Ears Flashcards
Ask the patient to_______ from the ear being assessed.
Tip the head away
If hair obstructs visualization,_____ the speculum with water.
Moisten
Ask the patient to tip the head away from the ear being assessed.
Select a speculum that would fit comfortably the patient.
Hold the otoscope securely in the dominant hand, with the handle held like a pencil between the thumb and the forefinger.
Rest the back of the dominant hand on the right side of the patient’s head.
Use the free hand to pull the right ear in a manner that will straighten the canal.
If hair obstructs visualization, moisten the speculum with water.
Slowly insert the speculum into the canal, looking as the speculum passes.
Assess the canal for inflammation, exudates, lesions and foreign bodies.
Procedure of assessing the ears
Visualize the tympanic membrane
COLOR
PERFORATIONS
LESIONS
BULGING OR RETRACTION
DILATION OF BLOOD VESSELS
BUBBLES
FLUIDS
Note the_____ of the TM while asking the patient to pinch the nose closed and blow gently.
Movement
Normal findings of ear canal
no redness, swelling, tenderness, lesions, drainage, foreign bodies or scaly surface areas.
varies in amount, consistency and color. Cerumen is white, dry, and flaky in patients of Asian and Native American descent and honeycolored and sticky in whites and African Americans.
Normal findings of cerumen
Normal findings of Tympanic membrane
Is pearly gray with clearly defined landmarks and a distinct cone-shaped light reflex. Should move when the patient blows against resistance.
Normal findings of blood vessels
seen only in the periphery, and the membrane does not bulged, retracted or have any evidence fluid behind it.
Abnormal findings of ear
EXTERNAL AUDITORY CANAL FOREIGN BODY
HARD, DARK CERUMEN
OTITIS EXTERNA
FURUNCULOSIS
OTITIS EXTERNA
EXOSTOSIS
SEROUS OTITIS
OTITIS MEDIA
ACUTE OTITIS MEDIA
PERFORATED EARDRUM
ACUTE PURULENT OTITITS MEDIA
HEMOTYMPANUM
PERFORATED TM
BLACK OR BROWN SPORES
AIR BUBBLES IN THE TYMPANIC MEMBRANE
Redness, swelling, scaling, or itching
of ear canal
OTITIS EXTERNA
deep infection of the hair follicle leading to abscess formation with accumulation of pus and necrotic tissue.
FURUNCULOSIS
“surfers ear”
EXOSTOSIS
yellowish membrane with fluid and air bubbles visible behind TM
Serous otitis
reddish TM with absent or distorted light reflex
OTITIS MEDIA
Note the red, bulging membrane; decreased or absent light reflex.
ACUTE OTITIS MEDI
blue to black TM from bleeding
HEMOTYMPANUM
round/oval dark area
Perforated TM
Greet the patient and explain the assessment.
Use a quiet room that will be free from interruptions.
Ensure adequate lighting
Place the patient in an upright sitting position.
Always compare the right and left sides of ears, nose, mouth and throat.
General approaches of hearing and equilibrium test
mainly used to establish a diagnosis in patients with unilateral hearing loss to distinguish between conductive and sensorineural hearing loss.
Test for lateralization
Weber test
a. Hold the handle of a 512 Hz tuning fork and strike the tine on the ulnar border of the palm to activate it.
b. Place the stem of the fork firmly against the middle of the patient’s forehead, on the top of the head at the midline, or on the front of the teeth.
c. Ask the patient if the sound is heard centrally or toward one side.
Weber test
Normal findings in weber test
The patient should perceive the sound equally in both ears or in the middle and there is no lateralization of sound.
The patient reports lateralization of sound to the poor ear-the client “hears” the sound in the poor ear.
The good ear is distracted by background noise, conducted air, which the poor ear has trouble hearing.
IN CONDUCTIVE HEARING LOSS
In conductive hearing loss, the poor ear receives most of the sound conducted by
Bone vibration
The client reports lateralization of sound to the good ear.
This is due to limited perception of sound due to nerve damage in the bad ear, making sound seem louder in the unaffected ear.
