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
