Eyes and Ears (HA)

External anatomy of the eye

Internal anatomy of the eye

lacrimal apparatus

eye muscles + cranial nerves

CN 3- oculomotor

CN4- trochlear

CN 6- abducens

subject data - eye

• vision

• pain

• strabismus (eye misalignment)

• diplopia (double vision)

• redness

• swelling

• ptosis (droopy eyelids)

• watery discharge

• history of eye surgery or injury

• glaucoma (been tested? fam history?)

• corrective lens

Snellen eye chart

corneal light reflex testing

assess alignment of eyes by having patient look at a penlight. the light reflex should fall within the pupil bilaterally

Cover - uncover test

testinging peripheral vision

testing visual fields

confrontation test

inspect the conjunctiva and sclera

inspection of ocular structures

inspection of anterior eyeball

documenting PERRLA

far vision- pupils dilate

near vision- pupils constrict

• pupils are equal round and reactive to light and accommodation

developmental competence: aging adults

• pupil size decreases

• lens loses elasticity, becoming hard decreased ability to accommodate for near vision; called presbyopia (farsightedness)

• visual acuity may diminish gradually after age 40 and more so after age 70

• by age 70, lens begin to thicken and yellow the beginning of cataracts

cataracts- results from a clumping of proteins in lens

glaucoma- increased intraocular pressure most common type (loss of peripheral vision)

macular degeneration or break down of cells in macula- loss of central vision is most common cause of blindness

External ear

Internal ear

Rinne and Weber test

Equilibrium

• the semicircular canals in inner ear constantly feed information to brain about body’s position in space

• if canal becomes inflamed, it feeds wrong information to brain, creating a staggering gait and a strong spinning whirling sensation called vertigo

Otosclerosis

• common cause of conductive hearing loss in young adults between ages 20 and 40

• gradual hardening that causes stapes to become fixed, impeding transmission of sound and causing progressive deafness

presbycusis

age-related hearing loss, is the cumulative effect of aging on hearing by nerve degeneration

• usually occurs in 50s and slowly progresses

impacted cercum is a common but reversible cause of hearing loss in older people

• accumulated cerumen is drier with aging because of atrophy of apocrine glands (dying of sweat glands)

hearing loss

Hearing loss:

• anything obstructing transmission of sound impairs hearing

Conductive hearing loss:

• involves a mechanical dysfunction of external or middle ear

sensorineural hearing loss

• involves pathology of the inner ear, CN 8. Can be caused by prebycusis or ototoxic drugs

mixed hearing loss

• is combination of conductive and sensorineural types in same ear

Conductive vs. Sensorineural

subjective data- ear

• earaches

• infections

• discharge

• hearing loss

• environmental noise

• tinnitus- ringing in ears

• vertigo/ dizziness

physical exam

• external ear (inspect and palpate)

• otoscopic examination

• external canal

• tympanic membrane

adult: pull ear up and back

child 3 or younger: pull ear down and back

testing hearing acuity

• conversational speech (CN8, vestibulocochlear is or is not in tact)

• whispering voice test (CN8)

• tuning fork test

  • weber test

  • rinne test

Romberg Test

assesses ability of vestibular apparatus in inner ear to help maintain standing balance

• they need to keep their eyes closed for 20 sec

• put your arm in front and behind them so that they don’t fall (should not need assistance)