WEEK 11- EARS Flashcards
Describe what to assess for in the inspection & palpation of external ear.
inspection of external ear: size and shape
skin condition
tenderness
external auditory meatus
Describe the technique & rationale for otoscope examinations.
objective data
Otoscopic examination
Position of head & ear
Holding & inserting otoscope
External canal
Color
Swelling
Lesions or foreign bodies
Discharge
Tympanic membrane
Color & characteristics
Position
Integrity of membrane
Describe the features normally observed on the external canal.
the external auditory canal. The canal is a cul-de-sac
that is 2.5 to 3 cm long in adults and terminates at the eardrum, or
tympanic membrane. The canal is lined with glands that secrete
cerumen, a yellow waxy material that lubricates and protects the
ear.
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Identify developmental considerations over the lifespan.
The use of earbuds
With age people experience hearing loss
Osteosclerosis- 20-40 year olds
Conductive hearing loss – older adult
Presbycusis- loss of high frequency tones – sensorineural hearing loss
Identify health promotion strategies
- reduce loud music in earbuds
- industrial noise- proper safety
risk factors predispose children to acute otitis media: absence of
breastfeeding in the first 3 months of age, exposure to
secondhand tobacco smoke, daycare attendance, male sex,
pacifier use, low birth weight, low socioeconomic status, and
formula feeding in the supine position
Describe the Whisper Test assessment & its purpose.
Related to testing of CN VIII – Acoustic Vestibulocochlear Nerve
Conversational speech & audiometer
Whispered voice test
Test one ear at a time
Stand 30-60cm away- behind client
Ask client to press on tragus of other ear
Cover your mouth & whisper a 2-syllable word & ask client to repeat word
Repeat on the other ear
Identify equipment needed for physical examination & safe infection prevention & control practices.
Otoscope with bright light (fresh batteries give off white—not
yellow—light
Outline abnormal findings: frostbite
frostbite-Skin discoloration (pale, white, or bluish)
Numbness or tingling sensation in the affected area
Hardened or waxy skin texture
Swelling and blistering
Pain or burning sensation as the affected area thaws
Severe frostbite can lead to tissue damage, necrosis, and potential loss of the affected body part if not treated promptly.
otitis externa-
cellulitis-
keloid-
foreign body-
External Ear
External auditory canal
Lined with glands that secrete cerumen
Tympanic membrane/eardrum
Pearly grey colour
Middle Ear
Tiny air filled cavity inside temporal bone
Conducts sound vibrations
Eustachian tube –equalization of air pressure
Inner Ear
Cochlea
Central hearing apparatus
Auditory System
Hearing process
Sound waves
Vibrations produced on tympanic membrane
Travel to cochlea
Converted to electrical impulses
Conducted to brain by CN VIII (Acoustic/vestibulocochlear nerve)
Hearing loss- conductive
mechanical dysfunction
Hearing loss- sensorineural
pathology of inner ear, CNVIII, cerebral cortex
- presbycusis
gradual nerve loss that occurs from nerve degeneration
subjective data- ears
earaches
infections
discharge
hearing loss
environmental noise
tinnitus
vertigo
self care behaviors
eustachian tube
infant- horizontal eustachian tube
adult- sloped eustachian tube
Positioning of ear
adult- pull pinna up and back
young child- pull pinna down
air conduction vs bone conduction
Air conduction
pathway is from the external ear and bone conduction pathway is
within the internal ear through the uncoiled cochlea. T
Hearing an alarm
suppose you hear an alarm bell ringing. Its sound waves
travel instantly to your ears. The amplitude is how loud the alarm
is; its frequency is the pitch (in this case, high), or the number of
cycles per second. The sound waves produce vibrations on your
eardrum. These vibrations are carried by the middle ear ossicles to
the oval window. Then the sound waves travel through the cochlea,
which is coiled like a snail’s shell, and are dissipated against the
round window. Along the way, the basilar membrane vibrates at a
point specific to the frequency of the sound. In this case, the alarm’s
high frequency stimulates the basilar membrane at its base near the
stapes (Fig. 16.4). The numerous fibres along the basilar membrane
are the receptor hair cells of the organ of Corti, the sensory organ
of hearing. As the hair cells bend, they mediate the vibrations into
electric impulses. The electrical impulses are conducted by the
auditory portion of cranial nerve VIII to the brainstem.
