HEALTH ASSESSMENT | NCM 101

CHAPTER 4: ASSESSING EARS

INTRODUCTION
EARS
• Sense organ of hearing and equilibrium.
• Consists of three distinct parts: the external ear, the middle ear,
and the inner ear.
• Tympanic membrane
- Separates the external ear from the middle ear.
• External ear and tympanic membrane
- Assessed by direct inspection and by using an otoscope.
• Middle ear and inner ear
- Cannot be directly inspected.
- Testing hearing acuity and the conduction of sound
assesses these parts of the ear. MIDDLE EAR
EXTERNAL EAR • Also called as tympanic cavity.
• Composed of the auricle, or pinna, and the external auditory • A small, air-filled chamber in the temporal bone.
canal. • Separated from the external ear by the eardrum and from the
inner ear by a bony partition containing two openings, the
round and oval windows.
• Contains three auditory ossicles: the malleus, the incus, and the
stapes.
1. MALLEUS, INCUS, AND STAPES
• These tiny bones are responsible for transmitting sound waves
from the eardrum to the inner ear through the oval window.
• Air pressure is equalized on both sides of the tympanic
membrane by means of the eustachian tube.
o Eustachian tube
- Connects the middle ear to the nasopharynx.
1. EXTERNAL AUDITORY CANAL
• S-shaped in the adult.
o Outer part of the canal
- Curves up and back.
o Inner part of the canal
- Curves down and forward.
• Modified sweat glands in the external ear canal
- Secrete cerumen.
o Cerumen
INNER EAR
- A wax-like substance that keeps the tympanic
• Also called as labyrinth.
membrane soft.
• Fluid filled and made up of the bony labyrinth and an inner
- Has bacteriostatic properties, and its sticky
membranous labyrinth.
consistency serves as a defense against foreign
bodies. • The bony labyrinth has three parts: the cochlea, the vestibule,
and the semicircular canals.
2. TYMPANIC MEMBRANE (EARDRUM) • Inner cochlear duct
• Has a translucent, pearly gray appearance - Contains the spiral organ of Corti.
• Serves as a partition stretched across the inner end of the o Spiral organ of Corti
auditory canal, separating it from the middle ear. - sensory organ for hearing.
• Concave and located at the end of the auditory canal in a tilted • Sensory receptors
position such that the top of the membrane is closer to the - Located in the vestibule and in the membranous
auditory meatus than the bottom. semicircular canals.
• Distinct landmarks of the tympanic membrane: - Sense position and head movements to help maintain both
A. Handle and short process of the malleus—the nearest static and dynamic equilibrium.
auditory ossicle that can be seen through the translucent - Nerve fibers from these areas form the vestibular nerve,
membrane. o Vestibular nerve
B. Umbo—the base of the malleus, also serving as a center - Connects with the cochlear nerve to form the
point landmark. eighth cranial nerve (acoustic or
C. Cone of light—the reflection of the otoscope light seen as vestibulocochlear nerve).
a cone due to the concave nature of the membrane.
D. Pars flaccida—the top portion of the membrane that
appears to be less taut than the bottom portion.
E. Pars tensa—the bottom of the membrane that appears to
be taut.
 HEALTH ASSESSMENT | NCM 101
CHAPTER 4: ASSESSING EARS

