Assessment of Ear

• Whisper Test

  • For LOW-PITCH deficits
  • Have patient cover opposite ear being tested
  • Stand about 1-2 ft behind patient, and Whisper
  • Note patient's ability to hear sound
• Whisper Test

  Normal: Patient repeats most words whispered in each ear at a distance of 1-2 ft.

  Abnormalities: Inability to repeat words: Low-tone frequency loss
• Watch-Tick Test

  • For HIGH-PITCH deficits

  • Have patient cover opposite ear being tested

  • Hold ticking watch within 5 inches from ear

  • Note patients ability to hear sound
• Watch-Tick Test

  Normal: Patients hears tick of a watch in each ear at a distance of 5 inches

  Abnormalities: Inability to hear watch ticking: High-tone frequency loss
• Weber Test

  • Perform if the client reports diminished or lost hearing in one ear
  • This test helps to evaluate the conduction of sound waves through bone to help distinguish between

  CONDUCTIVE HEARING - sound waves transmitted by the external and the middle ear

  SENSORINEURAL HEARING - sound waves transmitted by the middle ear (inner ear)

  • Hold tuning fork by stem
  • Tap tuning fork prongs on palm of your hand
  • Place vibrating tuning fork in the middle of the patient's forehead or on the top of patients head
  • Note patients ability to hear sound; note lateralization of sound
• Webers Test

  Normal:

  • Vibrations should be felt or heard equally in both ears
  • Negative lateralization

  Abnormalities:

  • Lateralization of sounds

  CONDUCTIVE HEARING LOSS

  • lateralization of sound to the poor ear

  SENSORINEURAL HEARING LOSS

  • lateralization of sound to the good ear
• Rinne's Test


  A test to assess hearing
• Normal Rinne's Test

  • 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
• Abnormal Rinne's Test

  • AC to BC ratios that differ markedly in each ear - UNILATERAL HEARING DEFICIT
  • CONDUCTIVE HEARING LOSS: AC less than twice BC, BC sound is heard longer than or equally as long as AC sound (BC ≥ AC)
  • SENSORINEURAL HEARING LOSS: finding will also be AC > BC, damage to inner ear (cochlea) or damage to the nerve pathways between the inner ear and brain, decreases a client's ability to hear faint sounds or even loud may be muffles
• Causes of Conductive Hearing Loss


  • Ear wax, impacted cerumen
  • Otitis media (middle ear infection)
  • Serous otitis media (allergies)
  • Damage to the ossicles of the middle ear
  • Fluid in the middle ear
  • Eustachian tube dysfunction
  • Perforated eardrum
  • Benign tumors
  • Infection in the ear canal (external otitis)
  • Presence of a foreign body
• Causes of Sensorineural Hearing Loss


  • Ototoxic drugs
  • Genetic hearing loss
  • Aging
  • Head trauma
  • Malformation of the inner ear
  • Loud noise exposure
• Romberg's 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 patients 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 fails
• Normal of Romberg's Test

  • Clients maintain position for 20 seconds without swaying or minimal swaying
  • Maintain balance
  • Negative Romberg
• Deviations from Normal of Romberg's Test

  • Clients moves feet apart to prevent falls or starts to fall from loss of balance

  > may indicate a vestibular disorder

  • Loss of balance

  > inner ear disorder

  > cerebellum damage

  > ingestion of intoxicants