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Lect 7. Ear

The document discusses the anatomy and assessment of the ear. It describes the external, middle, and inner ear as well as common causes of hearing loss. It provides guidance on inspecting the ear, using an otoscope, performing hearing tests, and assessing the vestibular system.

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29 views

Lect 7. Ear

The document discusses the anatomy and assessment of the ear. It describes the external, middle, and inner ear as well as common causes of hearing loss. It provides guidance on inspecting the ear, using an otoscope, performing hearing tests, and assessing the vestibular system.

Uploaded by

hla592071
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Physical Assessment

(NUR 122)
Lecture 7: Ear
Prepared by: Dr. Sarah Al-Ja’freh
Second Semester 2023/2024
Introduction
• The ear is the sensory organ for hearing and maintaining
equilibrium.

It has three parts:


• The external ear
• The middle ear
• The inner ear.
The external ear
The external ear called the auricle or pinna
• Consists of movable cartilage and skin
• Characteristic shape serves to funnel sound waves into its opening,
which is called the external auditory canal.
Auditory canal
• A cul-de-sac 2.5 to 3 cm long in adults that terminates at eardrum, or
tympanic membrane
• Lined with glands that secrete cerumen, a yellow waxy material that
lubricates and protects ear
The external ear (Tympanic membrane)
• Separates the external and middle ear

• Is tilted obliquely to the ear canal, facing


downward and forward

• It is translucent with a pearly grey


colour and a prominent cone of light in
the anteroinferior quadrant, which is the
reflection of the otoscope light.
The Middle Ear
• It contains tiny ear bones, or auditory ossicles: the malleus, incus,
and stapes. (‫)المطرقة والسندان والركاب‬
• Its opening to the outer ear is covered by the tympanic membrane.
• The openings to the inner ear are the oval window and the round
window.
• Another opening is the Eustachian tube, which connects the
middle ear with the nasopharynx and allows passage of air.
The Inner Ear
• It contains the bony labyrinth( ‫)متاهة عظمية‬, which holds the sensory
organs for equilibrium and hearing.
Within the bony labyrinth:
• The vestibule (‫)الدهليز‬
• The semi-circular canals( ‫)القنوات الهاللية‬
• The cochlea (‫)القوقعة‬
Hearing Pathways

• Air conduction (AC)

• Bone conduction (BC)


Hearing Loss
• Anything that obstructs the transmission of sound impairs hearing.
1. Conductive hearing loss involves a mechanical dysfunction of the external or middle
ear.
• It is a partial loss.
• Conductive hearing loss may be caused by impacted cerumen, foreign bodies, a
perforated tympanic membrane, pus or serum in the middle ear, and a decrease in
mobility of the ossicles.

2. Sensorineural (or perceptive) loss signifies pathology of the inner ear, cranial nerve
VIII, or the auditory areas of the cerebral cortex.
• Sensorineural hearing loss may be caused by nerve degeneration that occurs with
aging and by ototoxic drugs.

3. Mixed loss is a combination of conductive and sensorineural types in the same ear.
Clues that suggest hearing loss
1. Person lip-reads or watches your face and lips closely rather than
your eyes
2. Frowns or strains forward to hear
3. Postures head to catch sounds with better ear
4. Misunderstands your questions or frequently asks you to repeat
5. Acts irritable or shows startle reflex when you raise your voice
(recruitment)
6. Person's speech sounds garbled, possibly vowel sounds distorted
7. Inappropriately loud voice
8. Flat, monotonous tone of voice
Subjective Data

1. Earache (PQRST) Referred pain from a problem in teeth or oropharynx.


Infection
Rupture in tympanic membrane
2. Infections A history of chronic ear problems alerts you to possible
hearing loss.
3. Discharge Ottorrhea suggests infected canal or perforated eardrum

4. Hearing loss Gradual vs sudden


A trauma hearing loss is often sudden
Subjective Data

5. Environmental noise
Exposed to loud sound, Noise
protection
6. Tinnitus Occurs with sensorineural hearing loss, cerumen
Ringing, roaring, or buzzing in your ears impaction, middle ear infection, and other ear disorders
Ototoxic drugs
7. Vertigo Feeling of spinning of person (subjective vertigo) or
the objects around person (objective vertigo).

