objective 10

Question 1

Has a characteristic shape - funnels sound waves into the external
auditory canal
Consists of moveable cartilage and skin
* Ends at the tympanic membrane
* Lined with glands that secrete cerumen (yellow, waxy material)
* Cerumen forms a sticky barrier that helps keep foreign
bodies from entering the ear and reaching the tympanic
membrane
* Cerumen moves out to the meatus by the movements of
chewing and talking

Answer 1

external ear

Question 2

outer third of the canal

Answer 2

cartilage

Question 3

inner two thirds

Answer 3

bone covered by thin sensitive skin

Question 4

Separates the external ear and the middle ear
* Oval, slightly concave, and is slightly pulled in the center by the
malleus

Answer 4

tympanic membrane

Question 5

what are the 3 parts of the malleus

Answer 5

umbo
manubrium
short process

Question 6

small, slack superior section of the tympanic membrane

Answer 6

pars flaccida

Question 7

remainder of the tympanic membrane which is thicker and
more taunt

Answer 7

pars tensa

Question 8

outer fibrous rim

Answer 8

annulus

Question 9

tiny air-filled cavity inside the
temporal bone
* Contains auditory ossicles: malleus, incus,
stapes
* Has several openings:
* Outer ear
* Inner ear
* Eustachian tube

Answer 9

middle ear

Question 10

covered by tympanic membrane

Answer 10

outer ear

Question 11

oval window and the round window

Answer 11

inner ear

Question 12

connects the middle ear to the nasopharynx; allows the passage of air

Answer 12

eustachian tube

Question 13

what are the 3 functions of the middle ear?

Answer 13

Conducts sound vibrations -conducts them from the outer ear
to the central hearing apparatus in the inner ear
* Protects the inner ear - reduces the amplitude of sound
* Eustachian tube allows equalization of air pressure on each
side of the eardrum - prevents rupture of the membrane

Question 14

Embedded in bone, contains the Bony Labyrinth:
* Vestibule and semicircular canals:
* Cochlea:
* is not accessible to direct examination, however
the functions of the inner ear can be assessed.

Answer 14

inner ear

Question 15

holds the sensory organs for equilibrium and hearing

Answer 15

bony labyrinth

Question 16

constitute the vestibular apparatus

Answer 16

vestibule and semicircular canals

Question 17

contains central hearing apparatus

Answer 17

cochlea

Question 18

what are the 3 divisions of the auditory system?

Answer 18

peripheral
brain stem
cerebral cortex

Question 19

ear transmits sound, converts vibrations into
electrical impulses which are analyzed by the brain

Answer 19

peripheral

Question 20

Binaural interaction – allows a person to locate the
direction of a sound and identify the sound

Answer 20

brain stem

Question 21

Interprets the meaning of the sound and
begins the immediate response

Answer 21

cerebral cortex

Question 22

what are the pathways of hearing

Answer 22

Air Conduction (normal pathway)
* Bone Conduction (alternative route)

Question 23

what are the types of hearing loss?

Answer 23

Transmission of sound is obstructed and impairs hearing
* Conductive hearing loss (p. 361)
* Sensorineural hearing loss: (p. 361)
* Mixed loss: (p. 362)

Question 24

This type of hearing loss is due to a
mechanical dysfunction of the external ear or middle ear

Answer 24

conductive hearing loss

Question 25

This type of hearing loss indicates
pathology of the inner ear, cranial nerve VIII, or the auditory areas of
the cerebral cortex

Answer 25

sensorineural hearing loss

Question 26

This type of hearing loss is a combination of
conductive and sensorineural hearing loss in the same ear

Answer 26

mixed hearing loss

Question 27

impacted cerumen, foreign bodies, perforated eardrum,
pus or serum in the middle ear, otosclerosis

Answer 27

conductive

Question 28

presbycusis, ototoxic medications

Answer 28

sensorineural

Question 29

Labyrinth sends information to the brain about the
position of the body.
* If the labyrinth becomes inflamed, the wrong
information is sent to the brain.
* This causes the person to have a staggering gate and
vertigo (strong spinning, whirling sensation)

Answer 29

equilibrium

Question 30

what is the structure of an infants ear?

Answer 30

Inner ear begins to develop at 5th week of gestation
* If the mother develops a rubella infection in the first
trimester - can cause damage to the organ of corti and
impair hearing of the infant
* Infant’s Eustachian tube is relatively shorter, wider, and has
a more horizontal position than an adult’s
* Infant’s lumen easily occluded by lymphoid tissue that
surrounds it
* Increased risk of middle ear infections due to differences
in Eustachian tube and easily occluded lumen
* In infants and young children, the external auditory canal is
shorter and has an opposite slope (in comparison to an adults)

Question 31

what is the structure of an elder adults ear?

