Assessing the Ears

External parts of the ear

Auricle, helix, fragus, lobule

Middle parts of the ear

Malleus, incus, stapes

Inner parts of the ear

Cochlea, semicircular canals

Cranial nerve VIII

Hearing and balance

Audiometric testing

Hearing evaluation to assess sensitivity of hearing at high and low frequencies

Tympanometry

Use of air pressure in the ear canal to test for disorders of the middle ear

Sequence of assessment

Inspecting the ears, palpating the ears, assessing hearing, assessing the internal ear

Inspecting the ears normal findings

Color same as face, equal size and shape bilaterally, normal size (4-10cm), symmetrical, no deformities, inflammation, nodules, or drainage, angle of attachement <10 degrees

Inspecting the ears abnormal findings

Color is blue, white, red, or pale; asymmetrical, lesions drainage, cauliflower ear

Cauliflower ear

Ear deformity caused by destruction of underlying cartilage of the outer ear

Palpating the ears normal findings

No tenderness, firm consistency

Palpating the ears abnormal findings

Swelling, tenderness, lumps, nodules

Conductive hearing loss

Sound is not conducted through outer ear canal to eardrum and ossicles

Sensorineural hearing loss

Occurs when there is drainage to the inner ear (cochlea) or nerve pathways from inner ear to the brain

Mixed hearing loss

Includes conductive and sensorineural hearing loss

Whisper test

Assesses for impaired or high-frequency of hearing

Normal whisper test

Pt reports at least 3 of 6 letters or numbers correctly

Abnormal whisper test

Pt repeats < 3 of 6 letters or numbers correctly or did not hear what you whispered

Weber test

Assesses unilateral hearing loss

Unilateral hearing loss

Hearing loss in one ear

Normal Weber test findings

Sound quality is heard equally in both ears

Abnormal Weber test findings

Sound will be perceived as louder in the good ear and softer in the bad ear (sensorineural hearing loss); sound will be perceived as louder in the bad ear (conductive hearing loss)

Rinne test

Assesses bone conduction vs air conduction

Normal Rinne test findings

Positive Rinne: air conduction is heard twice as long as bone conduction

Abnormal Rinne test findings

Negative Rinne: bone conduction is heard longer than air conduction

Otoscope

Instrument used for visual examination of the ear

Assessing ear using otoscope normal findings

External ear canal patent; no inflammation or drainage; small amount of pale yellow, moist ear wax; tympanic membrane intact, pearly gray color, translucent, contour slightly conical; bony landmarks visible, cone of light present 

Assessing ear using otoscope abnormal findings

Excessive ear wax, otitis externa, otitis media, serous otitis media, scarred tympanic membrane, perforated tympanic membrane

Otitis externa

Infection of the outer ear (ear canal)

Otitis media

Infection of the middle ear

Serous otitis media

Fluid buildup in the middle ear that can follow acute otitis media or caused by obstruction of the Eustachian tube

Perforated tympanic membrane

Ruptured tympanic membrane; a dark oval, hole will be present in the membrane

Tinnitus

Ringing or buzzing in the ears

Vertigo

Dizziness