Ch. 17 Assessing the Ears Flashcards
External ear structures
pinna/auricle, external auditory canal
pinna
visible part, thin plate of yellow elastic cartilage, made in way to conduct sound waves to external auditory canal
External auditory canal
s shaped in adults, outer part curves up and back, inner part curves down and forward. contains modified sweat glands that secrete cerumen
Cerumen
keeps tympanic membrane soft, has bacteriostatic properties (traps bacteria), defense against foreign bodies
Middle ear
tympanic cavity, air filled chamber in temporal bone, three bones transmit sound waves to inner ear through oval window. tympanic membrane, Eustachian tube
Three bones in ear
malleus, incus, stapes
Tympanic membrane
translucent pearly gray, separates external and middle ear, cone of light = reflection of otoscope light cone shaped b/c membrane concave
Eustachian tube
connects middle ear to nasopharynx for air pressure equalization on both sides of tympanic membrane
inner ear
labyrinth, fluid filled, three parts - cochlea, vestibule, circular canals
cochlea
inner cochlear duct contains spiral organ of corti, sensory organ for hearing
Vestibule and circular canals
sensory receptors to sense position/head movement, maintain static/dynamic equilibrium, vestibular nerve - connects w/ cochlear nerve to form CN 8. dizziness
How does hearing occur?
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
Conductive hearing
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
sensorineural hearing
transmission of sound waves in inner ear. loss of this type is dysfunction of organ of corti, temporal lobe of brain or CN 8
Which type of hearing loss is more serious?
sensorineural (nerve damage)
Present health concern
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
History
personal - infections, trauma, earaches, past treatments/success. family - hearing loss in family?
Lifestyle for assessment
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?
Equipment for ear assessment
watch w/ second hand for Romberg test, tuning fork, otoscope
Preparing client for assessment
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
Which frequency of sound goes first?
high
general ear assessment
inspect auricle, tragus, lobule, palpate auricle/mastoid process, perform whisper test
Focused specialty ear assessment
inspect external auditory canal, tympanic membrane. perform weber test if reported diminished or hearing loss in one ear, rinne test, romberg test
Inspection of external ear
auricle, tragus, lobule. observe for lesions, discoloration, discharge
Palpation of external ear
auricle and mastoid process, should be no tenderness
Inspection of inner ear
otoscope, inspect external auditory canal. note discharge, color/consistency of ear canal walls, character of nodules, color/consistency of cerumen. inspect tympanic membrane
Cerumen and hairs in older clients
harder/drier cerumen b/c cilia more rigid. coarse, thick wire like hair at ear canal. only abnormal if affects hearing
Tympanic membrane (inspection)
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
What do you do for a ruptured tympanic membrane?
is no infection let heal on it’s own
Ear tests
whisper, weber, rinne, romberg
Whisper test
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
Performing weber test
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
Interpreting Weber test
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
Performing Rinne test
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
Air conduction sound is normally heard _________ than bone conduction sound
longer
Interpreting Rinne test
used to determine cause of hearing loss, not that loss is present. sensorineural - air conduction still greater. conductive - bone conduction greater
Romberg test is to assess
equilibrium
Performing Romberg test
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
