Skill: Assessing the Ears and Hearing

Performed
Preparation Yes No Mastered Comments
1. Assemble equipment:
• Otoscope with several sizes or
ear specula
Procedure
1. Introduce yourself and verify the
client’s identity. Explain to the
client what you are going to do,
why it is necessary, and how the
client can cooperate.
2. Perform hand hygiene and observe
other appropriate infection control
procedures.
3. Provide for client privacy.
4. Inquire if the client has any history
of the following:
• Family history of hearing
problems or loss
• Presence of any ear problems or
pain
• Medication history, especially if
there are complaints of ringing in
ears
• Any hearing difficulty: its onset,
factors contributing to it, and
how it interferes with activities
of daily living
• Use of a corrective hearing
device: when and from whom it
was obtained
5. Position the client comfortably—
seated, if possible.
Assessment
Auricles
6. Inspect the auricles for color,
symmetry of size, and position. To
inspect position, note the level at
which the superior aspect of the
auricle attaches to the head with
relation to the eye.
7. Palpate the auricles for texture,
elasticity, and areas of tenderness.
Gently pull the auricle upward,
downward, and backward.
Fold the pinna forward. (It should
recoil.)
Push in on the tragus.
 Apply pressure to the mastoid
process.

External Ear Canal

and Tympanic Membrane
8. Using an otoscope, inspect the
external ear canal for cerumen,
skin lesions, pus, and blood.
Attach a speculum to the otoscope.
Tip the client’s head away from you
and straighten the ear canal.
Hold the otoscope either right side
up, with your fingers between the
otoscope handle and the client’s head,
or upside down, with your fingers and
the ulnar surface of your hand against
the client’s head.
Gently insert the tip of the otoscope
into the ear canal, avoiding pressure
by the speculum against either side of
the ear canal.
9. Inspect the tympanic membrane
for color and gloss.

Gross Hearing Acuity Tests

10. Assess the client’s response to
normal voice tones. If the client has
difficulty hearing the normal voice,
proceed with the following tests.
Perform the watch tick test.
Have the client occlude one ear. Out
of the client’s sight, place a ticking
watch 2–3 cm (1–2 inches) from the
unoccluded ear.
Ask what the client can hear. Repeat
with the other ear.
Tuning Fork Tests
Perform Weber test.
• Hold the tuning fork at its base.
Activate it by tapping the fork
gently against the back of your
hand near the knuckles or by
stroking the fork between your
thumb and index finger
• Place the base of the
vibrating fork on top of the
client’s head and ask whether the
client hears the noise.
 Conduct Rinne test.
• Ask the client to block the
hearing in one ear
intermittently by moving a
fingertip in and out of the
ear canal.
• Hold the handle of the
activated tuning fork on the
mastoid process of one ear
until the client states that the
vibration no longer can be
heard.
• Immediately hold still the
vibrating fork prongs in
front of the client’s ear
canal. If necessary, push
aside the client’s hair. Ask
whether the client now hears
the sound.
11. Document findings in the client
record.