Ears Flashcards
What to look for when inspecting the external ear?
Size, shape, color of helix, antihelix, lobule, tragus, and concha
What to look for when inspecting external meatus?
presence of cerumen, discharge, foreign bodies, redness, edema, tenderness, or scaling
What tool can be used to remove excess cerumen from the external auditory meatus?
cerumen spoons
What to look for when inspecting tympanic membrane?
appearance of cone of light, umbo, and handle of malleus
Which way do you pull the auricle with adults?
up and back
Which way do you pull the auricle with children?
down and back
What information can you get from pneumatic otoscopy?
mobility of the tympanic membrane and the middle ear space
What is pneumatic otoscopy?
gentle puff of air that is sent through the head of the otoscope
What is a normal result when performing pneumatic otoscopy?
movement to positive and negative pressure and is noted by a change in the appearance of the cone of light
What is an abnormal result when performing pneumatic otoscopy and could be indicative of what?
no movement may indicate a perforation, or a sign of acute otitis media with or without effusion
What must you do when performing a pneumatic otoscopy?
a seal must be created between the otoscope speculum and the patient’s external auditory meatus
What does the tympanometer assess?
It is a reliable and objective way to assess the functioning of the ossicular chain, Eustachian tube, and tympanic membrane.
What does the tympanometer provide?
graphic presentation of the change in compliance of the middle ear system as air pressure is varied
What does the whisper test for?
used to test for significant hearing loss without using any tools
What is something simple you can do to differentiate between otitis externa from otitis media?
Palpate the tragus and pinna prior to insertion of otoscope for pain
How far away should you be standing behind the patient when performing the whisper test?
1-2 feet, and to the side of the patient of the ear you are testing
What does the patient do while you are performing a whisper test?
The patient places index finger in the ear canal that is not being tested and is continuously moving it throughout.
When performing the whisper test, what is the technique used to insure you are using a soft voice?
Exhale fully, THEN whisper
What are results of a normal whisper test?
the patient can correctly repeat the whispered letters/ numbers in both ears
What can lead to a false normal whisper test?
the patient did not properly occlude the other ear and they were able to hear out of both ears
What are results of a abnormal whisper test?
The patient is unable to correctly repeat all three numbers/letters. (Repeat in a medium or louder whisper if needed.)
What does the Weber test for?
lateralization
What tuning fork is used for the Weber test?
512 Hz
What does the Weber test assess?
Assesses hearing and differentiates between neurosensory and conductive hearing loss
How do you perform a Weber test?
Place vibrating fork in the middle of the patient’s vortex (top of the head), contacting the skull.
Ask patient where the sound is heard (both or particular ear)
What are results of a normal Weber test?
patient should be able to hear the sound equally in both ears
If the patient has an unilateral hearing loss, what ear will the patient hear the sound if the loss is neurosensory?
the sound is preferentially heard in the good ear
If the patient has an unilateral hearing loss, what ear will the patient hear the sound if the loss is conductive?
the sound is preferentially heard in the bad ear
bone bad block
When is the Weber test used?
It is only used in patients that are suspected of hearing loss
Can patients with normal hearing also lateralize?
yes (that’s why the Weber test should only be performed when a patient is suspected of hearing loss)
What does the Rinne test assess?
It assesses each individually to determine whether each ear detects sounds better through air or bone
The ear is better adapted to hear through air or bone?
air
When should the Rinne test be used?
used to determine origin of hearing loss and to distinguish between neurosensory hearing loss from conductive hearing loss
Which test is more accurate to distinguish between neurosensory from conductive hearing loss? Weber or Rinne.
Rinne is more accurate
What are the steps in conducting the Rinne test?
Bone conduction is tested by holding the stem of the vibrating tuning fork against the patient’s mastoid process, and ask the patient to tell you when they can no longer hear the sound. Be sure to note the time it takes.
Immediately move the tuning fork so that the vibrating tines are about 2.5 cm from the patient’s external auditory meatus, making the ‘U’ is facing the patient’s ear canal to maximize sound. Ask the patient to tell you when they no longer hear the sound. Note the time it takes.
Repeat in the other ear.
What are results of a normal Rinne test?
when the patient can hear the sound longer through the air than through bone.
It’s often twice as long
What are results of an abnormal Rinne test?
In conductive hearing loss, bone conduction will be heard longer in the affected ear.
In neurosensory hearing loss, air conduction will be heard longer than bone
In which order should the hearing tests be performed?
Whisper, Weber, Rinne
When is the Romberg test used for?
To test balance
What does the Romberg test evaluate?
It evaluates cerebellar function in conjunction with muscles involved in posture, proprioception, joint position, and visual input.
What can the Romberg test be indicative of?
Cerebellar dysfunction, vestibular dysfunction, or loss of position sense
Conductive loss is indicative of what?
external or middle ear disorder
What are causes of conductive loss?
Foreign body, otitis media, perforated eardrum, otosclerosis
Sensorineural loss is indicative of what?
inner ear disorder involving CN VIII
What are causes of sensorineural loss?
loud noise exposure, inner ear infections, trauma, acoustic neuroma, aging, familial disorders
In conductive loss, sound lateralize to which ear?
Sound lateralizes to the affected ear
In sensorimeural loss, sound lateralize to which ear?
Sound lateralizes to the good ear
