Chapter 17

Assessing Ears
Structure of the External Ear
 Auricle (or pinna)
o portion visible without any tools
 External auditory canal
o S shaped in an adult
o outer part curves up and back
o inner part curves down and forward

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Structure of the Ear

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Structure of the Middle Ear

 Tympanic cavity—small, air-filled chamber in the temporal

bone
 Separated from the external ear by the tympanic membrane
(eardrum)
 Distinct landmarks include the handle and short process of the
malleus
o umbo, cone of light, pars flaccida, pars tensa
 Round and oval windows
 Three auditory ossicles: the malleus, the incus, and the stapes
 Eustachian tube

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Structure of the Inner Ear
 Also known as the labyrinth
 Fluid filled and made up of bony and inner membranous
labyrinth
o Bony labyrinth has three parts: cochlea, vestibule,
and semicircular canals
 Inner cochlear duct contains the spiral organ of Corti
 Vestibular nerve and cochlear nerve: eighth cranial nerve

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Question #1
Is the following statement true or false?
The inner ear is an air-filled cavity.

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Answer to Question #1
False.
The inner ear is fluid filled and made up of the bony
labyrinth and an inner membranous labyrinth. The middle
ear is a small, air-filled chamber in the temporal bone.

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Hearing Loss
 Conductive hearing loss: Something blocks or impairs
the passage of vibrations from getting to the inner ear.
 Sensorineural or perceptive hearing loss: Damage is
located in the inner ear.

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Hearing

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Question #2
Is the following statement true or false?
Presbycusis often begins with a loss of the ability to hear
low-frequency sounds.

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Answer to Question #2
False.
Presbycusis often begins with a loss of the ability to hear
high-frequency sounds.

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Risk Factors for Hearing Loss #1

 Aging, especially due to many years of exposure to

sounds that can damage inner ear cells
 Heredity, with genetics that are related to susceptibility
to ear damage
 Occupational loud noises as regular part of the working
environment
 Recreational noises and exposure to explosive noises

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Risk Factors for Hearing Loss #2
 Ototoxic medications
 Illnesses, especially with high fever
 Noise exposure
 Smoking
 Cardiovascular risk factors
 Genetic and family susceptibility
 Premature birth

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Risk Factors for Hearing Loss #3
 Hypoxia during birth
 Rubella, syphilis, or certain other infections in pregnant
mother
 Inappropriate use of ototoxic drugs during pregnancy
 Neonatal jaundice, which can damage the otic nerve in a
newborn baby

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Risk Factors for Hearing Loss #4
 Infectious diseases such as meningitis, measles, mumps,
and chronic ear infections in childhood as well as in later
life
 Head injury or injury to the ear
 Wax or foreign bodies blocking the ear canal

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Risk Factors for Otitis Media
 Age
 Group childcare
 Babies fed from a bottle, especially lying down
 Seasons of fall and winter, due to exposure to colds, flu, and
increased allergens
 Poor air quality (especially irritants in the air, e.g., cigarette smoke)
 Family history
 Cleft palate
 Down syndrome
 Ethnicity
 Enlarged adenoids

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Risk Reduction to Preserve Hearing #1
 Avoid sound exposure louder than a washing machine.
 Avoid recreational risks that involve loud sounds or risks
of head or ear injury.
 Avoid listening to extremely loud music for long periods
of time.
 Wear hearing protectors and take breaks from the noise
in loud noise environments.
 Have hearing checked periodically, especially after age
50.

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Risk Reduction to Preserve Hearing #2
 If hearing loss is detected, obtain and use devices to
improve hearing.
 Immunize children against childhood diseases, including
measles, meningitis, rubella, and mumps.
 Be immunized against rubella before pregnancy if a
woman of child-bearing age.
 If pregnant, get screening for syphilis and other STIs,
adequate antenatal and prenatal care, and diagnosis and
treatment for baby born with jaundice.

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Risk Reduction to Preserve Hearing #3

 Avoid the use of ototoxic drugs unless prescribed by a

qualified health care worker and properly monitored for
correct dosage.
 If you have a newborn, avoid feeding from bottle while
infant is lying on back.
 Have newborn infant screened for hearing.
 Get treatment for ear infections as soon as they are
noticed; follow up with health care provider after
symptoms seem to be gone to make sure that there is
no fluid left in the ear.

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Risk Reduction to Preserve Hearing #4
 Get treatment for tonsil and adenoid infections and
inflammation.
 Keep child home from day care if possible when there is
an outbreak of ear infections.
 Teach child to avoid putting foreign bodies in ears.
 Avoid use of instruments to remove wax from ears due
to chance of impacting it further. See professional care
for wax removal.

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Nursing History of Ears and Hearing
 Changes in hearing
 Other symptoms
 Personal health history
 Family history
 Lifestyle and health practices

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Equipment for Ear Examination
 Watch with a second hand for Romberg test
 Tuning fork (512 or 1,024 Hz)
 Otoscope

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External Ear Structures
 Inspection and palpation
o Inspect the auricle, tragus, and lobule for size,
shape, position, lesions/discoloration, and discharge.
o Palpate the auricle and mastoid process for
tenderness.

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Whisper Test
 Have client place a finger on the tragus of one ear.
 Whisper a two-syllable word 1 to 2 ft behind the client.
 Repeat on the other ear.

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Weber Test
 Use tuning fork placed on the center of the head or
forehead.
 Ask whether the client hears the sound better in one ear
or the same in both ears.

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Question #3
Is the following statement true or false?
Weber test is used to test equilibrium in the client.

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Answer to Question #3
False.
Weber test helps to evaluate the conduction of sound
waves through bone to help distinguish between conductive
hearing and sensorineural hearing. The Romberg test is
used to test the client’s equilibrium.

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Rinne Test
 Use tuning fork and place the base on the client’s
mastoid process.
 When the client no longer hears the sound, note the time
interval, and move the tuning fork in front of the
external ear. When the client no longer hears the sound,
note the time interval.

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Romberg Test
 Tests equilibrium.
 Feet together and arms at side, close eyes for 20
seconds.
 Check for swaying.

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Internal Ear: Otoscopic Examination
 Inspection
o Inspect the external auditory canal for discharge,
color, consistency of cerumen, canal walls, and
nodules.
o Inspect the tympanic membrane for shape,
consistency, and landmarks.

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Expected Changes with Aging of the Ear
 Presbycusis common after 50 years of age
 Negative self-image with hearing aid
 Elongated earlobes with linear wrinkles
 Harder cerumen builds as cilia in ear canal become more
rigid
 Coarse, thick wire-like hair may grow at ear canal
entrance
 Eardrum appears cloudy

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Question #4
Is the following statement true or false?
With sensorineural hearing loss, bone conduction sound is
heard longer than air conduction sound (BC > AC).

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Answer to Question #4
False.
With sensorineural hearing loss, air conduction sound is
heard longer than bone conduction sound (AC > BC) if
anything is heard at all.

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Abnormalities of the External Ear and Ear
Canal
 Tophi, postauricular cyst
 Malignant lesion
 Otitis externa
 Build-up of cerumen in ear canal
 Polyp, exostosis

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Abnormalities of the Tympanic Membrane
 Acute otitis media
 Serous otitis media
 Blue/dark red tympanic membrane
 Scarred tympanic membrane
 Perforated tympanic membrane
 Retracted tympanic membrane

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Nursing Process
 Validating and documenting findings
 Diagnostic reasoning
 Nursing diagnoses
 Collaborative problems

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