conductive hearing loss
It is a partial loss because the person is
able to hear if the sound amplitude is increased enough to reach
normal nerve elements in the inner ear. Conductive hearing loss
may be caused by impacted cerumen, foreign bodies, a perforated
eardrum, pus or serum in the middle ear, or otosclerosis (a decrease
in mobility of the ossicles)
sensorineural hearing loss
A simple increase in amplitude may not
enable the person to understand words. Sensorineural hearing loss
may be caused by presbycusis, a gradual nerve degeneration that
occurs with aging, and by ototoxic medications, which affect the hair
cells in the cochlea. A mixed loss is a combination of conductive
and sensorineural types in the same ea
Inflamed labyrinth
If the labyrinth ever becomes inflamed, it feeds
the wrong information to the brain, creating a staggering gait and a
strong, spinning, whirling sensation called vertigo.
older adults
In older adults, the cilia lining the ear canal become coarse and stiff.
This may cause a decrease in hearing because it impedes sound
waves travelling toward the eardrum. It also causes cerumen to
accumulate and oxidize, which greatly reduces hearing. T
Presbycusis
However, presbycusis is a type of age-related hearing
loss that occurs even in people living in a quiet environment. It is a
gradual sensorineural loss caused by nerve degeneration in the
inner ear or auditory nerve
cerumen- dry- Asian
cerumen- wet- African and Euro-Canadian
Cerumen is genetically determined and comes in two major
types: (a) dry cerumen, which is grey, flaky, and frequently forms a
thin mass in the ear canal, and (b) wet cerumen, which is honey
brown to dark brown and moist. Among individuals of Asian or
Indigenous descent, the frequency of dry cerumen exceeds 80%,
whereas among individuals of African or Euro-Canadian descent,
the frequency of wet cerumen exceeds 97%.
full ear exam
Inspect external ear:
Size and shape of pinna
Position and alignment on head
Skin condition: colour, lumps, lesions
Movement of pinna and tragus (check for tenderness)
External auditory meatus: size, swelling, redness,
discharge, cerumen, lesions, foreign bodies
2. Perform otoscopic examination:
External canal
Cerumen, discharge, foreign bodies, lesions
Redness or swelling of canal wall
3. Inspect eardrum:
Colour and characteristics
Position (flat, bulging, retracted)
Integrity of membrane
4. Test hearing acuity:
Behavioural response to conversational speech
Voice test
5. Engage in teaching and health promotion
otitis externa
swimmers ear
Symptoms may include:
Ear pain (otalgia), which may worsen with movement of the outer ear
Itching or discomfort in the ear canal
Redness and swelling of the outer ear or ear canal
Drainage of pus or fluid from the ear
Decreased hearing or a sensation of fullness in the ear
Severe cases of otitis externa can lead to complications such as cellulitis or abscess formation.
cellulitis
Symptoms may include:
Redness, warmth, and swelling of the affected area
Pain or tenderness to touch
Fever and chills
Pus or drainage from the affected area
Enlarged and tender lymph nodes in the neck (if the infection spreads)
Cellulitis can spread rapidly and may lead to serious complications such as abscess formation, blood infection (sepsis), or tissue necrosis if not treated promptly with antibiotics.
keloid
Symptoms may include:
Raised, thickened, and firm scar tissue that extends beyond the boundaries of the original wound
Red or purple coloration of the scar
Itching, tenderness, or discomfort in the affected area
Restricted movement or function if the keloid is located near a joint or sensitive area
Keloids can be cosmetically bothersome and may cause psychological distress due to their appearance.
foreign body.
Symptoms may include:
Pain or discomfort in the ear
Feeling of fullness or blockage in the ear canal
Decreased hearing or ringing sensation (tinnitus)
Drainage or bleeding from the ear
The foreign body may be visible upon examination of the ear canal and may require removal by a healthcare professional to prevent complications such as infection or eardrum perforation.
