MS.

HINA ASLAM BSN,RN

ASSESSMENT
OF EARS
PGD-CCU

NURSING INSTRUCTOR
 AT THE END OF UNIT,STUDENTS WILL BE
ABLE TO
• Identify the component of health history
Leaning necessary for the examination of ears.
• Describe color, shape and location of
Objectives auricle, external ear canal and tympanic
membrane and gross hearing.
• Perform the examination of ear.
STRUCTURE
AND
FUNCTION
EAR

The ear is
the sense
organ of
hearing and
equilibrium.

It consists of • The external ear

three
distinct • The middle ear
parts: • The inner ear
External Ear

The external ear is composed of

1. The auricle or pinna
2. The external auditory canal.
• Modified sweat glands in the
external ear canal
secrete cerumen, a wax-like
substance that keeps the
tympanic membrane soft.
• The tympanic membrane, or
eardrum, has a translucent, pearly
gray appearance and separates
external ear from the middle ear.
 Middle Ear

• The middle ear, or tympanic cavity, is a small, air-filled

chamber in the temporal bone.
• The middle ear contains three auditory ossicles:
1. The malleus
2. The incus
3. The stapes
• These tiny bones are responsible for transmitting sound
waves.
• Air pressure is equalized on both sides of the tympanic
membrane by means of the eustachian tube, which
connects the middle ear to the nasopharynx.
Inner Ear

• The inner ear contains

1. The cochlea, a seashell-
shaped structure essential
for sound transmission and
hearing.
2. The vestibule that
maintains balance of body
3. The semicircular
canals, which
contain the organs
of equilibrium.
 1. Sound vibrations traveling through air
are collected by and funneled through
the external ear, causing the eardrum
to vibrate.
2. Sound waves are then transmitted
through auditory ossicles as the
vibration of the eardrum causes the
malleus, the incus, and then the stapes
Hearing to vibrate.
3. The sound waves are passed to the
fluid in the inner ear.
4. The movement of this fluid stimulates
initiates the nerve impulses that travel
to the brain by way of the acoustic
nerve.
 HEARING LOSS

Conductive hearing loss is the result Sensorineural hearing loss is the

of interrupted transmission of sound result of damage to the inner ear,
waves through the outer and middle the auditory nerve, or the hearing
ear structures. center in the brain
 Subjective Data
[The Nursing Health History]
 Physical
Examination
EQUIPMENT

1. Watch
2. Tuning
fork
3. Otoscope
 Inspect the Auricle
➢ Normal Findings
• Ears are equal in
External size bilaterally (normally
Ear: 4–10 cm).
• The auricle aligns with
Inspection the corner of each eye.
& • Earlobes may be
free, attached, or
Palpation soldered.
• The skin is smooth, with no
lesions, lumps, or nodules.
Abnormal Findings

❑ MALIGNANT LESION
Malignant lesions, more
commonly referred to as cancer,
are lesions which may form and
develop in the bone but have the
capacity to spread to other areas
of the body and continue to
grow. On the ear, they are most
frequently found on the helical
rim or the external side of the
auricle.
Abnormal Findings

❑ OTITIS EXTERNA
Otitis externa is a condition that
causes inflammation (redness and
swelling) of the external ear canal,
which is the tube between the outer
ear and eardrum.
It can be due to exposure to water
which causes inflamation.
 ➢ Abnormal Findings
1. A painful auricle or
PALPATE tragus is associated
THE with otitis externa or a
postauricular cyst.
AURICLE
AND 2. Tenderness over the
mastoid process
MASTOID suggests mastoiditis.
PROCESS 3. Tenderness behind the
ear may occur with
otitis media.
Abnormal
Findings
❑ MASTOIDITIS
Mastoiditis is an
infection of the
mastoid bone of the
skull. The mastoid is
located just behind
the ear. It can due to
spread of infection
of middle ear to
mastoid bone.
 Inspect the External Auditory
Canal
➢ Normal Findings
OTOSCOPIC • A small amount of odorless
EXAMINATION cerumen (earwax) is the only
discharge normally present.
• Cerumen color may be yellow,
orange, red, brown, gray, or
black.
• Consistency may be soft,
moist, dry, flaky, or even hard.
• The canal walls should be pink
and smooth, without nodules.
Abnormal Findings

❑ Build up of Cerumen in
ear canal.
Abnormal Findings

❑ POLYP
A polyp is a projecting
growth of tissue from a
surface in the body.It can be
due to genetic mutations.
Abnormal Findings

❑ EXOSTOSIS
A benign outgrowth of cartilaginous
tissue on a bone.
Common causes include injury,
chronic irritation of a bone, or a
family history of exostosis
INSPECT THE
TYMPANIC MEMBRANE
(EARDRUM)

1. The
tympanic membrane
should be pearly, gray,
shiny, and translucent,
with no bulging or
retraction.
2. It is slightly concave,
smooth, and intact.
Abnormal Findings

❑ ACUTE OTITIS MEDIA

• The red,
bulging membrane;
decreased or absent
light reflex.
• Otitis media can
occur as a result of a
cold, sore throat, or
respiratory infection.
Abnormal Findings

