Ch 14: Ear Assessment for advanced and specialty practice Flashcards
What is the function of the ear (basic function and internal function)
Hearing and sustaining equilibrium
What is the external ear designed to guide And what is a contribute to (basic function)
External ear design to guide sound to meatus of external ear canal
Contributes to hearing
When visualizing what ear portion would you find cerumen  and what can an accumulation of cerumen cause 
What can Cerumen block (other than sound, visualize)
When visualizing the external ear you can find cerumen
if an accumulation of Cerumen is present it can cause temporary hearing loss and sensation of fullness in the ear
Ceramic blocks visualization of tympanic membrane
What are used to visualize the tympanic membrane and what is the normal finding of the tympanic membrane
Using an otoscope you can visualize the tympanic membrane
Normal findings are translucent and pearly gray/white with a reflection on the malleus
What is the purpose of the middle ear and what can you visualize when looking at the middle ear
Purpose of the middle ears to dampen volume
You can visualize the ossicles: 3 bines of middle ear
- Malleus
- incus
- stapes
What is the valsalva maneuver done for and what is the process
2 processes : estachian tube and filling ballon
Who do you not perform the Valsalva maneuver on
Valsalva maneuver done to open up ears
Process: estachian tube opens briefly when you swallow or yawn because of its connection to the mid year in pharynx regulating pressure
Process: pinching nose closed, closing mouth, exhaling like you’re feeling a balloon and bearing down like if you’re having a bowel movement for 10 to 15 seconds
Do not perform on Katia patients
What is the inner ear responsible for in relation to the cranial nerve, which cranial nerve, Where does the translation travel to
The inner ear is responsible for sound translated to cranial nerve 8 (auditory),
Trouble cerebral cortex
What is the main responsibility of the inner ear
How do you test it
(Awareness)
The main responsibility of the inner ear is for vestibular function which accounts for proprioception does the awareness of position moving in balance
Tested by moving the patient’s thumb with her eyes closed and Them telling you what direction you moved it in
What ear structure is responsible for balance and what can it cause (feeling)
The semicircular canals are responsible for balance
Can cause vertigo: feeling of room spinning and stuffy ears
What is the entire goal of the Valsalva maneuver and how does it open the Estachian tube
The entire goal of the Valsalva maneuver is to create a balance in ear pressure
Open Estachian tube by force
What is the organ of Corti responsible for
Responsible for producing electrical impulses for cranial nerve 8
What causes problems with air conduction and hearing (in the way)
And what are these problems affected by
Blockage of external auditory canal
Affected by: any blockage(cerumen)
Inflammation
Foreign body
What are the two different pathways sound is perceived (give all related info)
Think rinne test 
Air condition: most efficient method, normal pathway of sound to middle ear
Bone conduction: deliver sound directly to inner ear by
- Vibrations
- Waves
What two components of sound does a cochlea interpret
Air condition and bone conduction
 what does the rinne test test
Give the process including counting of time
What is the normal finding
Rinne test evaluates air conduction and bone conduction
Process:
-activate tuning fork place over a message process
-Count seconds until patient cannot hear vibrating sound
-move to the opening of external ear(Without activating again)
-Count until patient cannot hear vibration
Normal finding: AC X2> BC
What does the weber test evaluate
what is the process
What are the normal findings v abnorm
We were test evaluates sensoneuro loss
Process:
-activate tuning fork and place in middle of parietal bones that lines with both ears
Normal finding: sound in both ears has equal intensity
Abnormal finding unilateral hearing loss (only1 ear hears) 


What does the Romberg test test for
Romberg test for equilibrium
What cranial nerve does a whisper test test for
what does the whisper test evaluate (what sounds picth)
Give the process of the whisper test
Give nirmal and abnorm findings
Whisper test evals CN8
Whisper test evaluate high pitch hearing loss
Process: -stand 18 inches away from testing ear(open ear) ON SAME SIDE  -whisper simple words “baseball” -Have patient repeat words -repeat on other ear
Normal: repeat words
Abnormal: patient can’t hear (hearing loss) 

