HA EARS Flashcards
INSPECT AND PALPATE THE EXTERNAL EAR
Structures of the ears that can be seen externally which includes pinna, helix, mastoid process and more.
SIZE AND SHAPE
Steps: Check the ears by looking on it
Considerations:
Ears of unusual size and shape might be a normal familial trait with no clinical significance
Normal Finding:
Ears are of EQUAL size BILATERALLY with NO SWELLING or THICKENING
Abnormal Finding:
1. Ears are smaller than 4 cm or longer than 10 cm
2. Misaligned or low set ears may be seen with genetic disorders or Chromosomal defects
SKIN CONDITION
Considerations:
DARWIN’S TUBERCLE, a small painless nodule at the helix. A congenital variation and is not significant
Normal Finding:
Skin color is consistent with the person’s facial skin color. The skin is intact, with no lumps or lesions
Abnormal Finding:
1. Enlarged preauricular and postauricular lymph nodes > INFECTION
2. Pale blue ear color > FROSTBITE
3. REDNESS, SWELLING, SCALING OR ITCHING > Otitis externa
TENDERNESS
Steps:
Move the Pinna and push on the tragus
Normal Finding:
They should feel firm and movement should produce no pain. Palpating the mastoid process should also produce no pain.
Abnormal Finding:
1. OTITIS MEDIA – tenderness behind the ear
2. MASTOIDITIS – Tenderness over the mastoid process
3. Painful auricle or Tragus – OTITIS EXTERNA, POSTAURICULAR CYST
THE EXTERNAL AUDITORY MEATUS
Steps:
Note the size of the opening in relation to the speculum to be used
Normal Finding:
No Swelling, Redness or Discharge should be present
Note: Cerumen = gray-yellow to light brown & Black
- From moist and waxy to dry and desiccated
Abnormal Finding:
A large amount of cerumen obscures visualization of the canal and drum
- OTITIS EXTERNA – foul smelling, sticky, yellow discharge
- PRESENCE OF FOREIGN BODIES such as bugs, plants and etc.
- CONDUCTIVE HEARING LOSS – impacted cerumen blocking the view of the external ear canal
NOTES WHEN USING THE OTOSCOPE
- Choose the largest speculum that will fit comfortably in the ear canal
- Adult – Pull the pinna up and back
- Child (Infant or under 3 years old) – Pull the pinna down
- It is important to perform the otoscopic examination before you test hearing
THE EXTERNAL EAR
Steps:
Note any redness and swelling, lesions, foreign bodies or discharge. If any discharge is present, note the color and odor. Clean any discharge from the speculum
Normal Finding:
No redness and swelling, lesions, foreign bodies or discharge.
Abnormal Finding:
1. OTITIS EXTERNA – reddened swollen canals
2. EXOSTOSES – nonmalignant nodular swellings
3. POLYPS – May block the view of ear drum
THE TYMPANIC MEMBRANE
- COLOR AND CHARACTERISTICS
- POSITION
- INTEGRITY OF MEMBRANE
THE TYMPANIC MEMBRANE -
A. COLOR AND CHARACTERISTICS
Normal Finding:
External eardrum is shiny and translucent with a pearly-gray color. Sections of the malleus are visible: UMBO, MANUBRIUM, SHORT PROCESS.
- Annulus looks whiter and denser
Abnormal Finding:
1. ACUTE OTITIS MEDIA – Red bulging eardrum and distorted
2. SEROUS OTITIS MEDIA – Yellowish bulging membrane with bubbles behind
3. POLYPS -Blocking the eardrum
THE TYMPANIC MEMBRANE -
B. POSITION
Normal Finding:
Eardrum is flat, slightly pulled in at the center and flutters when the person performs the VALSALVA MAANEUVER or holds the nose and swallow (Insufflation)
Abnormal Finding:
OTITIS MEDIA – The membrane does not move or flutter when the bulb is inflated
THE TYMPANIC MEMBRANE -
C. INTEGRITY OF MEMBRANE
Steps:
Inspect the eardrum and the entire circumference of the annulus for perforation
Normal Finding:
Tympanic membrane is intact
Abnormal Finding:
1. OTITIS MEDIA
TEST HEARING ACUITY
AUDIOMETER - gives a precise quantitative measure of hearing by assessing the person’s ability to hear sounds of varying frequency.
ABNORMAL FINDINGS:
1. MODERATE HEARING LOSS = 41 to 55 Decibels
2. MODERATE TO SEVERE HEARING LOSS = 56 to 70 Decibels
3. SEVERE HEARING LOSS = 71 to 90 Decibels
4. PROFOUND HEARING LOSS = 91 to 100 Decibels
VOICE TEST
Steps:
Placing one finger on the tragus and rapidly pushing it in and out of the auditory meatus
1. Shield lips
2. 30 to 60 cm, Whisper slowly two-syllable words
Normal Finding:
Normally the person hears and repeats each word correctly after you say it
Abnormal Finding:
Unable to repeat two syllable words after two tries which might indicate hearing loss.
TUNING FORK TESTS
Measure hearing by air conduction or bony conduction
ABNORMAL FINDING: Cannot hear sound or vibrations on either of the two conductions
WEBER TEST
Steps:
When a person report hearing better with one ear than the other.
Place a vibrating tuning fork in the midline of the person’s skull and ask if the tone sounds are the same in both ears or better in one.
Normal Finding:
Should hear the tone by bone conduction through the skull, and it should sound equally loud in both ears.
Abnormal Finding:
1. CONDUCTIVE HEARING LOSS – Lateralization of sound to the poor ear
2. SENSORINEURAL HEARING LOSS – Lateralization of sound to the good ear
RINNE TEST
Steps:
Compares air conduction and bone conduction sound
Place the stem of the vibrating tuning fork on the person’s mastoid process and ask him or her to signal when the sound goes away. Quickly invert the fork so the vibrating end near the ear canal; The person should still hear a sound.
Normal Finding:
AC > BC
Abnormal Finding:
1. With CONDUCTIVE HEARING LOSS,
BC > AC
2. With SENSORINEURAL HEARING LOSS,
AC > BC
- Damage to inner ear (cochlea)
- Most common type of permanent hearing loss
Causes: OTOTOXIC DRUGS, AGING, HEAD TRAUMA, MALFORMATION OF THE INNER EAR, and LOUD NOISE EXPOSURE.
VESTIBULAR APPARATUS
ROMBERG TEST
Steps:
Assess the ability of the vestibular apparatus in maintaining standing balance
Normal Finding:
CAN MAINTAIN BALANCE
Abnormal Finding:
Client moves feet apart to prevent falls or starts to fall from loss of balance