8. Patient-centered care
Clean your ears
Frequency of hearing assessment
Objective Data Equipment
Equipment needed
➢ Otoscope with bright light, fresh batteries, give off white, not yellow
light.
➢ Tuning forks in 512 and 1024 Hz
Inspection and Palpation (1 of 2)
Inspect external ear
➢ Size and shape
• Ears are of equal size bilaterally with no swelling or thickening.
• Ears of unusual size and shape may be a normal familial trait with no
clinical significance.
➢ Skin condition
• Skin color consistent with the person’s facial skin color
• Skin intact, with no lumps or lesions
• Darwin’s tubercle: a small painless nodule at the helix; this is a
congenital variation and not significant
Inspection and Palpation (2 of 2)
Palpate external ear
➢ Tenderness
• Move pinna and push on tragus; they should feel firm, and movement
should produce no pain.
• Palpating mastoid process should also produce no pain.
➢ External auditory meatus
• Note size of opening to direct choice of speculum for otoscope; no
swelling, redness, or discharge should be present.
• Some cerumen usually present with color and texture variation
External Canal
 Note any redness and swelling, lesions, foreign bodies, or
discharge.
 If any discharge is present note color and odor.

➢ Also, clean any discharge from speculum before examining other


ear to avoid contamination with possibly infectious material.
➢ For a person with hearing aid, note any irritation on canal wall
from poorly fitting ear molds.
Test for Hearing Acuity
Screening for hearing deficit begins during history; how well does a
person hear conversational speech?
➢ Ask the person directly if there is a hearing difficulty.
• If answer is yes, perform audiometric testing or refer for audiometric
testing.
• If the answer is no, screen using the whispered voice test.
➢ Useful to document presence of hearing loss
➢ Refer any abnormal findings for more accurate measures with pure
tone audiometry.
Whispered Voice Test
• Test one ear at a time while masking hearing in other ear by placing
one finger on tragus and rapidly pushing it in and out of auditory
meatus.
• Shield your lips so the person cannot compensate for a hearing loss
(consciously or unconsciously) by lip reading or using the “good”
ear.
• With your head 30 to 60 cm (1 to 2 ft.) from the person’s ear,
exhale and whisper slowly some two syllable words.
• Normally, the person repeats each word correctly after you say it.
Tuning Fork Tests (1 of 2)
• Measure hearing air conduction (AC) or by bone conduction (BC),
in which sound vibrates through cranial bones to the inner ear.
• AC route through ear canal and middle ear usually the more
sensitive route
• To activate tuning fork, hold it by stem and strike tines softly on
back of your hand.
• Perform Weber and Rinne tests to help distinguish between a
conductive hearing loss (CHL) and sensorineural Hearing Loss
(SHL)
Tuning Fork Tests (2 of 2)
 Weber test
➢ Normal finding—sound is equally heard in both ears
➢ Abnormal finding—sound lateralizes to one ear
➢ Conductive loss—Sound lateralizes to poorer ear (it is heard louder in the poorer ear)
➢ Sensorineural loss—Sound lateralizes to better ear (it is heard louder in the better ear)

 Rinne test
➢ Normal finding: AC greater than BC, noted as positive finding
➢ Abnormal finding relates to:
• Conductive loss: AC = BC or even longer (AC less than BC)
• Sensorineural loss: Normal ratio intact but reduced, the person hears poorly both ways
Vestibular Apparatus

Romberg sign
➢ Assesses ability of vestibular apparatus in inner ear to help
maintain standing balance
➢ Also assesses intactness of cerebellum and proprioception as it is
part of the neurologic system
Summary Checklist: Ear Examination
 Inspect external ear
➢ Size and shape of auricle, position and alignment on head
➢ Note skin condition.
➢ Check auricle and tragus for tenderness.
➢ Evaluate external auditory meatus.
 Otoscopic examination
➢ External canal—redness or swelling
➢ Cerumen discharge, foreign bodies, or lesions
 Test hearing acuity

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