Assessing The Ears ● Balance

Structure of the INNER EAR or LABYRINTH

a. Structure and function
Ear
● Organ of hearing
3 DISTINCT PARTS:
-Inner
-External
-Middle Ear
Tympanic Membrane/ Eardrum -Separates
external from the middle ear, Otoscope.
Structure of the EXTERNAL EAR
a. Auricle or Pinna
● A portion of the ear that is
visible;
● It has a thin plate of yellow
elastic covered by tight-fitting
skin
● Irregular funnel
b. External Auditory Canal
● S-shaped for adults;
● Secrets “CERUMEN” (wax-like
substance keeping tympanic
membrane soft)
Structure of the MIDDLE EAR (Tympanic
Cavity)
a. Tympanic Cavity
● Small, air-filled chamber in
the temporal bone.
b. Tympanic Membrane
● Translucent, pearly gray
appearance.
● Eardrum
c. 3 Auditory of ossicles
● Malleus, Incus, Stapes
● Responsible for transmitting
sound waves.
d. Eustachian tube
● Equalizes air pressure on
both sides.
a. Inner Ear or Labyrinth
● Fluid-filled and made up of
bony and membranous
labyrinth.
● Bony Labyrinth -cochlea,
vestibule, semi-circular
canals.
– Inner Cochlear duct
contains Spiral Organ of
Corti
– Sensory receptors
Maintain static and
dynamic equilibrium
– Nerve fibers from
Vestibular
Nerve connected to
Cochlear nerve (CN VIII-
Acoustic)
HEARING
● CONDUCTIVE HEARING
Transmission of sound waves
through external and middle ear.
● PERCEPTIVE or SENSORINEURAL
HEARING
Transmission of sound waves in the
inner ear.
HEALTH ASSESSMENT
1. Collecting Subjective Data: Nursing
Health History
2. History of Present Health Concerns
a. Changes in Hearing
b. Other Symptoms
c. COLDSPA (Character, Onset,
Location, Severity, Patterns,
Associated factors)
3. Personal Health History
4. Family History
5. Lifestyle and Health Practices.

a. Collecting Objective Data
1.) Inspect/ palpate auricle, tragus, and
lobule
– Size, shape, position.
Normal:
1. Ears– equal in size bilaterally (4-10
cm)
2. Auricle – aligns with the corner of
each eye.
3. Earlobes – are free, attached
soldered.
4. No lesions, limps, or deformities.
Abnormal
1. Ears – smaller (4cm); larger (10 cm)
2. Malaligned or Low set ears– GUT
disorders or chromosomal defects
(eg. down syndrome )
3. Microtia – congenital deformity;
external canal are not fully
developed.
2.) Move pinna and press tragus;
palpate mastoid process.
Normal:
● Auricle, tragus and mastoid process
– Firm and non-tender.
Abnormal
1. Otitis externa
2. Postauricular cyst
3. Mastoiditis- tenderness over mastoid
process.
4. Otitis Media- tenderness behind ear.
3.) Inspect the external auditory canal.
Normal:
● Presence of odorless cerumen
– Color: Yellow, Orange, Red,
Brown, Gray, and Black.
– Consistency: Soft, moist, flaky, dry
or hard.
4.) Observe Color and Consistency of Ear
Canal Walls and Characters of nodules.
Normal:
● Pink and smooth; without nodules
Abnormal:
1. Otitis externa – foul-smelling, yellow
discharge.
2. Otitis media with ruptured tympanic
membrane – Bloody, purulent
discharge.
3. Impacted cerumen
4. Presence of foreign bodies (eg.
pebbles, corn, bugs, insect)
5. Exostoses – nonmalignant nodular
swelling.
6. Polyps
5.) Inspect Tympanic Membrane
(eardrum).
– Color, shape, consistency, and
landmarks
Normal:
● Pearly gray, shiny, translucent, no
bulging, or retraction, slightly
concave, smooth intact.
Abnormal:
1. Acute Otitis Media– red, bulging
eardrum,
distorted/diminished/absent light
reflex
2. Serous Otitis Media– yellowish,
bulging membrane with bubbles
behind.
3. Skull Trauma – bluish or dark red
color behind the eardrum.
4. Scarring from Infection– white spots
5. Perforations– trauma from infection
6. Eardrum retraction from negative
ear pressure resulting from
obstructed eustachian tube–
PROMINENT LANDMARK
 7. Eardrum thickening from Chronic
Otitis Media– Obscured or absent
landmarks.
6.) Whisper Test
● Ask the client to occlude the
ear not being tested.
● Rub the tragus with a finger
in a circular motion.
● Start with a better hearing
ear.
● Nurses head is 2ft behind the
client.
● (2,2,2 || 2-syllables, 2x
repeat, 2ft away )
Normal:
– Able to repeat two-syllable word.
Abnormal:
Hearing loss– unable to repeat the
two-syllable word in two tries.
7.) Webers Test
● Evaluate conduction of
sound waves through bone
(vibration)
– Conductive Hearing- sound
waves transmitted by the
external and middle ear.
– Sensorineural Hearing-
sound waves transmitted by
inner ear.
Normal:
● Vibration heard equally well in both
ears; no lateralizations.
Abnormal:
● Conductive hearing loss– sound
lateralizes to the impaired ear.
● Sensorineural hearing loss– sound
lateralizes to the good ear.
8.) Rinne Test
– compares air and bone
conduction.
1. Strike fork and position
mastoid process.
2. Move the prongs of the fork
in front of the external
auditory canal.
Normal:
● Air conduction (AC) is normally
heard longer than the Bone
Conduction (BC) sound.
Abnormal:
● Conductive hearing– BC is greater or
equal to AC.
● Sensorineural Hearing– AC greater
than BC.
9.) Romberg Test
– evaluate the client’s equilibrium.
> Ask the client to stand with feet
together, arms at sides, eye open then with
closed eyes.
Normal:
● The client maintains a position for
20 seconds without swaying or with
minimal swaying.
Abnormal:
● Vestibular Disorder– The client
moves feet apart or there is a loss of
balance.
INTERPRETATION OD WEBER AND RINNE
TESTS
RINNE TEST WEBER TEST

Normal AC > BC Midline

bilaterally

Conductive BC> AC in Lateralized to

Hearing loss affected ear. affected ear.
AC>BC in
unaffected
ear.

Sensorineural AC> BC in Lateralizes to

Hearing loss both ears unaffected
ear, away
from affected
ear.