IN SENSORINEURAL HEARING LOSS
used to evaluate hearing loss in one ear.
differentiates sound transmitted through air conduction from those transmitted through bone conduction via the mastoid bone.
Rinne test
a. Stand behind or to the side of the patient the patient and strike the tuning fork.
b. Place the stem of the tuning fork against the patient’s right mastoid process to test bone conduction.
c. Instruct the patient to indicate if the sound is heard.
d. Ask the patient to tell you when the sound stops.
e. When the patient says the sound has stopped, move the tuning fork, with the tines facing forward, in front of the right auditory meatus, and ask the patient if the sound is still heard. Note the length of time the patient hears the sound (AIR CONDUCTION).
f. Repeat the test on the left ear.
Rinne test
Normal findings of rinne test
Air conduction is heard twice as long as bone conduction. This is noted as AC>BC or + Rinne
Bone conduction sound is heard longer than or equally as long as air conduction sound BC > AC
IN CONDUCTIVE HEARING LOSS
Air conduction sound is heard longer than bone conduction
IN SENSORINEURAL HEARING LOSS
Abnormal findings of rinne test
BC > AC = - RINNE
Occurs in conductive hearing loss, resulting from disease, obstruction or damage to the outer or middle ear.
BC> but with normal TM, patent Eustachian tube and middle ear
Most common cause of middle ear hearing loss in young adults (more common in women than in men)
Otosclerosis
HELPS TO DETERMINE WHETHER THE TYPE OF HEARING LOSS IS CONDUCTIVE OR SENSORINEURAL
Air Conduction
Bone Conduction
Air Conduction
SOUND—EAR CANAL—TYMPANIC MEMBRANE—OSSICULAR CHAIN—COCHLEA—AUDITORY NERVE—
Bone Conduction
SOUND—BONES OF THE SKULL—COCHLEA—AUDITORY NERVE
IF THE SOUND LATERALIZES IN THE AFFECTED EAR
CONDUCTIVE HEARING LOSS
This is the term which is used when there are problems which the flow of ear pressure waves down the ear canal, across the ear drum or through the ossicles.
IMPACTED CERUMEN
PERFORATED CERUMEN
CONDUCTIVE HEARING LOSS
IF THE SOUND LATERALIZES IN THE UNAFFECTED EAR
SENSORINEURAL HEARING LOSS
This is the term used when there is a problem in the cochlea, the auditory nerve or any other of the nerves linking the cochlea to the auditory cortex of the brain
SENSORINEURAL HEARING LOSS
Drug induced damage to the cochlea (antibiotics, certain diuretics, chemotherapy drugs)
Traumatic damage to the cochlea (noise, blow to the head, penetrating injury to the inner ear)
Age related to the cochlea (presbycusis)
Tumor on the auditory nerve
Certain infections, like meningitis
SENSORINEURAL HEARING LOSS
Voice Whisper Test
For Low Pitch Deficits
a. Instruct the patient to occlude one ear with a finger.
b. Stand 2 feet behind the patient’s other ear and whisper a 2-syllable word or phrase that is evenly accented.
c. Ask the patient to repeat the word or phrase.
d. Repeat the test with the other ear.
VOICE WHISPER TEST
Normal findings of voice whisper test
The patient should be able to repeat the words correctly or states that he or she is unable to hear anything.
Watch Tick Test
For High Pitch Deficits
Have patient cover opposite ear being tested.
Hold ticking watch within 5 inches from ear.
Note patient’s ability to hear sound.
WATCH TICK TEST
Normal findings in watch tick test
Patient hears tick of a watch in each ear at a distance of 5 inches.
ROMBERG’S TEST
Tests for Inner Ear Vestibular Function
Ask the client to stand with feet together and arms at sides and eyes open and then with the eyes closed.
TIP: Put your arms around the client without touching him or her to prevent falls
ROMBERG’S TEST
Normal findings of ROMBERG’S TEST
Client maintains position without swaying or with minimal swaying.
Abnormal findings of ROMBERG’S TEST
If the client moves feet apart to prevent fall or starts to fall from loss of balance may indicate a VESTIBULAR disorder.
