EAR ASSESSMENT

• External Ear: ear includes the auricle or pinna, the external auditory canal.
• Middle Ear or Tympanic cavity: is a small, air-filled chamber in the temporal bone.
• The middle ear contains three auditory ossicles: the malleus, the incus, and the stapes.
• malleus, incus, and stapes are tiny bones that is responsible for transmitting sound waves from the eardrum to the inner ear through the oval window.
• Hearing process

  1. A sound stimulus enters the external canal and reaches the tympanic membrane

  2. The sound waves vibrate the tympanic membrane and reach the ossicles

  3. The sound waves travel from the ossicles to the opening in the inner ear (oval window)

  4. The cochlea receives the sound vibrations

  5. The stimulus travels to the auditory nerve (the eighth cranial nerve) and the cerebral cortex
• CONDUCTIVE HEARING LOSS: Related to a dysfunction of the external or middle ear
• SENSORINEURAL HEARING LOSS: Related to dysfunction of the inner ear (e.g., organ of Corti, cranial nerve VIII, or temporal lobe of the brain)
• Auricle aligned with outer canthus of eye, about 10°, from vertical.
• Pinna should recoils after it is folded.
• Auricle: tenderness when moved or pressed (may indicate inflammation or infection of external ear)
• 1Palpate the auricles for texture, elasticity, and areas of tenderness.
• Inspect the external ear canal for cerumen, skin lesions, pus, and blood.
• Use the largest diameter that will fit the ear canal without causing discomfort.
• Low-set ears (associated with a congenital abnormality, such as Down syndrome)
• Tympanic membrane: Pearly gray color, semitransparent
• The thin, drum-like structure of the tympanic membrane is essential for hearing. It is also essential for promoting equilibrium and barring infection.
• ACUTE OTITIS MEDIA

  Note the red, bulging membrane; decreased or absent light reflex

  
• BLUE/DARK RED TYPANIC MEMBRANE

  Indicates blood behind eardrum due to trauma

  
• PERFORATED TYMPANIC MEMBRANE

  Perforation results from rupture caused by increased pressure, usually from untreated infection or trauma

  
• SEROUS OTITIS MEDIA

  Note the yellowish, bulging membrane with bubbles behind it

  
• RETRACTED TYMPANIC MEMBRANE

  Prominent landmarks are caused by negative ear pressure due to obstructed eustachian tube or chronic otitis media

  
• SCARRED TYMPANIC MEMBRANE

  White spots and streaks indicate scarring from infections.

  
• Have the client occlude one ear. Out of the client’s sight, at a distance of 0.3 to 0.6 m (1 to 2 ft), whisper a simple phrase
• Perform Weber’s test to assess bone conduction by examining the lateralization (sideward transmission) of sounds.
• Sound is heard in both ears or is localized at the center of the head (Weber negative)
• Weber's Test Positive: Sound is heard better in impaired ear, indicating a bone-conductive hearing loss;
• Sound is heard better in ear without a problem, indicating a sensorineural disturbance (Weber positive)
• Air-conducted (AC) hearing is should be greater than bone-conducted (BC) hearing
• Conduct the Rinne test to compare air conduction to bone conduction.
• Rinne test tuning fork placement: A, base of the tuning fork on the mastoid process; B, tuning fork prongs placed in front of client’s ear.
• The tuning fork vibrations conducted by air are normally heard longer.
• NORMAL

  Patient hears tone equally well in both ears
• RIGHT OR LEFT LATERALIZATION

  Patient hears tone better in one ear
• CONDUCTIVE HEARING LOSS

  Patient gears tone only in his impaired ear
• SENSORINEURAL HEARING LOSS

  Patient hears tone only in his unaffected ear
• Rinne Test: Ask the patient to tell you when the tone stops; note this time in seconds
•  CONDUCTIVE HEARING LOSS

  Patient hears BC tone as long or as longer than he hears AC tone (BC > AC)
• SENSORINEURAL HEARING LOSS

  Patient hears AC tone longer than he hears BC tone (AC > BC)