Define EXTERNAL conductive hearing loss
give a cause (in the way)
How do you resolve conductive hearing loss
(What are you doing 2things)
 conductive hearing loss is a sound wave transmission disrupted through external or middle ear
Cause: external ear blockage
Resolution: remove object
- Foreign body (can be insect)
- Cerumen
What can MIDDLE EAR Conductive hearing loss due to
Otitis media by fluid accumulation
What are four things hearing difficulties can result in
(increased risk, unhappy, health, increased hurt)
1 increased risk of depression
- Dissatisfaction with life
3 decrease in functional health
4 increase an injury
Why does an increased risk of depression occur with hearing difficulties and how can you resolve it
Resolved by?
Increase risk of depression with hearing difficulties happen because
- patient cannot socialize cannot participate and withdrawals
Resolved by assessing hearing
What is sensorineural hearing loss
Give two common examples of sensorineural hearing loss
- With age
- Ringing give causes 5 1 is a vaccine
Problem from inner ear to auditory complex
Examples
1.presbycusis: Gradual degeneration of nerve and other structures
Ralated to: age and ototixic rx
Resolve: assess medications
- Aminoglycosides (gentamicin)
- NSAID (moltrin)
- diuretic (LASIX)
- neoplatic rx
- vaccines: MMR
- Tinnitus: ringing in ear
Resolve: assess if on aspirin
What percentage of the population does tinnitus affect and why
Tinnitus affects 15% of the population due to high aspirin dose or unknown cause
Other than balance what are the semicircular canals provide
(Related to vestibular function)
Semicircular canals provide proprioception:
- equilibrium, awareness of position, orientation
What causes vertigo and what is vertigo
What convertible cause
How is vertigo treated with no cause
Vertigo caused by inflamed labyrinth
Vertigo is the feeling of a spinning room
Vertigo can cause spinning, n/V
If no known cause treat with symptomatic treatment (i.e: N/V meds)
What is Ménière’s disease
What causes Ménière’s disease, how long does it last
What are important patient teachings for Ménière’s disease
Ménière’s disease is vertigo with severe nausea and vomiting
Ménière’s disease caused by quick head movement usually last 24 hours
Teach slow head movement

What are lifespan consideration for older adults in regards to ears
Size/direction and why Ear hair characteristics Hearing and why Cerumen Reaction time because of what and with what age
Ears have increased prominence
-poke out due to extra cartilage and rigidity
Ear hairs become coarser ,thicker, and stiffer
Hearing decreases : PRESBYCUSIS with age
Cerumen becomes darker and dryer accumulate more and decreases hearing
Increased reaction time because of slowing electrical responses at age 70
Who do you see an increase in otitis media culturally and why
Why for 2 ethnic groups
Increased otitis media in Native Americans and Asians as well as those in lower socioeconomic statuses (dont seek treatment) 
Due to dry Cerumen being grey and flaky
Why is it more coming to see otitis media infections in children
(3 attributing characteristics to tubes)
Due to external auditory tubes being shorter wider and more horizontal
What are signs and symptoms that a child has otitis media
3
1. Very irritable (crying)
- Fever
- Tugging on affected ear
 When doing an urgent assessment for foreign object what are things you can see and who would do the removal
Urgent submit for foreign objects includes insects, buttons, batteries
Refer to otorhinolaryngologist! for removal
What kind of drainage needs immediate urgent assessment
What do you do as a nurse with the drainage
Foul smelling drainage needs immediate urgent attention because it could be serious infection
Get a culture and sensitivity test to identify cause
Define cholesteatoma and what it can lead to
Cholesteatoma is The abnormal accumulation of epithelium in the middle ear
Can lead to ossicle erosion and significant hearing damage
EAR TRAUMA
Define hemotympanum , give it causes and signs and symptoms
Hemotympanum is tympanic rupture
Causes: traumatic brain injury
S&s:
- basilar skull fractures
- Battle signs (echymosis to mastoid process)
- raccoon eyes (Mickey Mouse‘s to Peri orbital area)
- CSF leak
With hemotympanum what do you do if you note a CSF leak
With CSF leak You collect drainage and conduct
- a glucose & beta 2 transfer test to see if actual CSF
Define otorrhea
Discharge from external ear
What is important subjective data to collect as far as risk factors for the ears
Personal history
- ear problems, surgeries, ear infection or loss, tinnitus, vertigo, OTALGIA: ear pain
- Tympanostomy: tube insertion
Medications/allergies -aminoglycosides (gentamicin) -NSAID (moltrin) -ASA -diuretic (LASIX) -Antineoplastics -vaccine: MMR \+antimalirials
Fam history
-Family hearing loss, history of Ménière’s disease
Risk factors
- lifestyle factors(loud music)
- environmental
- occupation (construction any protection?)
-
When collecting subjective data how do you know if a patient is having difficulty hearing
Ear position Leaning Concentrating Mumbling Voice tone Asking Responding tone
 giving you the good ear Leaning into you Concentrating on your face (read lips) Mumbling answers ( dont understand) Dull monotonous voice (no tone change) Asking you to repeat Responding loudly (to hear themselves)
What is our number one Health Goal in relation to ears
What is The goal aimed at
Assess general hearing loss
-May require protective equipment
Assassin General hearing loss is aimed at decreasing hearing loss with early screenings