External Ear Structures ( INSPECTION &PALPATION)
Inspect the auricle, tragus, and lobule. Note size, shape and position.
Normal findings of size, shape and position of auricle, tragus, lobule
Ears are equal in size bilaterally (normally 4 to 10 cm). The auricle aligns with the corner of each eye and within a 10-degree angle of the vertical position. Earlobes may be free, attached, or soldered (tightly attached to adjacent skin with no apparent lobe).
Abnormal findings of size, shape and position of auricle, tragus, lobule
Ears are smaller than 4 cm or larger than 10 cm. Mal aligned or low-set ears may be seen with genitourinary disorders or chromosomal defects.
Microtia
Perichondritis
Darwinian tubercle
Underdeveloped pinna (external ear)
Microtia
Cauliflower ear
Perichondritis
a benign protrusion on upper part of helix
Darwinian tubercle
Normal findings for inspecting the auricle, tragus& lobule for lesions, discolorations, and discharge
The skin is smooth with no lesions, lumps, or nodules. Color is consistent with facial color. Darwin’s tubercle, which is a clinically insignificant projection, may be seen on the auricle. No foreign bodies, redness, drainage, deformities, nodules, and lesions.
COLOR-ear should match the flesh color of the rest of the patient’s
POSITION-located centrally and in proportion to the head top of the ear should pass the imaginary line from the outer canthus of the eye to the occiput.
CERUMEN-moist and does not obscure the TM
Abnormal findings for inspecting the auricle, tragus& lobule for lesions, discolorations, and discharge
Enlarged preauricular and postauricular lymph nodes—infection
Tophi (nontender, hard, cream-colored nodules on the helix or antihelix, containing uric acid crystals)—gout
Blocked sebaceous glands—postauricular cysts
Ulcerated, crusted nodules that bleed— skin cancer (most often seen on the helix due to skin exposure)
Redness, swelling, scaling, or itching— otitis externa
Pale blue ear color—frostbite
Parotitis
Inflammation of parotid glands
Bruising over the mastoid process
Battle’s sign
Inflammation of mastoid process
Mastoiditis
Normal findings of palpating the auricle and mastoid process
Normally the auricle, tragus, and mastoid process are not tender.
Abnormal findings of palpating the auricle and mastoid process
A painful auricle or tragus is associated with otitis externa or a postauricular cyst. Tenderness over the mastoid process suggests mastoiditis. Tenderness behind the ear may occur with otitis media.
OTITIS EXTERNA
MASTOIDITIS
■ Missing or malformed landmarks: Associated with hearing deficit.
■ Creased earlobe: Associated with heart conditions.
■ Ear pits or sinuses usually located anterior to the tragus: Associated with internal ear
anomalies.
■ Low-set ears or ears rotated posteriorly more than 15 degrees: Associated with mental
retardation.
■ Drainage: Bloody drainage can result from trauma and purulent drainage from an infection.
Clear drainage may be spinal fluid from a head injury.
■ Impacted cerumen.
■ Redness: Inflammation may indicate infection, fever.
■ Lesions: E.g., skin cancer from sun exposure.
Inspecting the external auditory canal
Note any discharge along with the color and consistency of cerumen (ear wax).
Normal findings in inspecting the external auditory canal
A small amount of odorless cerumen (ear wax) is the only discharge normally present. Cerumen may be yellow, orange, red, brown, gray, or black and soft, moist, dry, flaky, or even hard.
Abnormal findings in in inspecting the external auditory canal
Foul-smelling, sticky, yellow discharge— otitis externa or impacted foreign body
Bloody, purulent discharge—otitis media with ruptured tympanic membrane
Blood or watery drainage (cerebrospinal fluid)—skull trauma (refer client to physician immediately)
Impacted cerumen blocking the view of the external ear canal—conductive hearing loss
Normal findings in observing the color and consistency of the ear canal walls and inspect the character of any nodules.
The canal walls should be pink and smooth and without nodules.
Abormal findings in observing the color and consistency of the ear canal walls and inspect the character of any nodules.
