Ear

Assessment

BY:
Heaven Grace C
Dollente SN
Objectives:
After the discussion
the student nurses will
be able to:
-Describe the
anatomy and physiology
of the ear.
-Explain methods
used to assess hearing
and balance disorders
 Title
• Text
The ear is a delicate sensory
organ with the dual functions
of hearing and balance. The
sense of hearing is essential for
normal development and
maintenance of speech as well
as the ability to communicate
with others.
 Functions
• 1. Hearing
• 2. Sound conduction
• 3. Balance and equilibrium
• Divided into 3 parts:
• 1. External Ear
• A. Auricle- (pinna) collects the sound
waves and directs vibrations into the
external auditory canal.
• B. External Auditory canal- 2-3 cm
long, ends at the tympanic
membrane. The skin of the canal
contains: hair, sebaceous gland and
cerumen.
• 2. Middle Ear
• A. Tympanic Membrane- (eardrum) 1
cm in diameter and very thin, normally
pearly gray and translucent.
–80% is called pars tensa (3 layers)
–20% pars flaccida

B. Ossicle- contains 3 smallest

bones: Incus, Malleus, Stapes.
• 3. Inner Ear
A. Membranous Labyrinth- composed of the
utricle, saccule, cochlear duct, semilunar
canals, and the organ of corti, all of which is
surrounded by a fluid called endolymph.

B. Organ of Corti- house in the

cochlea(organ for hearing), a snail-shaped bony
tube about 3.5 cm long with two and half spiral
turns.
- Organ of hearing.
 Otoscopic
Examination
 The tympanic membrane is inspected
with an otoscope and indirect
palpation with a pneumatic otoscope.
To examine the external auditory
canal and tympanic membrane, the
otoscope should be held in the
examiner’s right hand, in a pencil-
hold position, with the examiner’s
hand braced against the patient’s
face
The largest speculum that the canal
can accommodate (usually 5 mm in an
adult) is guided gently down into the
canal and slightly forward.

The following landmarks are identified,

if visible: pars tensa, umbo,
manubrium of the malleus, and its
short process.
Title
Title
 Evaluation of
Gross Auditory
Acuity
 A general estimate of hearing can be
made by assessing the patient’s
ability to hear a whispered phrase,
testing one ear at a time. The Weber
and Rinne tests may be used to
distinguish conductive loss from
sensorineural loss when hearing is
impaired (Weber & Kelley, 2014).
Whisper Test

Whisper Test
To exclude one ear from the testing,
the examiner covers the untested
ear with the palm of the hand. The
examiner then whispers softly from a
distance of 1 or 2 feet from the
unoccluded ear and out of the
patient’s sight. The patient with
normal acuity can correctly repeat
what was whispered.
Whisper Test

Weber Test
uses bone conduction to test
lateralization of sound. A tuning
fork (ideally, 512 Hertz [Hz]), set
in motion by grasping it firmly by
its stem and tapping it on the
examiner’s knee or hand, is
placed on the patient’s head or
forehead
Weber test
A person with normal hearing hears the
sound equally in both ears or describes
the sound as centered in the middle of
the head. A person with conductive
hearing loss, such as from otosclerosis or
otitis media, hears the sound better in
the affected ear. A person with
sensorineural hearing loss, resulting from
damage to the cochlear or
vestibulocochlear nerve, hears the sound
in the better-hearing ear.
Whisper Test

Rinne Test
 Rinne test
the examiner shifts the stem of a
vibrating tuning fork between two
positions: 2 inches from the opening of
the ear canal (for air conduction) and
against the mastoid bone (for bone
conduction). As the position changes,
the patient is asked to indicate which
tone is louder or when the tone is no
longer audible.
 Rinne test
The Rinne test is useful for distinguishing
between conductive and sensorineural
hearing loss. A person with normal hearing
reports that air conducted sound is louder
than bone-conducted sound. A person with
a conductive hearing loss hears bone-
conducted sound as long as or longer than
air-conducted sound. A person with a
sensorineural hearing loss hears air-
conducted sound longer than bone-
conducted sound.
Thank you !