21/09/2020

Assessment of Learning objectives:

the EARS At the end of the session, the students shall be able to
NCM101 – Health Assessment
1st Semester, AY 2020-2021 ➢identify the equipment needed for assessment of the ears

➢discuss the importance of assessing the ears

Prepared by:

Ms. Alida L. Marallag, RN, MHPEd
September 25, 2020
College of Nursing
School of Nursing and Allied Health Sciences
St. Paul University Philippines
➢describe normal and abnormal findings in the external and
internal assessment of the ears
➢demonstrate proper assessment of external and internal ear
structures as well as hearing acuity

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The EARS The EAR STRUCTURES

• the sense organ for HEARING and • External ear

EQUILIBRIUM ➢Auricle or pinna
➢Extrernal auditory canal
• Middle ear
➢Tympanic membrane - eardrum
➢3 bones – malleus, incus, stapes
• Responsible for transmitting soundwaves from the eardrum to the
inner ear
• Inner ear – labyrinth
➢Cochlea – contains the organ of Corti
➢Vestibule
➢Semicircular canal

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ASSESSMENT of the EARS ASSESSMENT of the EARS

• Subjective Data • Objective Data • Equipment
➢Earaches • Ear discharge/s ➢Otoscope (with bright light)
➢History of infections ➢Pneumatic bulb attachment (for infants and young children)
• Redness
➢Discharge ➢Tuning fork
➢Hearing loss
• Swelling
• Foul smell ➢Watch with second hand
➢Environmental noise
➢Tinnitus • Integrity of the • Preparation
➢Vertigo tympanic membrane ➢Position the patient (adult) sitting up straight with his/her head
➢Self-care behaviors • Hearing acuity test at the nurse’s eye level
results

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ASSESSMENT of the EARS: ASSESSMENT of the EARS:

EXTERNAL STRUCTURES EXTERNAL STRUCTURES

STEPS STEPS NORMAL ABNORMAL

1. Greet the patient and 6. Inspect the auricles ⚫ ears are of equal ⚫ MICROTIA – ears are
introduce self. smaller than 4 cm
for color, symmetry, size bilaterally
2. Identify the patient vertically
using 2 identifiers. size and position.
3. Explain the procedure ⚫ no swelling or ⚫ MACROTIA – ears larger
to patient.
than 10 cm vertically
thickening
4. Wash hands, apply
⚫ presence of edema
gloves and observe
appropriate infection ⚫ low - set ears may
control procedures. indicate chromosomal
5. Provide for privacy. defects

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ASSESSMENT of the EARS: ASSESSMENT of the EARS:

EXTERNAL STRUCTURES EXTERNAL STRUCTURES

STEPS NORMAL ABNORMAL STEPS NORMAL ABNORMAL

6a. Inspect the skin ⚫ intact
condition. ⚫ no lumps or lesions
⚫ Darwin’s tubercle
may be present
⚫ redness 7. Palpate the auricles (pinna, ⚫ pinna, tragus and pain with movement
⚫
tragus and mastoid process) for
⚫ crusts and scaling texture, elasticity and areas of mastoid process are occurs with otitis
tenderness.
occur with otitis firm externa
externa, etc… ⚫ pain at mastoid

⚫ tophi, sebaceous ⚫ no tenderness elicited process indicate

crust mastoiditis
⚫ keloid ⚫ enlarged and tender

⚫ carcinoma lymph nodes

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ASSESSMENT of the EARS: ASSESSMENT of the EARS:

EXTERNAL STRUCTURES EXTERNAL STRUCTURES
STEPS NORMAL ABNORMAL
7a. Inspect the external ⚫ no swelling ⚫ ATRESIA – absence of an
opening or closure of the ear
auditory meatus. canal
⚫ no redness
⚫ a sticky yellowish
discharge due to otitis externa
or ruptured eardrum
⚫ a small amount of
odorless cerumen ⚫ impacted cerumen
(ear wax) is present

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ASSESSMENT of the EARS:

ASSESSMENT of the EARS:
Use of the OTOSCOPE
INTERNAL STRUCTURES
• Ask the client to sit comfortably with
the back straight and tilted slightly
• Use of the OTOSCOPE- a away from you toward his/her opposite
flashlight–type viewer used shoulder.
to visualize the external
auditory canal and eardrum • Choose the largest speculum that fits
comfortably into the ear canal and
attach it to the otoscope.

• Hold the instrument with the dominant

hand, and turn the light “ON.”

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ASSESSMENT of the EARS: ASSESSMENT of the EARS:

Use of the OTOSCOPE INTERNAL STRUCTURES

• Use the thumb and fingers of the opposite STEPS NORMAL ABNORMAL
hand to grasp the patient’s auricle. PULL it 1. Use the otoscope and ⚫ no redness, swelling, ⚫ redness and swelling
OUT, UP and BACK to straighten the auditory inspect the external
canal. (For children, PULL it OUT and DOWN) foreign body present ⚫ closed ear canal due
auditory canal.
to swelling
• Grasp the handle of the otoscope between
thumb and fingers of the dominant. 2. Note any redness and
⚫ purulent discharge
• Insert the speculum gently down and forward swelling, lesions or ⚫ a small amount of ⚫ frank blood or watery
into the ear canal. Be careful not to touch either
side of the inner portion of the canal wall. foreign bodies, or odorless cerumen drainage
discharge. (ear wax) is present ⚫ foreign body
• Move you head in close to the otoscope and
position your eye to look through the lens.

