Ears Assessment

external ear

External auditory canal

Tympanic membrane

middle ear

Malleus, incus, and stapes (ossicles)

Eustachian tube

inner ear

Vestibule and semicircular

canals

Cochlea

Auditory nerve

Vestibulocochlear nerve

Equilibirum

levels of auditory system

Peripheral

Brainstem

Cerebral cortex

pathways of hearing

Air conduction

Bone conduction

hearing loss

Conductive

Sensorineural

(perceptive)

equilibirum

vertigo

common/ concerning symptoms

Hearing loss

Earaches

Discharge

Tinnitus

Vertigo

hearing loss?

conductive versus sensorineural

earaches?

Frequency, sharp, dull

Otitis externa, otitis media, mastoiditis, auricular infection

discharge?

ear wax, pus, smell

tinnitus?

which ear, frequency, other symptoms

vertigo?

clarify patient’s def/ understanding

past medical history

Congenital hearing loss

Removal of cerumen

“Swimmer’s ear”

Ear surgery

Trauma/injury to the ear(s)

Infection

Exposure to hazardous noise levels/environmental noise

History of disease

family history

Hearing loss

Allergies

Smoking or exposure to cigarette smoke

additional history for infants and children

• Ear infections

• Hearing loss-consider verbal milestones

• Trauma

lifestyle habits

Occupation/hobbies/activities

Use of listening devices

Use of loud tools

Home location near a noisy area

Use of ear plugs/ear protection

Use of hearing aids

Medication and/or drug use that interfere with hearing or cause

dizziness

Hearing Checks?

preparation

position, cleaning of ear canal

equipment

otoscope

steps of ear assessment

inspection, palpation

inspect and palpate of external ear

• Size and shape

• Skin condition

• Tenderness

• External auditory meatus

pinna (auricle)

Inspect tissues for deformities, lumps, or skin lesions.

Ear pain, discharge, inflammation

Movement of pinna and tragus painful in otitis externa

Tenderness behind ear may be present with otitis media

external canal examination

Color

Swelling

Lesions

Discharge

tympanic membrane examination

Color and characteristics

Position

Integrity of membrane

landmarks

Cone of light

Umbo

Handle of malleus

abnormal findings of tympanic membrane

Retracted drum

Otitis media with effusion (OME)

Acute (purulent) otitis media

Perforation

Insertion of tympanostomy tubes

test hearing acuity

cranial nerve VII

whispered test

Test one ear at a time

Occlude non-test ear, slightly

rub tragus in a circular motion

Cover your mouth and

whisper 2 two-syllable words

Do not let patient read your

lips

Ask them to repeat what they

hear

infants and children

shorter & wider eustachian tube

Modified approach to the exam

adult

otosclerosis age 20-40 years

aging adult

coarse stiff cilia, increased cerumen,

presbycusis, slower auditory reaction time

health screening

Important to catch hearing deficits early

Early Hearing Detection and Intervention (EHDI) program

Language development delay

Increased potential for hearing loss due to overexposure to

high levels of noise (work, play, home)

Use appropriate ear protective devices

Limit overexposure to high levels of noise

Presbycusis

> 50 years 20% to 40%

> 80 years 80%

> 50 years presbycusis

20-40%

> 80 years presbycusis

80%