Unit 5A.6: EARS Assessment | Eyes, Ears, Nose & Sinuses, Mouth & Pharynx, Neck

1. Size, shape, and position of the auricle, tragus, and lobule

2. Lesions, discolorations, and discharge of the auricle, tragus, and lobule

3. External auditory canal

4. Color and consistency of the ear canal walls and inspect character of nodules

5. Whisper test

6. Watch tick test

7. Weber’s test

8. Rinne test

8 Steps of the Ears Assessment

1. Size, shape, and position of the auricle, tragus, and lobule

First Step of the Ears Assessment

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

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

• Earlobes either free, attached, or soldered

Normal Finding for 1. Size, shape, and position of the auricle, tragus, and lobule

Soldered

Identify the earlobe shape.

Attached

Identify the earlobe shape.

Free

Identify the earlobe shape.

Malaligned or low-set ears (may indicate chromosomal defects, like down syndrome)

Abnormal Finding for 1. Size, shape, and position of the auricle, tragus, and lobule

Low Set Ears

May indicate down syndrome

Lower pinna than lateral canthus

2. Lesions, discolorations, and discharge of the auricle, tragus, and lobule

Second Step for Ear Assessment

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

• Color is consistent with facial color

• Darwin’s tubercle

• No discharge

Normal findings for 2. Lesions, discolorations, and discharge of the auricle, tragus, and lobule

Darwin’s Tubercle

Normal findings for 2. Lesions, discolorations, and discharge of the auricle, tragus, and lobule

• Clinically insignificant projection that may be seen on the auricle

1. Enlarged Preauricular & Postauricular Lymph Nodes

2. Tophi

3. Postauricular Cysts

4. Ulcerated, crusted nodules

5. Otitis Externa

6. Frostbite

Abnormal Findings for 2. Lesions, discolorations, and discharge of the auricle, tragus, and lobule

Enlarged Preauricular & Postauricular Lymph Nodes

Abnormal Findings for 2. Lesions, discolorations, and discharge of the auricle, tragus, and lobule

• Indicate infection

Tophi

Abnormal Findings for 2. Lesions, discolorations, and discharge of the auricle, tragus, and lobule

• Nontender, hard, cream-colored nodules on the helix or antihelix, containing uric acid crystals

• Indicate gout

• Deposits‬‭ of‬ monosodium‬ urate‬ in ‬‭crystal‬ ‭form

Postauricular Cysts

Abnormal Findings for 2. Lesions, discolorations, and discharge of the auricle, tragus, and lobule

• Rare, ‬‭unilateral‬ ‭asymptomatic,‬ ‭extracranial‬ ‭swellings ‬‭that‬ ‭are ‬‭associated‬ with ‬‭a ‬‭delay‬‭ in‬ seeking ‬‭medical ‭intervention,‬‭ due‬ ‭to‬‭ blocked‬ sebaceous‬‭ gland ‭behind the ear‬

• Blocked sebaceous glands

Malignant Lesions

• Mass or lump of abnormal cells

• Some ear tumors are cancerous

Ulcerated, crusted nodules

Abnormal Findings for 2. Lesions, discolorations, and discharge of the auricle, tragus, and lobule

• Bleed

• Skin cancer

• Most often seen on helix due to skin exposure

Otitis Externa

Abnormal Findings for 2. Lesions, discolorations, and discharge of the auricle, tragus, and lobule

• “Swimmer’s Ear”

• Redness, pain, swelling, scaling, or itching, conductive hearing loss due to swelling

• Usually‬ ‭caused‬‭ by‬ ‭pseudomonas‬ ‭bacteria

Frostbite

Abnormal Findings for 2. Lesions, discolorations, and discharge of the auricle, tragus, and lobule

• Pale blue ear color

3. External auditory canal

Third Step of Ears Assessment

1. Pull out, up, and back the patient’s auricle

How to assess 3. External auditory canal?