Reddened, swollen canals—otitis externa
Exostoses (nonmalignant nodular swellings)
Polyps may block the view of the eardrum
Inspect the tympanic membrane (eardrum). Note color, shape, consistency, and landmarks.
NORMAL FINDINGS
The tympanic membrane should be pearly, gray, shiny, and translucent with no bulging or retraction. It is slightly concave, smooth and intact. A cone-shaped reflection of the otoscope light is normally seen at 5 o’clock in the right ear and at 7 o’clock in the left ear. The short process and handle of the malleus and the umbo are clearly visible.
Inspect the tympanic membrane (eardrum). Note color, shape, consistency, and landmarks.
ABNORMAL FINDINGS
Red, bulging eardrum and distorted, diminished or absent light reflex—acute otitis media
Yellowish, bulging membrane with bubbles behind—serous otitis media
Bluish or dark red color—blood behind the eardrum from skull trauma
White spots—scarring from infections Perforations—trauma from infection Prominent landmarks—eardrum retraction from negative ear pressure resulting from an obstructed eustachian tube
Obscured or absent landmarks—eardrum thickening from chronic otitis media
Related to the dysfunction of the eternal or middle ear (impacted ear wax, otitis media, foreign object, perforated eardrum, drainage in the middle ear or otosclerosis)
Conductive
Related to dysfunction of the inner ear ( Organ of Corti- sensory organ for hearing, cranial nerves VIII, or temporal lobe of brain)
Sensorineural
Otosclerosis
often occurs with aging as the auditory ossicles develop a spongy consistency that results in conductive hearing loss
a gradual sensorineural hearing loss due to degeneration of the cochlea or vestibulocochlear nerve, is common in older (over age 50) clients.
presbycusis
Composed of the auricle and pinna and the external auditory canal
External ear
Sweat glands in the external ear canal secrete
Cerumen
A wax like substance that keeps the tympanic membrane soft
Cerumen
Distinct landmarks of the tympanic membrane
Handle &short process malleus
Umbo
Cone of light
Pars flaccida
Pars tensa
Separates the external ear from the middle ear
Tympanic membrane
Small air filled chamber in the temporal bone
Tympanic cavity
The tympanic cavity is separated from the external ear by_____ and from the eardrum by 2 bony partitions ______
eardrum; round & oval windows
Middle ear contains 3 auditory ossicles
Malleus, incus, stapes
The 3 auditory ossicles are responsible for
Transmitting sound waves from the eardrum to the inner ear through the oval window
Air pressure is equalized on both sides of the tympanic membrane by means of
EUSTACHIAN TUBE
Connects the middle ear to the nasopharynx
Eustachian tube
Is fluid full and is made up of bony labyrinth and inner membranous labyrinth
Inner ear or labyrinth
The bony labyrinth has 3 parts:
Cochlea, vestibule , semicircular canals
The inner cochlear duct contains the_____which is the sensory organ of hearing
Spiral organ of corti
The organs of balance in the inner ear are called
Vestibule/Vestibular System
is a hammer-shaped small bone or ossicle of the middle ear. It connects with the incus, and is attached to the inner surface of the eardrum. The word is Latin for ‘hammer’ or ‘mallet’.
Malleus
attached to the eardrum
Hammer (Malleus)
in the middle of the chain of bones
Anvil(Incus)
attached to the membrane-covered opening that connects the middle ear with the inner ear (oval window)
Stirrup (Stapes)
is a hollow tube deep in your ear. It looks like a spiral-shaped snail shell and plays an important part in helping you hear: It changes sounds into nerve messages and sends them to your brain.
Cochlea
External ear
Ear canal/auditory canal (external acoustic meatus
Auricle
Eardrum( Tympanic membrane)
Helix
Antitragus
Pinna/Auricle
Antihelix
Concha
Lobule
Tragus
Middle ear parts
Ossicles(malleus,incus, stapes)
Eardrum
Tympanic cavity
Eustachian tube
Inner ear parts
Cochlea, vestibule, semicircular canals, oval & round window, Vestibulocochlear nerves, auditory tube
