Chapter 10: Assessing the Ears (Exam 2)

Types of Hearing Loos

- Conductive - Sensorineural - Mixed

What are some health history questions related to the ear?

- Do you have difficulty hearing words when an individual is talking? - Do you have difficulty communicating w others? Watching television? - Does background noise affect your ability to hear? - Do you have hearing loss? When did it start? - Have you had ear surgery or any injury to the ears? - Have you been exposed to loud noises? - Ear pain, earaches, or discharge present? - Ringing (tinnitus) or buzzing? - Do you wear hearing aids or have a cochlear implant?

Assessing the Ears: Abnormal Findings

- Earwax (cerumen) - Otitis externa - Otitis media - Serous otitis media - Otomycosis - Scarred tympanic membrane - Perforated tympanic membrane

Assessing the Ears: Normal Findings

- External ear canal patent - No inflammation or drainage - Small amount of yellow, moist wax - Tympanic membrane intact - Bony landmarks visible - Cone of light present

What is the sequence of an ear assessment?

- Inspection - Palpation - Assessing hearing - Assessing the internal ear

What are the most common complaints in which individuals seek medical care for the ears?

- Otalgia (ear pain) - Otorrhea (ear drainage)

Ear Assessment

1. Stand in front of the patient and assess both ears for: size, shape, color, symmetry, landmarks 2. Assess the angle of attachment by doing the following: draw an imaginary line from the external canthus of the eye to the top of the helix, draw an imaginary line perpendicular to the ear, assess the angle of attachment

What is normal sizing for ears?

4-10 cm

Perforated Tympanic Membrane

A ruptured tympanic membrane; a dark oval, hole will be present in the membrane

Macrotia

Abnormally large ears; greater than 10 cm vertically

Serous Otitis Media

Accumulation of fluid in the middle ear caused by an obstruction of the eustachian tube; tympanic membrane will appear to be yellowish color with air bubbles, and bulging

Whispered Voice Test: Step 4

Ask the patient to cover the right ear that you are not testing

Microtia

Congenital deformity; the pinna is underdeveloped or incompletely formed; may involve one or both ears; less than 4 cm vertically

Darwin's Tubercle

Congenital deviation is a small cartilaginous protuberance on the helix of the ear

Sensorineural Hearing Loss

Considered 'inner ear hearing loss' occurs when there is damage to the inner ear (cochlea), or to the nerve pathways from the inner ear to the brain; speech may sound unclear or muffled; most common type of permanent hearing loss

Conductive Hearing Loss

Considered 'middle hearing loss' is when sound is not conducted through the outer ear canal to the eardrum and the tiny bones (ossicles) of the middle ear; involves a reduction in sound level or the ability to hear faint sounds

Whispered Voice Test: Step 9

Document your findings

Whispered Voice Test: Step 1

Explain the technique to the patient

Otomycosis

Fungal infection of the external auditory canal; black and white dots will be present on the eardrum or external canal

Tophi

Hard, whitish, or cream-colored, nontender deposits of uric acid crystals indicative of gout

Scarred Tympanic Membrane

Has less blood supply and appears to have white, dense, streaks, and spotting; the individual may have had many ear infections during childhood

Whispered Voice Test: Step 6

Have the patient repeat what you wispered

Whispered Voice Test: Step 7

If the patient responds incorrectly, repeat the test using a different number/letter combination

Mixed Hearing Loss

Includes both conductive and sensorineural hearing loss

Otitis Media

Inflammation of the inner ear causing pain, inflammation, pressure, and a build-up of fluid; bright, red, bulging eardrum with diminished or no cone of light visible

Otitis Externa (Swimmer's Ear)

Inflammation of the outer ear causing redness, inflammation, discharge, and pain; may be related to infection

What is a normal angle of attachment for ears?

Less than 10°

Cauliflower Ear

Occurs from repeated trauma or hitting the ear; a blood clot forms under the skin or there is damage to the cartilage causing a change in the shape and structure of the ear (wrestlers)

What device is used during a assessment of the ears?

Otoscope

What are normal findings of the Whispered Voice Test?

Patient repeats at least three of the six letters/numbers correctly

Normal Tympanic Membrane Intact

Pearly gray color; translucent; contour slightly conical

What may bloody or clear drainage coming from the ear be related to?

Perforated eardrum or head injury

Whispered Voice Test: Step 2

Place the patient in sitting position

Whispered Voice Test: Step 8

Repeat steps 3,4,5, and 6 on the right side

Whispered Voice Test: Step 3

Stand behind the patient to his/her left side about 2 feet away so you cannot be seen

What is the purpose of the conducting the Whispered Voice Test?

To assess for impaired or high-frequency hearing loss

Whispered Voice Test: Step 5

Whisper six random letters/numbers toward the left ear

How do you test function of cranial nerve VIII?

Whispered Voice Test