How do you reduce risk of cancer prevention in relation to the ears
(sun protection)
If patient commonly exposed to sun teach:
MELENOMAS COMMON ON EAR
- Apply SPF to ear neck face
- Where large brim hat
- Reapply every two hours
- Avoid Hot sun 10 AM 4 PM
What are very important tips for ear cleaning
Cleaning device
Cerumen
Inserting
Don’t use Q-tips
Increase of cerumen is not associated with lack of hygiene
Don’t stick anything into ear
If a patient has hearing difficulties what can you do to help the patient understand you
(This does not pertain to closing the door and turning off TV)
- Stand close to patient
- speak clear and slow
- use normal tone DONT ⬆️tone
- ensure patient can see face and lips
What does it mean if severe otalgia is followed by a relief of pain and drainage give the medical name
If severe otalgia (ear pain) is followed by relief of pain and drainage from ears there has been a
•rupture to the tympanic membrane! 
If a patient has sudden hearing loss what do you assess for
Hit
Foreign body
Work
- trauma
- an obstruction
- occupational exposure to loud noise
Give common signs and symptoms related to ears
- hearing loss
- vertigo : spinning room
- tinnitus : check for ototoxic drugs
- otalgia : ear pain could be otitis media
- ear infections: assess for odor and drainage
In relation to hearing decrease what is common among older populations
In older populations presbycusis (Gradual degeneration of nerve plus other structures) sensorineural 
In a child what do you want to assess for in relation to ears If a child is pulling on here
If a child is pulling an ear assess for otitis media
Child will be
- irritable
- febrile
- talking on affected ear
What are risk factors for otitis media and children
Time of year, immediate environment, being cared for
- Wintertime
- Around environment of smokers
- At a daycare
Why would someone get a tympanostomy
Child we get tympanostomy (tube insertion) if frequent otitis media
If a patient has a complaint of the right ear what year do you assess first and why
Efficient has a complaint of right ear assess the good ear first to use as a baseline
What do you wanna ensure with the Level of ears when inspecting in helping
Ensure ears are at the level of the canthus (punctum) meaning they are symmetrical
What are common assessment for hearing acuity
Whisper test CN8,rinne, webber test
How do you pull the year for an adult and a child when using an otoscopE
What are you visualizing with an otoscope
Adult: up and back
Child: down and back
Otoscope used to visualize tympanic membrane
What is the most accurate test for estimating sensorineural loss (hearing loss) 
Audio meter/audio gram
What test for equilibrium in a patient’s whole body
The Romberg test
Who is most likely to have low years that do not align with the canthus 
Children with neural development issues or kidney issues
How do you know if the tympanic membrane is infected
It is NOT pearly white/gray or translucent
Is bulging, red, draining

What diagnostic test you run for clear drainage suspected of CSF during a traumatic brain injury
Glucose and beta 2 transferrin test
Give patient outcomes related to ears
Patient is free from ear pain
Patient explains plan to accommodate hearing impairment
Given nursing interventions for ear pain
Turn off TVs, radios when communicating
Close door to muffle sounds
Give nursing diagnosis related to ears
Disturbed auditory sensory perception
Pain
Risk for infection
