Ears Assessment

• Auricle and mastoid process


  • May be seen on the auricle
  • The older client often has elongated earlobes with linear wrinkles
  • The auricle frigus, and mastoid process are not tender
• Otoscopic Examination


  1. Inspect the external auditory canal

  2. Observe the color and consistency of the ear canal walls and inspect the character of any nodules

  3. Inspect the tympanic membrane (Ear drum)
• Cerumen color


  • yellow, orange, red, brown, gray, or black
• Cerumen consistency


  soft, moist, dry, flaky, or even hard
• In some older clients, harder, drier cerumen tends to build as cilia in the ear canal become more rigid. Coarse, thick, wire-like hair may grow at the car canal entrance.
• Canal walls


  • pink and smooth without nodules
• Tympanic membrane


  • pearly, gray, shiny and translucent with no bulging or retraction
  • It is slightly concave, smooth and intact
  • A cone-shaped reflection of the otoscope light is normally seen at 5 o'clock in the right ear and 7 o'clock in the left ear
  • The short process and handle of the malleus and the umbo are clearly visible
• Tympanic membrane in older clients

  • Their eardrum may appear cloudy
  • The landmarks may be more prominent
• Small amount of odorless cerumen. Cerumen color may be yellow, orange, red, brown, gray, or black and soft, moist, dry, flaky, or even hard.
• Painful auricle or tragus; Tenderness over the mastoid process; Tenderness behind the ear.
• foul-smelling sticky yellow discharge; Bloody, purulent or watery drainage; Impacted cerumen; presence of foreign bodies
• reddened swollen; Exostoses (nonmalignant nodular swellings); Polyps
• Red, bulging eardrum and distorted, diminished, or absent light reflex; yellowish bulging membrane with bubbles behind; bluish or dull red color; White spots; Perforations; Prominent landmarks; Obscured or absent landmarks
• Hearing and Equilibrium Tests


  1. Perform the whisper test hearing acuity test

  2. Perform Weber's Test

  3. Perform the Rinne test
• Whisper test


  Stand 1-2 feet behind client so they cannot read your lips, instruct client to place one finger on tragus of left ear to obscure sound, whisper word with 2 distinct syllables towards client's right ear, ask client to repeat word back
• Able to correctly repeat the 2-syllable word as whispered from 1-2 feet.
• Unable to repeat the 2-syllable word after two tries.
• Weber's Test


  Strike tuning fork softly, place the vibrating fork on the middle of the client's head or forehead, ask client if the sound is heard better in one ear or the same in both ears
• As tuning fork is placed at the middle of the head, the client reports vibration was felt heard equally well in both ears without lateralization of sound to either ear.
• Client reports lateralization of sound to the poor ear; client reports lateralization of sound to the good ear.
• Rinne test


  Strike a tuning fork and place the base of the fork on the client's mastoid bone/ mastoid process, ask client to tell you when the sound is no longer heard, immediately move the prongs of the tuning fork to the auditory meatus/ front of the external auditory canal, ask the client to tell you if the sound is audible after the fork is moved
• Air conduction sound is normally heard longer than bone conduction sound (AC> BC).
• Bone conduction sound is heard longer than or equally as long as air conduction; air conduction is heard longer than bone conduction in affected ear, but less than 2:1 decrease ability to hear faint.
• Romberg test


  Ask the client to stand with feet together, arms at sides, and eyes open, then with the eyes closed
• Client maintains position for 20 seconds without swaying or with minimal swaying.
• Client moves feet or starts to sway, preventing falls from the loss of balance