• Small amount of odorless cerumen (earwax)

• Cerumen may be yellow, orange, red, brown, gray or black. Consistency soft, moist, dry, flaky, or even hard

Normal Finding for 3. External auditory canal

1. Foul-smellling, sticky, yellow discharge

2. Bloody, purulent discharge

3. Blood or watery drainage

4. Impacted cerumen blocking external ear canal

5. Foreign Bodies

Abnormal Finding for 3. External auditory canal

Foul-smelling, sticky, yellow discharge

Abnormal Finding for 3. External auditory canal

• Caused by Otitis Externa or Impacted Foreign Body

Bloody, purulent discharge

Abnormal Finding for 3. External auditory canal

• Otitis Media with Ruptured Tympanic Membrane

Blood or watery drainage (CSF)

Abnormal Finding for 3. External auditory canal

• Skull trauma

Impacted cerumen blocking view of external ear canal

Abnormal Finding for 3. External auditory canal

• Conductive hearing loss

Foreign Body Occlusion

Abnormal Finding for 3. External auditory canal

• Presence of bugs, plants, food, et for prompt removal due to possible swelling and infection

• Button-type batteries need urgent medical attention as leaking chemicals can burn and damage the ear canal

Cerumen Impaction

• Accumulation of wax in the ear canal which can affect the flow of sound to the tympanic membrane

• Excessive cerumen can cause problems with hearing and balance

4. Color and consistency of the ear canal walls and inspect character of nodules

Fourth Step of Ear Assessment

Canal walls pink and smooth, without nodules

Normal findings for 4. Color and consistency of the ear canal walls and inspect character of nodules

1. Otitis Externa

2. Nonmalignant Nodular Swellings

3. Polyps

Abnormal findings for 4. Color and consistency of the ear canal walls and inspect character of nodules

Otitis Externa

Abnormal findings for 4. Color and consistency of the ear canal walls and inspect character of nodules

• Reddened, swollen canals

Exostoses

Abnormal findings for 4. Color and consistency of the ear canal walls and inspect character of nodules

• Benign,‬‭ bony‬ ‭growths ‬‭covered‬ ‭by‬‭ skin

• Often ‬‭seen‬ ‭in‬‭ those ‬‭who‬ ‭have ‬‭been‬ ‭repeatedly‬ exposed‬‭ to ‬‭cold‬ water ‬‭(i.e.‬ swimmers)

Polyps

Abnormal findings for 4. Color and consistency of the ear canal walls and inspect character of nodules

• May block the view of the eardrum

Microtia

• Congenital deformity wherein the pinna is either small, abnormally shaped, or absent

• Can occur on just one side or on both

Aural Atresia

• Malformation ‬‭of‬ the ‬‭external ‬‭ear‬ canal

• Usually on ‬‭just‬ one ‬‭side‬‭ and‬‭ can ‬‭be ‬‭a‬ complete ‬‭or‬ partial‬ closure.‬

• Extent ‬‭of ‬‭the‬ ‭closure‬‭ directly‬ affects ‬‭that‬ person’s‬ conductive‬ hearing loss.‬

1. Acute Otitis Media

2. Serous Otitis Media

3. Chronic Otitis Media

Abnormalities of the Tympanic Membrane

Acute Otitis Media

Abnormality of the Tympanic Membrane

‭Bacteria ‬‭or‬‭ viral ‬‭infection ‬‭of‬‭ the‬‭ middle‬ ear,‬‭ usually ‬‭accompanying ‬‭an ‬‭upper‬ ‭respiratory infection.‬

Serous Otitis Media

Abnormality of the Tympanic Membrane

• ___ ___ with effusion

• Fluid in the ear, middle ear effusion (MEE), or secretory otitis media

• Fluid resides in the middle ear

Chronic Otitis Media

Abnormality of the Tympanic Membrane

• Describes a variety of signs, symptoms, physical findings that result from the long-term damage to the middle ear by infection and inflammation

• Includes:

  • Severe ‬‭retraction ‬‭or‬ ‭perforation ‬‭of‬‭ the‬‭ eardrum ‬‭(a‬

    ‭hole in the eardrum)‬

  • ‭Scarring ‬‭or ‬‭erosion ‬‭of ‬‭the‬ ‭small, ‬‭sound ‬‭conducting‬ ‭bones of the middle ear‬

