health history problems related to the
ear.
 The examiner should be alert to signs of hearing loss such as
inappropriate answers, frequent requests for repetition, and so on.
 Answers to these types of questions help you to evaluate a client’s risk for
hearing loss and, in turn, present ways that the client may modify or
lower the risk of ear and hearing problems.
 COLLECTING OBJECTIVE DATA

 To evaluate the condition of the external ear, the condition and patency of
the ear canal, the status of the tympanic membrane, bone and air
conduction of sound vibrations, hearing acuity, and equilibrium.
 Inspect – external ear structures and ear canal
Tuning fork – bone and air conduction
Otoscope – condition of the structures of the tympanic membrane.
 PREPARING THE CLIENT

 Make sure the client is seated comfortably during the ear examination.
 Explain the test thoroughly to guarantee accurate results.
 Explain in detail what you will be doing to ease client’s anxiety.
 Answer the questions the client may have.
 Carefully note how the client responds to your explanations. Initial
observation provides you with clues as to the client’s hearing.
 EQUIPMENT

 Watch with second hand

for Romberg test

 Tuning fork
 Otoscope
 PHYSICAL ASSESSMENT

Before performing the examination, make sure to:

 Recognize the role of hearing in communication
 Know how to use the otoscope effectively when performing the ear
examination
 Understand the usefulness and significance of basic hearing tests
OTOSCOPE

1. Ask the client to sit comfortably with the back straight and the head titled
slightly away from you toward his other opposite shoulder.
2. Choose the largest speculum that fits comfortably into the client’s ear canal
(usually 5 mm in the adult) and attach it to the otoscope. Holding the
instrument in your dominant hand, turn the light on the otoscope to “on”.
3. Use the `thumb and fingers of your opposite hand to grasp the client’s auricle
firmly but gently. Pull out, up, and back to straighten the external auditory
canal. Do not alter this positioning at any time during the otoscopic
examination.
OTOSCOPE
4. Grasp the handle of the otoscope between your thumb and fingers and hold
the instrument up or down.
5. Position the hand holding the otoscope against the client’s head or face. This
position prevent forceful insertion of the instrument and helps to steady your
hand throughout the examination, which is especially helpful if the client
makes any unexpected movements.
6. Insert the speculum gently down and forward into the ear canal (app. 0.5 in).
As you insert the otoscope, be careful not to touch either side of the inner
portion of the canal wall. This area is bony and covered by a thin, sensitive
layer of epithelium. Any pressure will cause the client pain.
OTOSCOPE

7. Move your head in close to the otoscope and position your eye to look
through the lens.
 EAR ASSESSMENT
EXTERNAL EAR STRUCTURE
1. Inspect the auricle, tragus, and lobule. Note size, shape, and position.
NF: Ears are equal in size bilaterally (normally 4-10cm).
The auricle aligns with the corner of each eye and within a 10-degree angle of the vertical
position.
Earlobes may be free, attached, or soldered (tightly attached to adjacent skin with no
apparent lobe).
AF: Ears are smaller than 4 cm or larger than 10 cm.
Malaligned or low-set ears may be seen with genitourinary disorders or chromosomal
defects.
Microtia – a congenital deformity in which the external ear and sometimes the ear canal
are not fully developed. An excessive enlargement of the external ear. *insert pic*
Ear malformations are often related to other congenital anomalies such as face, jaw, dental,
and kidney disorders.
1. a. Observe for lesions, discolorations, and discharge.
NF: Skin is smooth, with no lesions, lumps, or nodules.
Color is consistent with the facial color. Darwin’s tubercle, a clinically
significant projection, may be seen on the auricle. No discharge should
be present.
AF: Enlarged preauricural and postauricular lymph nodes - infection
Tophi – gout
Blocked sebaceous glands – postauricular cysts

2. Palpate the auricle, tragus and mastoid process.

NF: Not tender.
AF: Painful auricle or tragus – postauricular cyst
Tenderness of mastoid process – mastoiditis
INTERNAL EAR STRUCTURE
3. Inspect the external auditory canal. Use otoscope. Note any discharge along with the color and
consistency of cerumen (earwax).
NF: Small amount of odorless cerumen is the only discharge
present.
Cerumen color may be yellow, orange, red, brown, gray, or
black.
Consistency may be soft, moist, dry, flaky, or even hard.
AF: Foul-smelling discharge
Bloody, purulent discharge
Blood or watery drainage – skull trauma
Impacted cerumen blocking the view of the external ear canal – conductive hearing loss
If here are foreign such as bugs, plants, or food, prompt removal must be done to avoid
swelling and infection.
If object, button-type battery, medical attention is urgent because of leaking chemicals
that
can burn and damage the ear canal, even within 1 hour.
3. a. Observe the color and consistency of the ear canal walls and inspect the character of any
nodules.
NF: Canal walls should be pink and smooth, without nodules.

AF: Reddened, swollen canals

Exostoses
Polyps may block the view of the
eardrum
4. Inspect the tympanic membrane (eardrum). Note color, shape, consistency, and landmarks.
NF: Pearly gray, shiny, and translucent, no bulging or retraction
Slightly concave, smooth, and intact.
Cone-shaped reflection of the otoscope is normally seen at 5 o’clock in right ear, and 7
o’clock in the left ear.

AF: Red or bulging eardrum and distorted, diminished, or absent light reflex
Yellowish, bulging membrane with bubbles behind
Bluish or dark red color
White spots – scarring from infection
Perforations – trauma from infection
GENERAL OBSERVATION OF HEARING AND EQUILIBRIUM TEST
5. Perform the whisper test. By asking he client to gently occlude the ear not being tested and rub.
The tragus with finger in a circular motion. With your head 2 ft behind the client, whisper a two
syllable word such as “popcorn” or “football”. As the client to repeat it back to you.
NF: Able to correctly repeat the two-syllable word as whispered.
AF: Unable to repeat the two-syllable word after two tries indicates hearing loss and requires
follow-up testing y an audiologist.
6. Perform the Weber test if the client reports diminished or lost of hearing in one ear. Strike a
tuning fork softly with the back of your hand and place it at the center of the client’s head or
forehead. Ask whether the client hears the sound better in one eat or the same in both ears.
NF: Vibrations are heard equally well in both ears, No lateralization of sound to either ear.
AF: With conductive hearing loss, the client reports lateralization of sound to the poor ear- that is,
the client “hears” the sound in the poor ear.
With sensorineural hearing loss, the client reports lateralization of the sound to the good
ear.
7. Perform the Rinne test.. Strike a tuning for and place the base of the fork on the client’s mastoid
process. Ask the client to tell you when the sound is no longer heard. Move the prongs of the tuning
fork to the front of the external auditory canal. Ask the client to tell you if the sound is audible
after the fork moved.
NF: Air conduction (AC) sounds is normally heard longer the bone conduction (BC) sound.
AF: With conductive hearing loss, bone conduction (BC) sound is heard longer than or equally as
long as air condition (AC) sound (BC>AC).
Conductive hearing loss occurs when sound is not conducted through the outer ear canal to
the eardrum and ossicles of the middle ear.
7. Perform the Romberg test This test the client’s equilibrium. Ask the client to stand with feet
together, arms at sides, and eyes open, then with the eyes closed.
NF: Client maintains position for 20 seconds without swaying or with minimal swaying.
AF: Client moves feet apart to prevent falls or starts to fall from loss of balance. This may indicate
a vestibular disorder.
CHECKLIST