HEALTH ASSESSMENT: COLLECTING SUBJECTIVE DATA

• Gather data from the client about the current level of hearing
and ear health as well as past and family history problems
related to the ear.
• The examiner should be alert to signs of hearing loss such as
inappropriate answers, frequent requests for repetition, etc.
• Collect data concerning environmental influences on hearing
and how these problems affect the client’s usual ADLs.
HEALTH ASSESSMENT: COLLECTING OBJECTIVE DATA
PREPARING THE CLIENT
• Make sure that the client is seated comfortably during the ear
examination.
• The test should be explained thoroughly to guarantee accurate
results.
HEARING • To ease any client anxiety, explain in detail what you will be
Sound vibrations travel through air doing and answer any questions the client may have.
| • Carefully note how the client responds to your explanation.
They are collected by and funneled through the external ear, causing • Does the client respond to you verbally or nonverbally or do
the eardrum to vibrate. you have to repeat what you say to get a response?
|
Sound waves are then transmitted through auditory ossicles as the EQUIPMENT
vibration of the eardrum causes the malleus, the incus, and then the • Watch with a second hand for Romberg test
stapes to vibrate. • Tuning fork (512 or 1024 Hz)
| • Otoscope
As the stapes vibrates at the oval window, the sound waves are NORMAL FINDINGS
passed to the fluid in the inner ear. • Normal ear size
| - 4-10 cm
The movement of this fluid stimulates the hair cells of the spiral
ABNORMAL FINDINGS
organ of Corti and initiates the nerve impulses that travel to the
brain by way of the acoustic nerve. • Otitis media
- Sudden decrease in ability to hear in one ear.
CONDUCTIVE HEARING
- Tenderness behind the ear may occur.
• The transmission of sound waves through the external and • Presbycusis
middle ear - Often begins with a loss of high-frequency sounds
• Conductive hearing loss (woman’s voice) followed later by the loss of low-
- Would be related to a dysfunction of the external or frequency sounds.
middle ear (e.g., impacted ear wax, otitis media, foreign • Drainage (otorrhea)
object, perforated eardrum, drainage in the middle ear, or - Usually indicates infection.
otosclerosis). - Purulent, bloody drainage suggests an infection of the
PERCEPTIVE OR SENSORINEURAL HEARING external ear (external otitis).
• The transmission of sound waves in the inner ear. o Purulent drainage associated with pain and a popping
• Sensorineural hearing loss sensation is characteristic of otitis media with
- Would be related to dysfunction of the inner ear (i.e., perforation of the tympanic membrane.
organ of Corti, cranial nerve VIII, or temporal lobe of • Earache (otalgia)
brain). - Can occur with ear infections, cerumen blockage, sinus
BONE CONDUCTION infections, or teeth and gum problems.
• The bones of the skull also conduct sound waves. • Ringing in the ears (tinnitus)
• This bone conduction, though less efficient, serves to augment - May be associated with excessive earwax buildup, high
the usual pathway of sound waves through air, bone, and finally blood pressure, or certain ototoxic medications (such as
fluid. streptomycin, gentamicin, kanamycin, neomycin,
ethacrynic acid, furosemide, indomethacin, or aspirin),
loud noises, or other causes.
• Vertigo (true spinning motion)
- May be associated with an inner-ear problem.
o Subjective vertigo is when clients feel that they are
spinning around.
o Objective vertigo is when clients feel that the room is
spinning around them.
 HEALTH ASSESSMENT | NCM 101
CHAPTER 4: ASSESSING EARS

• Otitis externa (swimmer’s ear) • Obscured or absent landmarks

- Can occur when water stays in the ear canal for long - Eardrum thickening from chronic otitis media.
periods of time, providing the perfect environment for
germs to grow and infect the skin.
- Germs found in pools and at other recreational water
venues are one of the most common causes of swimmer’s
ear.
- Symptoms include: itchiness inside ear, redness and
swelling of the ear, pain in the ear when pressure is
applied to the ear or the ear is pulled on (pain may be
severe), drainage of pus.
• Mastoiditis
- Tenderness over the mastoid process.
ABNORMAL FINDINGS THAT SUGGEST VARIOUS DISORDERS
• Enlarged preauricular and postauricular lymph nodes
- Infection.
• Tophi (nontender, hard, cream-colored nodules on the helix or
antihelix, containing uric acid crystals)
- Gout.
• Blocked sebaceous glands
- Postauricular cysts.
• Ulcerated, crusted nodules that bleed
- Skin cancer (most often seen on the helix due to skin
exposure).
• Redness, swelling, scaling, or itching
- Otitis externa.
• Pale blue ear color
- Frostbite.
ABNORMAL FINDINGS THAT ARE ASSOCIATED WITH SPECIFIC
DISORDERS
• Foul-smelling, sticky, yellow discharge
- Otitis externa or impacted foreign body.
• Bloody, purulent discharge
- Otitis media with ruptured tympanic membrane.
• Blood or watery drainage (cerebrospinal fluid)
- Skull trauma (refer client to physician immediately).
• Impacted cerumen blocking the view of the external ear canal
- Conductive hearing loss.
ABNORMAL FINDINGS IN THE EAR CANAL
• Reddened, swollen canals
- Otitis externa
• Exostoses (nonmalignant nodular swellings)
• Polyps
- May block the view of the eardrum
ABNORMAL FINDINGS IN THE TYMPANIC MEMBRANE
• Red, bulging eardrum and distorted, diminished, or absent
light reflex
- Acute otitis media.
• Yellowish, bulging membrane with bubbles behind
- Serous otitis media
• Bluish or dark red color
- Blood behind the eardrum from skull trauma.
• White spots
- Scarring from infection.
• Perforations
- Trauma from infection.
• Prominent landmarks
- Eardrum retraction from negative ear pressure resulting
from an obstructed eustachian tube.
HEALTH ASSESSMENT | NCM 101
CHAPTER 4: ASSESSING EARS
HEALTH ASSESSMENT | NCM 101
CHAPTER 4: ASSESSING EARS
HEALTH ASSESSMENT | NCM 101
CHAPTER 4: ASSESSING EARS
HEALTH ASSESSMENT | NCM 101
CHAPTER 4: ASSESSING EARS
HEALTH ASSESSMENT | NCM 101
CHAPTER 4: ASSESSING EARS
HEALTH ASSESSMENT | NCM 101
CHAPTER 4: ASSESSING EARS
HEALTH ASSESSMENT | NCM 101
CHAPTER 4: ASSESSING EARS
HEALTH ASSESSMENT | NCM 101
CHAPTER 4: ASSESSING EARS