Assessing Ears

Objective 1: Describe the functions and structures of the ears.

Slides 3–7

Main functions

The ears have two primary functions:

1. Hearing: Detection of sound.

2. Equilibrium: Balance.

The ear is divided into three distinct sections.

External ear

Auricle (pinna)

• Visible portion of the ear.

• Composed of cartilage.

External auditory canal

• S-shaped in adults.

• Outer portion curves upward and backward.

• Inner portion curves downward and forward.

• Contains modified sweat glands that secrete cerumen (earwax).

Middle ear (tympanic cavity)

Tympanic membrane

• Also called the eardrum.

• The lecture identifies the cone of light as a landmark.

Auditory ossicles

Three small bones:

• Malleus

• Incus

• Stapes

Eustachian tube

- Connects the middle ear to the nasopharynx.

Inner ear (labyrinth)

Contains:

• Cochlea

• Vestibule

• Semicircular canals

• Vestibular and cochlear nerve (cranial nerve VIII)

Types of hearing

Remember: Conductive = external/middle ear. Sensorineural = inner ear/CN VIII/Organ of Corti.

The lecture asks students to review the sound-vibration pathway to the acoustic nerve but does not spell out the complete sequence.

Objective 2: Discuss risk factors for hearing loss across cultures.

Slides 8–10, 19

Hearing loss overview

Hearing loss may be:

• Unilateral or bilateral

• Temporary or permanent

• Sudden or slow-developing

Hearing impairment can affect relationships, school or job performance, and safety.

Safety concerns include difficulty hearing alarms, responding to warnings, or following prescribed instructions.

Risk factors

Risk factors may be genetic or non-genetic.

Cultural variations and population considerations

• Ear size and shape vary.

• Earlobes may be free or attached.

• The lecture cites approximately 466 million people worldwide with disabling hearing loss.

• Approximately 34 million are children.

• Approximately 50% of cases are described as avoidable through primary prevention.

• About one-third of adults over age 65 are affected by disabling hearing loss.

These are the statistics reported in the lecture, not updated estimates.

Special populations

Newborns

• React to loud noises with the startle reflex.

• Auditory canal curves upward and is short and straight.

• All newborns should be screened for hearing loss before one month of age.

Children and adolescents

- Inner ear matures.

Older adults

- Presbycusis is identified as an older-adult hearing concern.

Nursing priority: Review strategies for reducing hearing-loss risks with clients.

Objective 3: Interview a client for an accurate nursing history of hearing and the ears.

Slides 11–12

During the interview, observe the client for signs of hearing loss.

History of present health concern

Ask:

• Have you experienced recent changes in hearing?

• Are you concerned about losing your ability to hear?

• Do you have ear drainage?

• Do you have ear pain?

• Do you experience ringing (tinnitus) or crackling?

• Do you experience spinning sensations?

• Do you feel dizzy or unbalanced?

Important: Use COLDSPA when assessing ear pain.

The lecture also references a hearing self-assessment tool. Answering yes to three or more questions may indicate a need for hearing evaluation.

Personal, family, and lifestyle history

Key takeaway: Ask about hearing changes, ear symptoms, past problems, noise exposure, and effects on daily life.

Objective 4: Perform a physical assessment of the ears and hearing ability.

Slides 13–18

The slide specifically emphasizes three assessments:

1. Inspection of the outer ear

2. Whisper test

3. Romberg test

Preparing the client

• Position the client comfortably in a seated position.

• Explain the tests before performing them.

• Observe the client's response during explanations.

Equipment mentioned includes a watch, tuning fork, and otoscope. The lecture indicates that tuning fork and otoscope examinations are not typically performed in acute care settings.

A. Inspection of the external ear

Inspect the:

• Auricle

• Tragus

• Lobule

Assess:

• Size

• Shape

• Position

• Lesions

• Discoloration

• Discharge

B. Otoscopic assessment

The lecture includes these assessment findings, although otoscopy is not a primary acute-care focus.

External auditory canal

• Earwax may normally be present.

• Note any other discharge.

Tympanic membrane

Assess:

• Color

• Shape

• Landmarks

C. Whisper test

Purpose: Assess hearing ability.

The lecture includes the whisper test as a required assessment and provides a normal documentation example:

- Client distinguishes two-syllable words from 2 feet away in both ears.

The slide asks how to perform the test but does not give a complete step-by-step procedure.

D. Romberg test

Purpose: Assess equilibrium.

Steps from slide 17

1. Have the client stand with feet together.

2. Position arms at the sides.

3. Have the client stand with eyes open.

4. Have the client close their eyes.

5. Maintain safety throughout the test.

Slide 18 includes a demonstration image of the client standing with feet together while the examiner remains beside them.

The normal documentation example identifies a negative Romberg.

Additional hearing tests

Objective 5: Differentiate between normal and abnormal findings of the ear and hearing.

Slides 19–22

Normal findings

The documentation example on slide 22 identifies:

• No erythema or swelling of the auricle, tragus, or earlobes.

• No tragus or mastoid tenderness.

• Scant brown cerumen in the external canals.

• Ear canals without redness, edema, or discharge.

• Ability to distinguish two-syllable whispered words from 2 feet bilaterally.

• Negative Romberg.

Abnormal external ear findings

Abnormal tympanic membrane findings

• Acute otitis media

• Serous otitis media

• Blue or dark red tympanic membrane

• Scarred tympanic membrane

• Perforated tympanic membrane

• Retracted tympanic membrane

The slides identify these abnormalities without providing detailed definitions or mechanisms for each.

Subjective findings requiring assessment

• Hearing loss or changes in hearing

• Ear pain

• Drainage

• Tinnitus

• Dizziness

• Vertigo

• Problems with balance

Objective 6: Analyze data from the ear/hearing interview and physical assessment to make clinical judgments.

Slides 22–23

The lecture identifies the following clinical judgment process:

1. Validate assessment findings.

2. Document findings.

3. Identify abnormal findings.

4. Make clinical judgments.

5. Determine the type of client concern.

Categories of client concerns

Documentation example from slide 22

Subjective findings: No ear redness, swelling, pain, hearing changes, bleeding, drainage, tinnitus, or vertigo.

Objective findings: No bilateral external ear swelling or redness, no tragus or mastoid tenderness, scant brown cerumen, clear canals without edema or discharge, whispered two-syllable words distinguished at 2 feet bilaterally, and negative Romberg.

Ears: Exam review