Ch. 17 Assessing the Ears

Question 1

External ear structures

Answer 1

pinna/auricle, external auditory canal

Question 2

pinna

Answer 2

visible part, thin plate of yellow elastic cartilage, made in way to conduct sound waves to external auditory canal

Question 3

External auditory canal

Answer 3

s shaped in adults, outer part curves up and back, inner part curves down and forward. contains modified sweat glands that secrete cerumen

Question 4

Cerumen

Answer 4

keeps tympanic membrane soft, has bacteriostatic properties (traps bacteria), defense against foreign bodies

Question 5

Middle ear

Answer 5

tympanic cavity, air filled chamber in temporal bone, three bones transmit sound waves to inner ear through oval window. tympanic membrane, Eustachian tube

Question 6

Three bones in ear

Answer 6

malleus, incus, stapes

Question 7

Tympanic membrane

Answer 7

translucent pearly gray, separates external and middle ear, cone of light = reflection of otoscope light cone shaped b/c membrane concave

Question 8

Eustachian tube

Answer 8

connects middle ear to nasopharynx for air pressure equalization on both sides of tympanic membrane

Question 9

inner ear

Answer 9

labyrinth, fluid filled, three parts - cochlea, vestibule, circular canals

Question 10

cochlea

Answer 10

inner cochlear duct contains spiral organ of corti, sensory organ for hearing

Question 11

Vestibule and circular canals

Answer 11

sensory receptors to sense position/head movement, maintain static/dynamic equilibrium, vestibular nerve - connects w/ cochlear nerve to form CN 8. dizziness

Question 12

How does hearing occur?

Answer 12

sound vibrations through air collected by external ear, eardrum vibrates, sound waves transmitted through auditory ossicles as eardrum vibrates malleus incus and stapes, waves pass through fluid of inner ear, fluid moves and stimulates hair cells of spiral organ of corti, initiates nerve impulses that travel to brain by way of acoustic nerve

Question 13

Conductive hearing

Answer 13

transmission of sound waves through external/middle ear. loss of this type is dysfunction of external or middle ear. ex: perforated eardrum, drainage, impacted ear wax

Question 14

sensorineural hearing

Answer 14

transmission of sound waves in inner ear. loss of this type is dysfunction of organ of corti, temporal lobe of brain or CN 8

Question 15

Which type of hearing loss is more serious?

Answer 15

sensorineural (nerve damage)

Question 16

Present health concern

Answer 16

hearing changes - recent, all sounds or just some, high vs low frequency, concerned losing hearing. ears - ear drainage, pain (COLDSPA), ringing/roaring/crackling, dizzy/room spinning

Question 17

History

Answer 17

personal - infections, trauma, earaches, past treatments/success. family - hearing loss in family?

Question 18

Lifestyle for assessment

Answer 18

live/work w/ loud noises, swim a lot/protect, hearing loss affected work/social/care for self, last hearing exam, hearing aids, care for ears?

Question 19

Equipment for ear assessment

Answer 19

watch w/ second hand for Romberg test, tuning fork, otoscope

Question 20

Preparing client for assessment

Answer 20

seated comfortably, listen to, answer questions, detect hearing issues by conversation (ex: asking what, talking loud). for you, understand role of hearing in communication/adapting to environment (especially w/ aging), how to use otoscope, basic hearing tests/why

Question 21

Which frequency of sound goes first?

Answer 21

high

Question 22

general ear assessment

Answer 22

inspect auricle, tragus, lobule, palpate auricle/mastoid process, perform whisper test

Question 23

Focused specialty ear assessment

Answer 23

inspect external auditory canal, tympanic membrane. perform weber test if reported diminished or hearing loss in one ear, rinne test, romberg test

Question 24

Inspection of external ear

Answer 24

auricle, tragus, lobule. observe for lesions, discoloration, discharge

Question 25

Palpation of external ear

Answer 25

auricle and mastoid process, should be no tenderness

Question 26

Inspection of inner ear

Answer 26

otoscope, inspect external auditory canal. note discharge, color/consistency of ear canal walls, character of nodules, color/consistency of cerumen. inspect tympanic membrane

Question 27

Cerumen and hairs in older clients

Answer 27

harder/drier cerumen b/c cilia more rigid. coarse, thick wire like hair at ear canal. only abnormal if affects hearing

Question 28

Tympanic membrane (inspection)

Answer 28

pearly gray, shiny, translucent. note color, shape, consistency, landmarks, no bulging/retraction. cone shape reflection - 5 in right ear, 7 in left. may be cloudy in older adults

Question 29

What do you do for a ruptured tympanic membrane?

Answer 29

is no infection let heal on it’s own

Question 30

Ear tests

Answer 30

whisper, weber, rinne, romberg

Question 31

Whisper test

Answer 31

close ear not being tested, start w/ better side, nurse head two feet behind (so can’t read lips), whisper two syllable word/repeat back, repeat w/ other ear and different word. if unable to hear indicates hearing loss - follow up w/ audiologist

Question 32

Performing weber test

Answer 32

differentiates between conductive and sensorineural hearing loss. strike tuning fork/place on center of client’s head, ask if hear sound better in one ear or same in both. same is normal

Question 33

Interpreting Weber test

Answer 33

if conductive hearing loss = poor hearing ear hears better b/c not distracted by other sounds. if sensorineural hearing loss = good hearing ear hears better b/c nerve damage in bad ear limits perception of sound in that ear

Question 34

Performing Rinne test

Answer 34

compares air/bone conduction sounds. strike tuning fork, put base on mastoid process, ask them to say when sound is gone, move prongs to external auditory canal, ask them if sound is audible after fork is moved. should hear air conduction 2x longer

Question 35

Air conduction sound is normally heard _________ than bone conduction sound

Answer 35

longer

Question 36

Interpreting Rinne test

Answer 36

used to determine cause of hearing loss, not that loss is present. sensorineural - air conduction still greater. conductive - bone conduction greater

Question 37

Romberg test is to assess

Answer 37

equilibrium

Question 38

Performing Romberg test

Answer 38

ask client to stand w/ feet together/arms at sides, eyes open but then eyes closed, should maintain position for 20 sec w/o swaying/minimal swaying for both open/closed. stay close in case of fall but don’t touch