Ear Assessment Flashcards
External Ear:
External auditory canal tympanic membrane (eardrum)
Middle Ear:
Malleus, incus, stapes
Middle Ear: Eustachian tube
- Passage of air
- Opens and closes with swallowing
- Equalizes air pressure on either side of eardrum
Infant and Children: developmental considerations
-Infant and children:
Developed at 5th week of gestation
-Normal (N.) placement at eye level.
-Also lumen has increased lymph tissue—increased during childhood therefore lumen occludes easily.
-Auditory canal—is short and slightly sloped.
What effects can maternal rubella have on a fetus in the first trimester?
Damage to Organ of Corti—hearing loss.
Infant N. eustachian tube:
shorter and wider and more horizontal—increase ear infections.
Hearing testing in NB::
- Mandatory screening at birth
- Decreased speech development after 2 years
Adult: Developmental Considerations
- Sloped ET
- Straight ear canal
- Otosclerosis at 20 to 40 years—normal conductive hearing loss—hardening of stapes—impedes transmission—causes progressive hearing loss.
Aging: developmental Considerations
- If Otitis media (OM) frequent—increase scarring on TM—increased hearing loss.
- Increased noise—increased hearing loss (Sensorineural loss)
- 50% Canadians > 65 have hearing loss –high frequency tone loss –garbled speech and decreased ability to hear high pitched components of sound eg consonants not clearly heard but can hear vowels.
Testing for older adults:
- If exposed to increase noise levels
- Should be yearly after 65
Cultural Considerations:
- OM—increased in aboriginal, premature infant, Down’s Syndrome, bottle fed infants in supine position.
- After OM fluid in middle ear causes effusion and impairs hearing and in young child causes impaired child development.
What is the 3rd most prevalent chronic contain in older adults?
Hearing loss
Describe dry cerumen:
Dry –grey, flaky. Asian and Aboriginal >80%
Describe wet cerumen:
Honey brown to dark brown and moist –African and Euro /caucasian –97%
Inner Ear:
Bony labyrinth (balance) Cochlea (central hearing apparatus
Conductive hearing loss:
- Mechanical dysfunction or blockage external/middle ear
- Ask people to speak louder
Sensorineural loss:
- Disease of inner ear, nerve conduction or auditory cortex
- Eg. Presbycusis –ageing of the auditory nerves
- Trouble with discrimination
Equilibrium:
- Labyrinth of inner ear
- Vertigo with inflammation
- Spinning sensation, staggering gate
What is Otitis Media?
- Middle ear infection
- Obstruction of eustachian tube by nasal secretions
- Can cause fluid in the middle ear with subsequent developmental delay due to hearing loss
Who is Otitis Media common in?
Common in children
Very high in aboriginal children, premature infants, Downs syndrome, bottle fed babies fed in supine position
Older Adult: common hearing loss issues
- Cilia become coarse and stiff impeding sound transmission
- Ear wax dries and thickens (Cerumen impaction)
Subjective History:
-Earache
-Infections
-Discharge
-Hearing loss
-Environmental noise
-Tinnitus
-Vertigo
-Self-care behaviors
Cleaning, hearing tests
Objective Exam: Inspection
- Equal size bilaterally
- No swelling
- Colour consistent with facial colour
- No tenderness to pinna or tragus
- No pain at mastoid
- No redness, swelling or discharge at external meatus
Otoscope Inspection:
-Choose largest speculum that fits meatus
-Patient tilts head away from you
-Pull up and back on pinna of adult/older child, down on infants < 3 years
-Ears may be cleaned with gentle insertion of mineral oil/hydrogen peroxide
Irrigate against canal wall
How to use an otoscope:
Keep traction on ear during full insertion
Otoscope upside down
Dorsal surface of hand along cheek as brace, protects from forceful insertion
Insert gently
Try not to touch canal wall
If no eardrum seen, remove, reposition head, apply more traction
Tympanic Membrane: Ear Drum
- Shiny, gray in color
- 5 o’clock light in the right
- 7 o’clock light in the left
Testing Hearing Acuity:
- Gently press in and out on tragus of one ear while whispering two syllable word in opposite ear
- Should be 30-60 cm from patients ear
Vestibular Apparatus: Rombergs Test
-Patient stands with feet together, arms at sides
-Close eyes
-Observe patient for 20 seconds
-Obvious swaying/loss of balance may indicate vestibular damage
=POSITIVE ROMBERGS
