Ear Assessment

Ear, organ of hearing and balance. Only vertebrates, or animals with backbones, have ears. Invertebrate animals, such as jellyfish and insects, lack ears, but have other structures or organs that serve similar functions. The most complex and highly developed ears are those of mammals. Assessment of the ear is done to detect any abnormalities present in its structure and function. Thus, preventing any further damage or alleviating any present suffering especially hearing loss. Hearing can be accounted to many factors like: ageing, noise, heredity and traumatic injury. There are two types of hearing loss, sensorineural and conductive. Sensorineural hearing loss occurs when sound waves are directed to the auditory canal by air conduction and damage is in the inner ear. While conductive hearing loss occurs when something blocks the passage of vibration in the inner ear.

Procedure Inspect external structures for symmetry, size and position.

Normal findings -Ears are symmetrical -Size is proportion to the head -Position: superior aspect of ears is the same level with the eyes lateral edge -normal size of the ear is

Abnormal Findings -ears assymetrical -too big or small ears -in different position - tender

4-10 cm. -Not tender

Procedure Palpate auricle for texture, elasticity and tenderness Do the ff: pull auricle downward, upward and backward fold pinna forward push on tragus Apply pressure at the back of the ears and mastoid process Procedure Inspect the external ear canal and the tympanic memebrane using an otoscope (if available) to determine internal structures integrity. Ask someone else to do the following: attach a speculum in the otoscope hold the otoscope either upside down or right side up. Position depends on preference of the examiner. gently insert into the ear canal, avoid pressure

Normal findings Auricle is elastic and folds and turn back to original place immediately, not tender

Abnormal Findings Stiif ears Inflammation at the back of the ear is due to a condition called otitis media Inflammation in front of the ear- otitis externa Inflammation in mastoid process- mastoiditis

Normal findings -Ear canal is red in appearance -presence of earwax is normal -no obstruction -no bleeding

Abnormal Findings -has foreign bodies obstructing the canal. -bleeding

EASY TIPS:

Use Largest Speculum Tip Clients Head Away Adult: Up and Back, Slightly Away Child: Down and Back

Procedure Assess tympanic membranefor color and gloss

Normal findings -Color should be pearly gray -shiny -translucent Variations occur in ageing person -ear drum is cloudy -has more prominent landmarks

Abnormal Findings Bluish- indicates presence of blood Red/pink-inflamed

Procedure Assess response to normal voice: engage in a conversation and assess answers and how person absorbs information If client has problem hearing normal voice tone proceed to the following: Watch tick test ask client to occlude one ear and from behind place a ticking watch 2-3 cm from the unoccluded ear. Ask client to say what he can hear. Repeat to the other ear.

Normal findings -answers correctly the question -doesnt have trouble hearing normal voice

Abnormal Findings -has trouble hearing normal voice - hears question when examiner increases vocal tone.

-person hears ticking watch

-person fails to hear ticking watch

Procedure Do tuning fork tests:

Normal findings

Abnormal Findings

Weber test- assess hearing through bone conduction Activate tuning fork while holding at its base. Place vibrating tuning fork above the head at the center. Note: Centering is important to ensure equal distribution of sound and prevent lateralization due to position of tuning fork. Procedure Rhine test- assess hearing through bone and air conduction Perform the ff: Activate a tuning fork Place tuning fork in the mastoid process and instruct person to

Person reports no lateralization of sound on either ears

For conductive hearing loss, there is presence of sound lateralization. Sound is best heard at the poor ear. Good ear is distracted by other sounds in the environment. For sensorineural hearing loss, there is lateralization of sound in the good ear because nerve damage is present in the bad ear.

Normal findings

Abnormal Findings

Air conduction sound is heard longer than bone conduction (AC> BC). Commonly AC is twice BC.

For conductive hearing loss, bone conduction is heard longer than air conduction For sensorineual

tell whether sound is not anymore heard. When sound is not heard anymore, place the tuning fork prong in front of persons ear canal. Ask if client now hears the sound Note time in secondss

hearing loss, air conduction is heard longer than bone conduction. That is if theres still a sound heard.

Reference: McCann, J.A.S. RN. MSN. (2007). Health assessment made incredibly visual. New York, NY: Lippincott Williams and Wilkins. Kozier&Erbs.(2009). Fundamentals of Nursing Checklist (8th edition). Weber, J. RN., EdD, Kelley J., RN, PhD.(2007). Health assessment in nursing (3rd ed.) USA: Lippincott Williams and Wilkins.

Lederer, Francis L. "Ear." Microsoft Encarta 2009 [DVD]. Redmond, WA: Microsoft Corporation, 2008.