Ears

Question 1

Ears Subjective Data

Answer 1

1. Earache
2. Infections
3. Discharge
4. Hearing loss
5. Environmental noises
6. Tinnitus
7. Vertigo
8. Patient centered care

Question 2

Ears Objective Data

Answer 2

1. Inspect external ear
   - size and shape of auricle
   - Position and alignment on head
   - Note skin condition (colors, lumps, lesions)
   - Check movement of auricle and tragus for tenderness
   - Evaluate external auditory meatus (note size, swelling, redness, discharge, cerumen, lesions, foreign bodies
2. Otoscopic examination
   - Palpate and inspect the PINNA
   - External canal
   - Cerumen, discharge, foreign bodies, lesions
   - Redness or swelling of canal wall
3. Inspect tympanic membrane
   - Color and characteristics
   - Note position (flat, bulging, retracted)
   - Integrity of membrane
4. Test hearing acuity
   - Note behavioral response to conversational speech
   - Whispered voice test

Question 3

Objective Data Equipment

Answer 3

• Otoscope with bright light and fresh batteries
• Pneumatic bulb attachment, sometimes used with infant or young child
• Tuning forks in 512 and 1024 Hz

Question 4

How do you perform an otoscope exam on an adult vs a child?

Answer 4

Adult: Pinna back and up

Infant to 3 yo: Pinna straight down

Question 5

Otitis Externa

Answer 5

Sever swelling of canal, inflammation, tenderness

Question 6

Otitis Media

Answer 6

occurs when middle ear fluid is infected
- an absent light reflex from increasing middle ear pressure (early sign)
- Redness and bulging
- earache and fever

Question 7

Perforated Membrane

Answer 7

if the acute otitis media is not treated, the drum may rupture from increased pressure or from trauma
- appears as a round or oval darkened area on the drum

Question 8

Insertion of Tympanostomy Tubes (Ear Tube)

Answer 8

Polyethylene tubes are inserted surgically into the eardrum to relieve middle ear pressure and promote drainage of chronic or recurrent ear infections

Question 9

Tests for Auditory Acuity

Answer 9

1. Whispered voice test
2. Tuning Fork Test
   - Weber test - conductive loss/ sensorineural loss
   - Rinne test: Measures air conduction (AC) or by bone conduction (BC)

Question 10

Health Promotions and Patient Teaching

Answer 10

1) 1-3-6 program of universal newborn hearing screening
2) Otoacoustic emissions (OAE) test
3) Auditory brainstem response (ABR) test

> Early intervention and amplification leads to better outcomes
Encourage yearly hearing assessment for the older adult

Question 11

Pathways of Hearing

Answer 11

1. Air conduction (AC)
   - normal pathway for hearing
   - MOST efficient
2. Bone conduction (BC)
   - bones of the skull vibrate and are transmitted directly to inner ear and cranial nerve VIII