Ears Assessment

Question 1

Subjective Data

Health History Questions

EIDHETVS

Answer 1

Earaches
Infections
Discharge
Hearing loss
Exposure to environmental noise
Tinnitus- ringing, cracking or buzzing in ears
Vertigo- strong spinning, whirling sensation 
Self-care behaviours

Question 2

Objective Data

4 Steps

Answer 2

1. Inspect and palpate the external ear
   - Size & shape, skin condition, tenderness, external auditory meatus
2. Otoscope exam
   - External canal, tympanic membrane
3. Testing hearing acuity
   - Whispered voice test
4. Vestibular apparatus
   - Romberg test

Question 3

External Ear- inspect & palpate

4 parts SSTE

Answer 3

Shape and size
-Equal size bilaterally, no swelling/thickening

Skin condition

• Intact, no lumps or bumps
• Darwin’s tubercles- small painless nodule on helix

Tenderness
-Move pinna, push on tragus, palpate mastoid process

External auditory meatus
-Size, swelling, redness, discharge, cerumen

Question 4

Otoscope Exam

What is the head position for the exam

How are adults and children different

How do you hold the otoscope?

Avoid touching what?

Do this test before what?

Answer 4

Head position- tilt slightly away and toward opposite shoulder

Pinna

• Adults- pull up & back
• Children <3 years- pull down

Hold otoscope UPSIDE DOWN
-Hold back of your hand against the pt’s cheek

Avoid touching the canal walls

Do this BEFORE testing hearing

Question 5

Otoscope Exam

What do you look for within the External Canal

CSLDFC

Answer 5

Colour
Swelling
Lesions
Discharge
Foreign bodies
Cerumen

Question 6

Otoscope Exam

Tympanic Membrane

Looking for 4 things

Answer 6

Colour- shiny, translucent, pearly grey

Characteristics

• Light reflex: 5:00 in right ear, 7:00 in left ear
• Landmarks: malleus parts (umbo [middle axis of ear], manubrium [long line shaft thing/ a radius kind of], short process [bone at the end])

Position

• Flat, slightly pulled in at centre
• To assess eardrum mobility- Valsalva manoeuvre

Integrity- perforations

Question 7

Test Hearing Acuity

3 Tests

important to note that these are “crude” tests to document the presence of hearing loss. Audiometry is used to measure actual hearing loss.

Answer 7

Conversational speech
Assess during health history

Whispered Voice Test
-Test one ear at a time. Shield lips. With head 30-60 cm from pt’s ear whisper 2 syllable word (i.e. “baseball”). Ask pt to repeat it.

Tuning Fork Tests
-No longer considered reliable

Question 8

Vestibular Apparatus

What does this test look for and how do you do this test

What does a positive sign indicate

Answer 8

Tests the ability of the vestibular apparatus in the inner ear to help maintain balance

Have pt stand with feet together, arms at sides, with eyes closed for 20 seconds

Positive Romberg sign- loss of balance with eyes closed

Question 9

Development Considerations

Infants and Children 4

Answer 9

External auditory canal and Eustachian tube are shorter and more horizontal

Greater risk for middle ear infections

Pull auricle straight down to straighten out the canal for otoscope

Note external ear position and alignment

• Top of the pinna should be aligned with the corner of the eyes
• Low-set ears or deviation in alignment may indicate intellectual disability
• Normal alignment should be less then 10 degrees from the pinna to the curve of helix

Question 10

Development Considerations

Teens 2

Answer 10

Increased use of ear buds – future hearing loss

Recommend 60-60 rule

Question 11

Development Considerations

Adults
Otosclerosis

Answer 11

Otosclerosis- gradual hardening that causes the stapes to become fixed on the oval window

Common cause of conductive hearing loss in those 20-40 years

Question 12

Development Considerations

Older Adults
Physiologic changes
Presbycusis

Answer 12

Physiologic changes- impacted cerumen, sensorineural loss

Presbycusis- gradual nerve degeneration that occurs with aging

Recommendation for regular hearing testing (annually over age 65)

Question 13

Abnormal Findings

Otitis Media, its causes and S&S

Otitis Externa, its causes and S&S

Answer 13

Otitis Media- Inflammation of the middle ear and tympanic membrane

• Causes: obstruction of Eustachian tube, bottle feeding supine, bacterial, viral
• S&S: Red & bulging eardrum, pain, fever, hearing loss

Otitis Externa- inflammation of the outer ear and ear canal

• Causes: swimming
• S&S: Severe redness & swelling of canal, severe pain with movement of pinna & tragus scanty purulent discharge, fever