ANATOMY yThe ear is responsible for hearing and balance yConsists of 3 regions yExternal ear yMiddle ear yInner ear .

Long in adult and ends at the eardrum. Lined with glands that secrete cerumen .STRUCTURE AND FUNCTION y External Ear y auricle/pinna movable cartilage and skin Mastoid process= important Landmark External Auditory Canal the opening in the external ear. 2.5 to 3 cm.


FUNCTION OF OUTER EAR yCollect sound yLocalization yProtection ySensitive (earlobe) yOther? .

y Outer 1/3 of canal is cartilage, inner 2/3

consists of bone covered with skin y TWO types of cerumen y Whites and blacks ± wet, sticky, and honey colored y Asians and Native Americans ± dry and flaky Lubricates & protects Moves to meatus with chewing & talking

Tiny air±filled cavity in the temporal bone contains:
Auditory ossicles (bones)
Malleus Incus Stapes


Openings to
Outer ear covered by tympanic membrane Inner ear = oval and round windows Eustachian tube connects middle ear to the nasopharnyx for air passage (normally closed, opens with swallowing/yawning)


OSSICLES y Malleus (hammer) y Incus (anvil) y Stapes (stirrup) smallest bone of the body .



Conducts sound vibration from outer ear to inner ear 2.Middle ear has 3 functions 1. Eustachian tube allows equalization of air pressure on each side of the ear drum to avoid rupture ( high altitudes) . Protects the inner ear by reducing the amplitude of loud sounds 3.

Vestibule 2. Cochlea (contains the central hearing apparatus) . Semicircular canals 3.INNER EAR y Contains the Bony Labyrinth which holds the sensory organs for hearing and equilibrium 1.

FUNCTION OF INNER EAR y Convert mechanical sound waves to neural impulses that can be recognized by the brain for Hearing .

Major Divisions of the Ear Peripheral Mechanism Central Mechanism VIII Outer Middle Inner Cranial Ear Ear Ear Nerve Brain .

Amplitude=loudness Frequency=pitch . The electrical impulses are conducted by the auditory process of cranial nerve VIII (Acoustic) to the brain stem 1. Peripheral ² ear transmits sound and converts its vibrations into electrical impulses that can be analyzed by the brain. 2.HOW HEARING ? y 3 levels 1.

the cochlea and are scattered against the round window y The basilar membrane of the cochlea contain the organ of Corti receptor hair cells that translate the vibrations to electric impulses y The impulses go to the brainstem via Acoustic nerve (VIII) .y Sound waves cause the eardrum to vibrate y Vibrations travel via the ossicles through the oval window.

2. The acoustic nerve (Cranial nerve VIII) sends signals from each ear to both sides of the brain stem. Brain stem function is binaural interaction permits identification of sound and locating the direction of a sound in space. Brainstem is sensitive to intensity & timing from the ears depending on head position .

Cerebral cortex interprets the meaning of the sound and begins the appropriate response .3.

Bone conduction (BC) bones of the skull vibrate and transmit vibrations to the inner ear and acoustic nerve . the most efficient 2. Air conduction (AC) normal pathway of hearing.PATHWAYS OF HEARING 1.




INSPECT USING OTOSCOPE y Pull pinna up & back for adult/older child y Pinna down for infant & 3yrs. Maintain hold on pinna until exam is complete. y Avoid inner. bony section of canal because y more sensitive to pain .

y Clean or change speculum before examining other ear because y INFECTION .INSPECT USING OTOSCOPE y External canal y Color y Swelling y Lesions y Discharge . color and odour.


pearl-grey y Characteristics landmarks.Tympanic membrane y Color normal is shiny. cone of light y Position flat. umbo and short process. slightly pulled in at the center y Integrity of membrane intact? y Scarring = dense white patch . translucent.

HEARING TESTS y Begins with the history-Conversational tone y The following tests may indicate the presence of hearing loss .

place your head 1 2 feet from your client s other ear and say a 2 syllable word. Repeat on the opposite ear using another word. have the client identify the words (Used to detect high-tone loss) y Normal Response to Voice test y Correct identification of words bilaterally .yVOICE place a finger on the tragus of one ear and while rapidly pushing it in and out of the meatus.