  • ‭Chronic‬‭ or ‬‭recurring ‬‭drainage‬ ‭from the ear‬

  • ‭Inflammation‬‭ causing ‬‭erosion‬ ‭of ‬‭the ‬‭bony‬‭ cover‬‭ or ‬‭the ‬‭facial‬ ‭nerve,‬‭ balance‬‭ canals, ‬‭or‬ ‭cochlea (hearing organ)‬

  • ‭Erosion‬‭ of‬‭ the ‬‭bony ‬‭borders ‬‭of‬ ‭the ‬‭middle ‬‭ear ‬‭or‬‭ mastoid,‬ ‭resulting‬‭ infection‬‭ spreading‬ ‭the‬‭ meninges‬‭ (the‬‭ coverings‬ ‭of the brain) or brain‬

  • Presence of cholesteatoma‬

  • ‭Persistence ‬‭of‬‭ fluid‬‭ behind ‬‭an‬ ‭intact eardrum‬

Tympanic Membrane Perforation

• When there is a tear in the tympanic membrane leading to a connection between the external auditory canal and the middle ear

5. Whisper Test

Fifth Step of Ear Assessment

1. Ask client to rub tragus of opposite ear then occlude it.

2. Stand 2 feet behind the client

3. Whisper a two-syllable word

4. Ask client to repeat.

5. Needs to repeat 3-6 words to pass the test

How does 5. Whisper Test work?

Able to correctly repeat at least 3-6 two syllable words at two feet distance whispered

Normal Finding for 5. Whisper Test

Unable to repeat two-syllable word after two tries indicates hearing loss

Abnormal Finding for 5. Whisper Test

6. Watch Tick Test

Sixth Step of the Ear Assessment

1. Hold ticking watch approximately 5 in away from one of the client’s ears.

2. Ask client to cover opposite ear.

3. Slowly move watch closer after every inch not hear

How does the 6. Watch Tick Test work?

Reports hearing watch tick within 5 inches from the ear

Normal Finding for 6. Watch Tick Test

1. Conductive Hearing Loss

2. Sensorineural Hearing Loss

Abnormal Findings for 6. Watch Tick Test

Conductive Hearing Loss

Abnormal Findings for 6. Watch Tick Test

• Sound is heard better in one ear than the other, or there is a significant reduction in hearing ability

• May indicate conditions affecting the outer or middle ear, like earwax impaction, middle ear infections, or otosclerosis

Sensorineural Hearing Loss

Abnormal Findings for 6. Watch Tick Test

• Client is unable to hear the ticking sound at all or hears it less clearly in one ear

• May indicate damage to the inner ear or auditory nerve commonly seen in presbycusis

7. Weber’s Test

Seventh Step for Ear Assessment

Conduction of sound waves through bone to help distinguish between conductive hearing and sensorineural hearing

What does 7. Weber’s Test help evaluate?

1. Strike tuning fork and place it at the center of the client’s head

2. Ask client if they hear the sound better or same in the ears

How to conduct 7. Weber’s Test?

Vibrations heard equally well in both ears; no lateralization of sound to either ear

Normal Findings for 7. Weber’s Test

1. Conductive Hearing Loss

2. Sensorineural Hearing Loss

Abnormal Findings for 7. Weber’s Test

Conductive Hearing Loss

Abnormal Findings for 7. Weber’s Test

• Lateralization of sound to the poor ear, “hearing” the sounds in the poor ear

• Good ear is distracted by background noise and conducted air, which the poor ear has trouble hearing

Sensorineural Hearing Loss

Abnormal Findings for 7. Weber’s Test

• Lateralization of sound to the good ear

• Limited perception of the sound due to nerve damage in the bad ear, making sound seem louder in the unaffected ear

8. Rinne Test

Eighth Step of Ears Assessment

Air and Bone conduction sounds

What does 8. Rinne Test compare?

Air conduction sound is normally heard longer than bone conduction sound (AC > BC).

Normal Finding for 8. Rinne Test

Sensorineural Hearing Loss

Abnormal finding for 8. Rinne Test

• Air conduction sound is heard longer than bone conduction sound (AC>BC) if anything is heard at all

• Occurs with damage to the inner ear or to the nerve pathays between the inner ear and brain

• Most common type of permanent hearing loss