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ASSESSMENT of the EARS: ASSESSMENT of the EARS:

INTERNAL STRUCTURES INTERNAL STRUCTURES

STEPS NORMAL ABNORMAL STEPS NORMAL ABNORMAL

3. Inspect the ⚫ pearly, gray, shiny and ⚫ red, bulging eardrum and 5. Note the position of ⚫ it is flat, slightly pulled in at ⚫ retracted drum
the center ⚫ bulging drum
tympanic translucent with no diminished, distorted or the eardrum.
absent light reflex ⚫ flutters when the person ⚫ eardrum does not move

membrane. bulging or retraction

⚫ yellowish, bulging membrane holds the nose and
⚫ slightly concave, smooth swallows
with bubbles behind 6. Note integrity of the
and intact ⚫ bluish or dark red color (blood)
4. Note color, membrane.
shape, ⚫ perforation shows as a
⚫ tympanic membrane is dark oval area or larger
consistency and 7. Document all
intact opening on the drum
landmarks. findings. ⚫ some adults may show ⚫ vesicles present on the

scarring drum

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ASSESSMENT of the EARS: ASSESSMENT of the EARS:

ABNORMAL FINDINGS HEARING ACUITY

STEPS NORMAL ABNORMAL

GROSS HEARING ⚫ patient responds to ⚫ patient has difficulty
ACUITY verbal stimuli responding
➢ Assess the patient’s appropriately to verbal
Build up of cerumen in the ear Polyp Otitis externa
canal responses to normal cues
voice tones
⚫ cocks the head
⚫ tends to lip read when

communicating

Perforated tympanic Scarred tympanic

Acute otitis media membrane
membrane

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ASSESSMENT of the EARS:
HEARING ACUITY
STEPS
WHISPER TEST
1. Ask the patient to hold the heel
of the hand over the left ear.
2. Standing at the patient’s side –
1 to 2 feet distance, whisper a
simple phrase such as “The
weather is hot today.”
3. Ask the patient to repeat the
phrase.
4. Repeat the assessment on the
other ear using a different
phrase.
5. Document findings.
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ASSESSMENT of the EARS:
HEARING ACUITY
STEPS
WEBER TEST
1. Explain the procedure.
2. Get a tuning fork and strike it
gently to vibrate.
3. Place the vibrating fork at the
forehead or center of the
patient’s head.
4. Ask the patient whether sound
is heard better on only one or
both ears.
5. Document findings.
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NORMAL ABNORMAL
⚫ patient correctly ⚫ patient verbalizes
repeats whispered difficulty in repeating
phrases to both ears whispered phrases
• requests examiner to
repeat whispered
phrases
⚫ does not repeat
whispered phrases at
all
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NORMAL ABNORMAL
⚫ patient is able to ⚫patient’s ability to
hear the vibrations hear better on one
equally on both ears
ear suggests:
(no lateralization of
➢ Unilateral conductive
sounds)
hearing loss - sound
lateralizes toward the
affected ear.
➢ Unilateral sensorineural
loss - sound lateralizes
to the normal or better-
hearing side
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ASSESSMENT of the EARS:
HEARING ACUITY
STEPS NORMAL ABNORMAL
WATCH TICK TEST ⚫ patient is able to ⚫ patient verbalizes
1. Have the patient occlude one detect the sound of a difficulty in earing the
ear. ticking watch on both ticking sound
2. Out of the patient’s sight, place
ears
a ticking watch 2-3 cm (1-2
inches) from the unoccluded
⚫ claims not to hear any
ear.
3. Ask what the patient can hear. sound
4. Repeat the assessment on the
other ear.
5. Document findings.
ASSESSMENT of the EARS:
HEARING ACUITY
STEPS NORMAL ABNORMAL
RINNE TEST ⚫ patient is able to ⚫ In conductive hearing
1. Explain the procedure. hear the sound better loss, bone conduction is
2. Get a tuning fork and strike it
on air than on bone greater than air
gently to vibrate.
3. Place the vibrating fork at the conduction (twice longer conduction.
patient’s mastoid process. is a positive result) ⚫ In sensorineural hearing
4. Ask the patient to inform when
loss, air conduction is
sound is no longer heard. Note
greater than bone
time.
5. Quickly move the tuning fork conduction in both ears (as
in front of the patient’s external ear.
in normal hearing), however,
6. Ask the patient to inform when sound
hearing is decreased in the
is no longer heard. Note time.
7. Repeat on other ear. affected ear.
8. Document findings.
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WEBER and RINNE TESTS VIDEO on HEARING TESTS

WEBER TEST RINNE TEST

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References:
o Jarvis, C. (2004). Pocket Companion for Physical Examination and Health Assessment (4 th Ed.). St.
Louis, Missouri, Saunders
o Kozier, B. et al. (2008). Fundamentals of Nursing: Concepts, Process and Practice. (8th Ed.).New
Jersey, Pearson-Prentice Hall.
o Weber, J. et al. (2014). Health Assessment in Nursing. (5th Ed.). Philadelphia, Lippincott

Video credits:
• https://youtu.be/m9E1L1F3qzw
• https://youtu.be/UvOcBxhdIVc

Photo credits:
• Oxford Medical Education – Otoscopy and Hearing Test
• Healthwise Incorporated – Otoscopy

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