Weber test used when hearing is reported as better in one ear than other y . hold it by the stem and strike the tines softly on the back of the hand 1.TUNING FORK TESTS measure hearing by AC and BC y To activate the tuning fork.


In cases of sensorineural hearing loss. the sound lateralizes to the better-hearing ear. the sound is heard well in the affected ear. such as from otosclerosis or otitis media.y Normal finding for the Weber test is y Tone heard = loud bilaterally y In cases of conductive hearing loss. . resulting from damage to the cochlear or vestibulocochlear nerve.

Normally sound is heard 2X as long by air conduction than bone conduction 2. Normal response . RINNE TEST compares bone conduction and air conduction 1. positive Rinne Test = AC>BC Bilaterally .2.


Sound is heard longer by BC sensorineural air-conducted sound is audible longer than bone conducted sound.INTERPRETATION conductive loss. .


DIAGNOSTIC EVALUATION y AUDIOMETRY y pure-tone audiometry. in which the spoken word is used y TYMPANOGRAM y measures middle ear muscle reflex to sound stimulation and compliance of the tympanic membrane by changing the air pressure in a sealed ear canal. the greater the hearing loss). y speech audiometry. y AUDITORY BRAIN STEM RESPONSE y The auditory brain stem response is a detectable electrical potential from cranial nerve VIII and the ascending auditory pathways of the brain stem in response to sound stimulation y MIDDLE EAR ENDOSCOPY . in which the sound stimulus consists of a pure or musical tone (the louder the tone before the patient perceives it.

SEVERITY OF HEARING LOSS LOSS IN DECIBELS INTERPRETATION 0 15 >15 25 >25 40 >40 55 >55 70 >70 90 >90 -Normal hearing -Slight hearing loss -Mild hearing loss -Moderate hearing loss -Moderate to severe hearing loss -Severe hearing loss -Profound hearing loss END .


moistens and filters y inhaled air Sensory organ for smell y .Nose First segment of the respiratory y system Warms.

External parts .

ciliated mucous membrane red due to bld supply y Septum-divides cavity into 2 passages y Superior. extends back over the roof of the mouth y Nasal hair. middle.Internal y Nasal cavity. inferior turbinates. Merge into the olfactory nerve (I) goes to the temporal lobe of the brain .in roof of the nasal cavity & upper part of septum.3 parallel bony projections on lateral walls of each cavity y Olfactory receptors.


Ethmoid sinuses 4. Maxillary sinuses 3. Sphenoid sinuses Frontal & Maxillary sinuses are accessible to examination .Types of sinus 1. Frontal sinuses 2.


SUBJECTIVE DATA NOSE y Discharge y Frequent colds y Sinus pain y Trauma y Epistaxis y Allergies y Altered smell .

y Sores. lesions y Sore throat y Bleeding gums y Toothache y Dysphagia y Altered taste y Smoking y Alcohol intake y behaviors .

deformity y Inflammation y Skin lesions y Color y If injury palpate gently .OBJECTIVE DATA y Nose Inspect and palpate y INSPECT for: y Symmetry.

y Test for Patency y Test for Sense of Smell Cranial nerve I (olfactory) y Inspect nasal cavity/ septum y Deviated septum? y Can see middle & inferior turbinates y Inspect and palpate Paranasal Sinuses y Press thumbs over frontal & maxillary sinuses .


Foreign Body .




Throat Area behind the mouth & nose Oropharynx separated from the mouth by a fold of tissue on each side called anterior tonsillar pillars Tonsils lymphoid tissue behind pillars .

yNasopharynx continues from the oropharynx but it is above it and behind the nasal cavity. It holds the adenoids and the eustachian tube openings. .



3+ touching the uvula y .Inspect y Tonsils y Grade size 1+ visible y .stick out tongue y Halitosis Due to ???? y PALPATE LYMPH NODS .Throat .2+ ½ way b/t tonsillar pillars and uvula y . hypertrophy y Gag reflex cranial nerves IX = glossopharyngeal y Cranial nerve XII = hypoglossal.erethema.4+ touching each other y Posterior pharyngeal wall.