Answer 31

Cilia lining the ear canal becomes coarse and still
* Cerumen is drier - due to atrophy of the apocrine glands
* Eardrum: may appear whiter, more opaque, and duller; repeated ear
infections may have resulted in scarring on the eardrum
* Hearing loss: Impacted cerumen & exposure to noise pollution over years
can be causes
* Persons affected by presbycusis usually have a loss of hearing involving
high-tone frequencies
* May have pendulous earlobes with linear wrinkling
* Due to loss of elasticity of the pinna

Question 32

how do we prep to assess an ear?

Answer 32

Position the client - sitting up straight with head at
examiner’s eye level.
* Check the ear canal for cerumen:
* If present and partially filling the ear canal, further
intervention will be needed. Cerumen will obstruct your
view of the eardrum

Question 33

what equipment do we need for an ear exam?

Answer 33

Otoscope with a bright light
* Pneumatic bulb attachment (used sometimes with
infants/young children)

Question 34

what are the normal size and shape for the ear?

Answer 34

ears equal in size bilaterally; no
swelling; no thickening

Question 35

what are the abnormal findings for the size and shape of the ear?

Answer 35

Microtia -ears smaller than 4 cm
vertically.
* Macrotia -ears larger than 10 cm
vertically.
* Edema - swelling

Question 36

what are the normal findings of the skin of the ear?

Answer 36

skin colour consistent with client’s facial skin; skin
intact with no lumps or lesions

Question 37

what are the abnormal skin findings of the ear?

Answer 37

Reddened, warm skin - inflammation
* Crusts and scaling - otitis externa eczema, contact
dermatitis
* Red-blue discolouration - frostbite

Question 38

what are the normal findings when checking the ear for tenderness?

Answer 38

feels firm and movement does not cause pain

Question 39

what are the abnormal findings when assessing the ear for tenderness?

Answer 39

pain with movement (occurs with otitis media)

Question 40

how do we assess the auditory meatus and what is normal?

Answer 40

Assess the size of the opening
* No redness, swelling or discharge should be noted
* Cerumen is often present
* Colour and texture will vary
* Colour: gray-yellow to light brown and black
* Texture: moist and waxy to dry and desiccated
* Presence in larger amounts will obscure assessment of the
canal and eardrum

Question 41

how do we inspect with the otoscope?

Answer 41

Assess the external canal for redness, lesions, foreign bodies, or
discharge.
* Chose the appropriate size speculum for the ear canal.
* Tilt client’s head slightly away from examiner toward the opposite
shoulder
* Pull the pinna up and back (older children and adults)
Hold the pinna gently but firmly – do not release traction until the
examination is finished and the otoscope is removed.
* The examiner holds the otoscope upside down along their
fingers.
* The dorsa of the examiner’s hand should be along the client’s
cheek to brace the otoscope.
* Insert the speculum slowly and carefully along axis of the canal.
* Avoid touching inner bony section of the canal wall
* The examiner will watch the insertion and then put their eye up
to otoscope.
* Position the otoscope to view the tympanic membrane.

Question 42

what are the normal findings of the eardrum?

Answer 42

shiny, translucent,
pearly gray colour, cone shaped light
reflex is prominent in the
anteroinferior quadrant (right
eardrum - 5:00 position; left eardrum
- 7:00 position)
Eardrum is flat; slightly pulled at the center
tympanic membrane intact

Question 43

what are the abnormal findings of the eardrum?

Answer 43

yellow-amber
eardrum discolouration, redness,
swelling, absence or distortion of
landmarks
retracted eardrum, bulging eardrum, perforation

Question 44

what is the whispered voice test?

Answer 44

Test one ear at a time
* Mask sound in the ear not being tested
* Place finger on the tragus and push in and out
* The examiner stands 2 feet behind the client
* The examiner exhales fully, and slowly whispers a set of three random
numbers and letters such as “4 D 9”
* Findings:
* Normal: client repeats each number/letter correctly when said.
* If not, repeat the test using different letters/numbers.
* Passing score: correct repetition of at least 3/6 possible numbers or
letters
* Abnormal: Inability to hear whispered words

Question 45

what is the romberg test?

Answer 45

Used to assess the ability of the
vestibular apparatus to help maintain
standing balance.
* This test is also used as part of the
neurological system assessment and
will be discussed in that system
* Description of the test [p. 717]