Assessment of Ears

Prepared by: Group 2 (Salcedo, Locanas, Buan)

Learning Outcomes

1. Functions and Structures of the Ears:
   • Discuss the functions and structures of the ears.
   • Understand auditory perception, equilibrium, and sound transmission.
2. Physical Assessment:
   • Perform ear and hearing assessments using correct techniques.
3. Normal vs Abnormal Findings:
   • Differentiate between normal and abnormal findings.
4. Data Analysis:
   • Analyze data to formulate nursing diagnosis, collaborative problems, and referrals.
5. Documentation and Reporting:
   • Document and report assessment findings accurately.

Functions of the Ears

• Sensory Organs: Responsible for hearing and equilibrium.
• Hearing (Auditory Perception):
  • Ability to perceive sounds.
  • Detects vibrations and pressure changes.
  • Relies on ears for transmission and interpretation.

Anatomy of the Ear

• External Anatomy: Collects sound vibrations.
• Internal Anatomy:
  • Eardrum vibrates from sound.
  • Vibrations move through auditory ossicles (malleus, incus, stapes).
  • Stapes vibrates the oval window, transmitting sound to the inner ear fluid.
  • Hair cells in the spiral organ of Corti stimulated, initiating nerve impulses.
  • Impulses travel via the acoustic nerve to the brain for interpretation.

Types of Hearing

• Conductive Hearing: Sound transmission through external and middle ear.
• Sensorineural Hearing: Sound transmission in the inner ear.

Bone and Air Conduction

• Air Conduction (AC): Transmits sound through ear canal.
• Bone Conduction (BC): Sound waves travel through skull bones.

Hearing Loss Types

• Conductive Hearing Loss: Issues in external or middle ear (e.g., earwax, otitis media).
• Sensorineural Hearing Loss: Problems in inner ear (e.g., Organ of Corti, cranial nerve VIII).

Importance of Hearing Assessment

• Begins during initial client interaction.
• Provides insight into environmental interaction capability.
• Early detection of gradual changes.

Subjective Data Collection

• Current Symptoms: Changes in hearing, ear discharge, ringing.
• Past History: Previous ear problems, surgeries, hearing aids.
• Family History: Genetic ear problems or hearing loss.
• Lifestyle: Exposure to loud noise, use of ear protection.

Purpose of Ear and Hearing Examination

• Evaluate external ear and ear canal condition.
• Assess tympanic membrane status and sound conduction.
• Test hearing acuity and equilibrium.

Assessment Methods

• External Ear & Canal Inspection: Visual inspection.
• Tuning Fork: Evaluate bone and air conduction.
• Otoscope: Assess tympanic membrane structures.

Preparing the Client

• Ensure comfortable seating.
• Explain procedures to ensure understanding.
• Address concerns to reduce anxiety.

Equipment Needed

• Watch with second hand (for Romberg test).
• Tuning fork (512 or 1,024 Hz).
• Otoscope.

Examination Procedures

• Inspection and Palpation:
  • Inspect auricle, tragus, lobule.
  • Note size, shape, and position.
• Cultural Considerations:
  • Differences in earlobe attachment across ethnicities.
• Older Adult Considerations:
  • Possible elongated, wrinkled earlobes.

Abnormal Findings

• Small or large ears, malalignment, microtia, macrotia, lymph node enlargement, tophi, blocked sebaceous glands.

Otoscope Examination

• Normal Findings: Small, odorless cerumen.
• Abnormal Findings: Foul-smelling discharge, impacted cerumen, foreign objects.

Tympanic Membrane Inspection

• Normal Findings: Pearly gray, shiny, translucent.
• Abnormal Findings: Red, bulging TM, white spots, perforations.

Hearing and Equilibrium Tests

• Whisper Test: Assess low pitch deficits.
• Weber Test: Evaluate bone conduction.
• Rinne Test: Compare air vs. bone conduction.
• Romberg Test: Assess equilibrium.

References

• Weber, J.R., & Kelley, J.H. (2022). Health Assessment in Nursing.
• DAmico, D., & Barbarito, C. (2019). Health & Physical Assessment in Nursing.