❑BLUE/DARK
RED TYMPANIC
MEMBRANE
• Indicates blood behind
eardrum due to trauma.
Abnormal Findings

❑PERFORATED
TYMPANIC MEMBR
ANE
Perforation results
from rupture caused
by increased
pressure, usually from
untreated infection or
trauma.
 Abnormal Findings

❑ SEROUS OTITIS MEDIA

• The yellowish,
bulging membrane
with bubbles behind it.
• It is result of an upper
respiratory infection or an
allergic attack
 Abnormal Findings

❑SCARRED
TYMPANIC MEMBRA
NE
• White spots and streaks
indicate scarring from
infections.
Abnormal Findings

❑RETRACTED
TYMPANIC MEMBRANE
• Prominent landmarks are
caused by negative ear
pressure due
to obstructed
Eustachian tube or chronic
otitis media.
 Hearing and Equilibrium Tests

Whisper Test

Weber’s Test

Rinne Test

Romberg Test
 1. A simple and accurate test for detecting
hearing impairment. It is the only test of hearing
that requires no equipment.

2. Stand at arm's length (0.6 m) behind the

seated patient (to prevent lip-reading) and
WHISPER whisper a combination of three numbers and
letters (for example, 4-K-2) and then ask the
patient to repeat the sequence.
TEST 3. You should quietly exhale before whispering
to ensure as quiet a voice as possible.

4. If the patient responds incorrectly, the test

is repeated using a different
number/letter combination.
 5. The patient is considered to have
passed the screening test if they repeat at
least three out of a possible six numbers or
letters correctly (ie 50% correct).

6. Each ear is tested individually, starting

WHISPER with the ear with better hearing. During
testing, the non-test ear is masked by
TEST gently occluding the auditory canal with a
finger and rubbing the tragus in a circular
motion.
7. The other ear is assessed similarly with a
different combination of numbers and letters
 WEBER TEST & RINNE TEST

Weber test and rinne test is test for hearing loss.

They help determine whether you may have
conductive or sensorineural hearing loss.
 WEBER TEST
PROCEDURE
1. Perform Weber’s Test if the client
reports diminished or lost hearing in
one ear.
2. The test helps to evaluate the
conduction of sound waves through
bone to help distinguish between
conductive hearing (sound waves
transmitted by the external and middle
ear) and sensorineural hearing (sound
waves transmitted by the inner ear).
3. Strike a tuning fork softly with the back
of your hand and place it in the center
of the client’s head or forehead
Centering is the important part.
4. Ask whether the client hears the sound
better in one ear or the same in both
ears.
NORMAL FINDINGS:
1. Vibrations are heard equally well in both
ears.
2. No lateralization of sound to either ear.

ABNORMAL FINDINGS
1. With CONDUCTIVE HEARING LOSS, the
client reports lateralization of sound to the
poor ear—that is, the client “hears” the
sounds in the poor ear.
2. The good ear is distracted by background
noise, conducted air, which the poor ear
has trouble hearing.
3. Thus the poor ear receives most of the
sound conducted by bone vibration.
4. With SENSORINEURAL HEARING LOSS, the
client reports lateralization of sound to the
good ear. This is because of limited
perception of the sound due to nerve
damage in the bad ear, making sound seem
louder in the unaffected ear.
 RINNE TEST PROCEDURE
1. Perform the Rinne test.
2. The Rinne test compares air and bone conduction sounds.
3. Strike a tuning fork and place the base of the fork on the
client’s mastoid process .
4. Ask the client to tell you when the sound is no longer heard.
5. Move the prongs of the tuning fork to the front of the
external auditory canal
6. Ask the client to tell you if the sound is audible after the fork
is moved.
NORMAL FINDINGS
Air conduction sound is normally heard longer
than bone conduction sound (AC > BC)

ABNORMAL FINDINGS
With conductive hearing loss, bone conduction sound
is heard longer than or equallyOas long as air
conduction sound (BC > AC).
With sensorineural hearing loss, air conduction sound
is heard equal to bone conduction sound (AC=BC).
 ROMBERG TEST

Perform the Romberg Test. This tests

the client’s equilibrium. Ask the
client to stand with feet together
and arms at sides and eyes open and
then with the eyes closed.

NORMAL FINDINGS:
Client maintains position for 20
seconds without swaying or with
minimal swaying.

ABNORMAL FINDINGS:
Client moves feet apart to prevent
falls or starts to fall from loss of
balance. This may indicate a
vestibular disorder.
REFERENCES:

• Janet R. Weber, Jane H. Kelley (2014)

Health Assessment in Nursing (5th
edition). Philadelphia: Lippincott
Williams & Wilkins.
• Susan Fickertt Wilson, Jean Foret Giddens
(2017) Health Assessment for Nursing
Practice (6th edition). Elsevier, Inc.
• Kozier and Erb’s (2016) Fundamentals of
Nursing (10th edition). Pearson Education,
Inc.
• Lynn S. Bickley (2017) BATES’ Guide to
Physical Examination and History Taking
(12th edition). Wolters Kluwer.