EAR ASSESSMENT

Inspect Auricle, Tragus, and Lobule

1. – Size, Shape, and Position

• Normal Findings:

• Ears are equal in size bilaterally (4–10 cm).

• Auricle aligns with the corner of each eye and within a 10-degree angle of vertical.

• Earlobes may be free, attached, or soldered.

• Deviations:

• Ears smaller than 4 cm or larger than 10 cm.

• Malaligned or low-set ears may indicate genitourinary disorders or chromosomal defects.

Inspect for Lesions, Discolorations, and Discharge

• Normal Findings:

• Skin is smooth, no lesions, lumps, or nodules.

• Color is consistent with face.

• Darwin’s tubercle may be present.

• No discharge should be present.

Enlarged lymph nodes

• (preauricular/postauricular): infection.

Tophi on helix/antihelix

• gout.

• Blocked sebaceous glands: postauricular cysts.

• Ulcerated/crusted nodules: skin cancer.

otitis externa.

Redness, swelling, scaling, itching

Palpate Auricle and Mastoid Process

• Normal Findings: Auricle, tragus, and mastoid process are not tender.

Otitis externa or postauricular cyst

Painful auricle/tragus

Mastoiditis

Tender mastoid

Otitis media

Tenderness behind ear

Inspect External Auditory Canal

• Small amount of odorless cerumen.

• Color: yellow, orange, red, brown, gray, or black.

• Consistency: soft, moist, dry, flaky, or hard.

Inspect Canal Walls and Nodules

Normal Findings:

• Pink, smooth canal walls.

• No nodules.

Deviations:

• Red, swollen canals: otitis externa.

• Exostoses: nonmalignant swellings.

• Polyps: may block view of eardrum.

Inspect Tympanic Membrane

Normal Findings:

• Pearly gray, shiny, translucent, slightly concave and intact.

• Cone of light:

• 5 o’clock in right ear.

• 7 o’clock in left ear.

• Visible landmarks: short process, handle of malleus, umbo.

Acute otitis media

Red, bulging membrane, absent light reflex

Serous otitis media

Yellowish, bulging with bubbles

Whisper Test

• Normal: Correctly repeats 3 out of 6 words.

• Deviation: Inability to repeat after 2 tries indicates hearing loss, needs audiologist referral.

Weber’s Test

Normal

• Sound heard equally in both ears (no lateralization).

Deviation:

• Conductive loss: Sound lateralized to poor ear.

• Sensorineural loss: Sound lateralized to good ear.

Rinne’s Test

• Procedure: Tuning fork on mastoid, then in front of auditory canal.

• Normal: Air conduction (AC) > Bone conduction (BC).

• Deviation: Conductive loss: BC ≥ AC.

Romberg Test

• Procedure: Stand with feet together, arms at sides, eyes open then closed.

• Normal: Maintains position for 20 seconds with no or minimal sway.

• Deviation: Moves feet or falls; may indicate vestibular disorder.