Ears Flashcards
Objective Data Preparation
- Position sitting up straight with head at eye level
- partially filled with cerumen
- If TM intact and no current infection present, a method of cleaning canal is to soften cerumen with a warmed solution of mineral oil and hydrogen peroxide
- Do not irrigate if history or examination suggests perforation or infection
Inspect and palpate external ear
Size and shape
Skin condition: same color as skin
Tenderness
External auditory meatus: serum has different color variation
-Darwin’s tubicle: normal genetic variation
Inspect with Otoscope: As you inspect external ear, note
size of auditory meatus
- Choose largest speculum that will fit comfortably in ear canal
- Tilt person’s head slightly away from you
- Pull pinna up and back on an adult to straighten S-shape of canal
- —Pull pinna down on an infant and a child under 3
- Hold pinna gently but firmly; do not release traction until removed otoscope
Insert speculum slowly and carefully along axis of canal
- Avoid touching inner “bony” section of canal wall covered by a thin epithelial layer because it is sensitive to pain
- Once in place, you may need to rotate otoscope
- Last, perform otoscopic examination before you test hearing
- —Canals with impacted cerumen give the erroneous impression of pathologic hearing loss
External Canal what should you note:
- Any redness and swelling, lesions, foreign bodies, or discharge
- If any discharge is present, note color and odor
Tympanic Membrane:
Color and characteristics: pearly white
Position: flat
Integrity of membrane
Anterior-Inferior position using scope = 5 o clock for right, 7 o clock for left
Test for Hearing Acuity:
- Screening for hearing deficit begins during history
- Whispered voice test
- Tuning fork tests
Whispered Voice Test:
- Test one ear at a time while masking hearing in other ear by placing one finger on tragus and rapidly pushing it in and out of auditory meatus
- Shield your lips so the person cannot compensate
- With your head 30 to 60 cm (1 to 2 ft) from person’s ear, exhale and whisper slowly some two-syllable words
- Normally, person repeats each word correctly after you say it
Tuning Fork Tests:
- Measure hearing air conduction (AC) or by bone conduction (BC), in which sound vibrates through cranial bones to the inner ear
- AC route through ear canal and middle ear usually the more sensitive route
- To activate tuning fork, hold it by stem and strike tines softly on back of your hand
- Should be able to hear air conduction twice as long than bone conduction
Vestibular Apparatus
Romberg test
Romberg test:
assesses ability of vestibular apparatus in inner ear to help maintain standing balance
Also assesses intactness of cerebellum and proprioception as it is part of the neurologic system
Aging Adult:
- May have pendulous earlobes with linear wrinkling because of loss of elasticity of pinna
- Coarse, wiry hairs may be present at opening of canal
- Eardrum normally may be whiter in color and more opaque, duller and thicker than in younger adult
- High-tone frequency loss apparent for those affected with presbycusis, hearing loss that occurs with aging
Summary Checklist: Ear Examination
-Inspect external ear
Size and shape of auricle, position and alignment on head
Note skin condition
Check auricle and tragus for tenderness
Evaluate external auditory meatus
-Otoscopic examination
External canal – redness or swelling
Cerumen discharge, foreign bodies or lesions
-Inspect tympanic membrane
Color, characteristics, position, and integrity
-Test hearing acuity
Abnormal Findings:Abnormalities of External Ear
Frostbite: reddish blue swollen, tender or necrotic
Otitis externa: “swimmer’s ear” - tissue swells internally, some discharge, alcohol drops or vinegar
Abnormal Findings:Lumps and Lesions on External Ear
Sebaceous cyst
Tophi: small white hard nodule - see persons w/ gout
Keloid
Carcinoma
