Assessment

1. Health Assessment
Unit # 4-B
Assessment of Ears
Shahzad Bashir
MSN (DUHS), Post RN. BScN, DCHN, Dip. Card. RN.
Assistant Professor
Jinnah College of Nursing
March 14, 2022
In The Name of God
(A Project of S.M Sohail Trust)
Acknowledge:
Myung-Hee Pak, RN, MSN, CNS

2. Learning Objectives
• Identify the component of health history necessary for
the examination of eye & ear.
• Describe the following:
– Eye structure and position
– Upper and lower eyelids
– Gross visual perception
– Characteristics of the cornea, sclera, pupil, and lens fundi.
– Peripheral fields
– Color, shape, and location of auricle
– External ear canal and tympanic membrane
– Gross hearing
• Perform the examination of eye and ear.
• Document findings.
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3. Ear Anatomy
• Sensory organ of the body
• Used for hearing and maintaining
equilibrium
• Composed of 3 sections
– External ear
– Middle ear
– Internal ear
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4. Structure and Function
• External ear
– External auditory canal
– Tympanic membrane
• Middle ear
– Malleus (hammer), incus (anvil), and stapes (stirrup)
– Eustachian tube
• Inner ear
– Vestibule
– Vestibule and semicircular canals
– Cochlea
– Frequency range of 20–20,000 Hz
– Decibel range 0–140
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5. Conti….
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6. Cont…
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7. Conti….
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8. Structure and Function
(cont.)
• Hearing
–Levels of auditory system
–Peripheral
–Brainstem
–Cerebral cortex
• Pathways of hearing
–Air conduction
–Bone conduction
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9. Cont…
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10. Middle Ear Anatomy
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11. Inner Ear Anatomy
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12. Structure and Function
(cont.)
• Hearing loss
–Conductive
–Sensorineural (perceptive)
• Equilibrium
–Vertigo
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13. Structure and Function
(cont.)
• Developmental Care
– Infants and children
– The adult
– The aging adult
• Cross-cultural Care
– Otitis media
– Cerumen
– Hearing loss
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14. Equipment
• Otoscope
• Nasal speculum
• Penlight
• Tuning fork in 256 , 512 and 1024
Hz
• Tongue blade
• Watch
• Gauze square
• Cotton-tipped applicators
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15. Assessment of the Ears
• Subjective Data-
– Hx. Earaches
– Infections
– Discharge (otorrhea)
– Hearing loss
– Environmental noise
– Tinnitus
– Vertigo
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16. Assessment of the Ears
•Objective data:
•Inspect and palpate external ear:
•Note color, lesions, tenderness, discharge
•If S/S of ear infection, inspect unaffected ear
first to avoid transferring infected material.
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17. Inspect/Palpate EAR
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18. Otitis Externa
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19. Keloid scar
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20. Otoscopic Examination
1. Ask the client to sit comfortably with the back
straight and the head tilted slightly away from you
toward his or her opposite shoulder.
2. Choose the largest speculum that fits comfortably
into the client’s ear canal (usually 5 mm in the
adult) and attach it to the otoscope. Holding the
instrument in your dominant hand, turn the light
on the otoscope to “on.”
3. Use the thumb and fingers of your opposite hand
to grasp the client’s auricle firmly but gently. Pull
out, up, and back to straighten the external
auditory canal. Do not alter this positioning at any
time during the otoscope examination.
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21. Conti….
• 4. Grasp the handle of the otoscope between
your thumb and fingers and hold the
instrument up or down.
5. Position the hand holding the otoscope against
the client’s head or face. This position prevents
forceful insertion of the instrument and helps
to steady your hand throughout the
examination, which is especially helpful if the
client makes any unexpected movements.
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22. Conti….
6. Insert the speculum gently down and forward into
the ear canal (approximately 0.5 inch). As you
insert the otoscope, be careful not to touch either
side of the inner portion of the canal wall. This
area is bony and covered by a thin, sensitive layer
of epithelium. Any pressure will cause the client
pain.
7. Move your head in close to the otoscope and
position your eye to look through the lens.
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23. Otoscopic Examination
• Insert otoscope and examine ear canal noting:
redness, swelling, lesions, discharge or foreign
bodies
• Inspection of Tympanic Membrane normally TM
- Pearly gray, shiny, translucent
• Flat, slightly pulled in at center
• Skin intact, no redness/ discharge
• Canal- clear, no obstructions
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26. 7/18/2022 26

27. Objective Data—Physical Exam
(cont.)
• Otoscopic examination
– Position of head and ear
– Method of holding and inserting otoscope
– External canal
– Color
– Swelling
– Lesions
– Discharge
• Tympanic membrane
– Color and characteristics
– Position
– Integrity of membrane
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28. Objective Data—Physical Exam
(cont.)
• Test hearing acuity
– Conversational speech
– Whispered voice test
– Tuning fork tests
– Weber test
– Rinne test
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29. Objective Data—Physical Exam
(cont.)
• Vestibular apparatus
– Romberg test
• stand with feet together and arms at sides, close eyes
should hold position for 20 seconds without loosing
balance
– Developmental Care
– Infants and young children
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30. Ear Drum (light reflex)
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31. Light cone (Reflex) Tympanic membrane
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33. • Normal findings
–Tympanic membrane is pearly gray with
well-defined landmarks
–Light reflex present at 5 o’clock in right
ear and 7 o’clock in left ear
–Tympanic membrane moves when patient
blows against resistance
–No redness, swelling, tenderness, lesions,
drainage, foreign bodies
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34. Normal TM
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35. Otomycosis: Fungal Infection
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36. Cerumen obstructing TM
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37. Retraction of TM
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38. Perforated membrane
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39. Infection-red, bulging TM with Otitis
Media
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40. Hearing Loss
•Conductive
•Transmission of sound
waves through the external
& middle ear is referred to
as “Conductive Hearing”
•Mechanical dysfunction
of external /middle ear
•Examples include:
impacted Cerumen,
foreign body, pus or
perforated TM,
otosclerosis
•SENSORINEURAL
•Transmission of sound
waves in the inner ear is
referred to as
“Sensorineural hearing”.
•Pathology of inner ear,
CNVIII, temporal lobe of
brain
•Example: presbycus-
gradual nerve degeneration
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41. Pathways of Hearing
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42. Causes of Hearing Loss
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43. Hearing Acuity
•Without Audiometry, other tests are crude
measures.
•Whisper test:
•Test one ear at a time
•Press on tragus
•Whisper words from 1-2 ft. away
•Person should be able to repeat back the words
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44. Weber Test
•Weber test- valuable when person reports
hearing better with one ear.
•Strike tuning fork and place on midline of
skull
•Tone should be equally loud bilaterally
•Person should hear the tone by bone conduction
(BC)
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45. Conti…
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46. Conti…
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47. Conti…
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48. Rinne Test
• Strike and place tuning fork on mastoid process.
(Sound heard via bone conduction = BC)
• Instruct person to signal when sound stops.
• Quickly reposition fork in front of ear close to ear
canal (sound heard via air conduction = AC)
• Instruct person to signal when sound stops.
• Normally sound is heard twice as long by AC as by
BC.
• Recorded as AC > BC
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49. Conti….
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50. Sample Charting
•Subjective
– States hearing is good. No earaches,
infections, discharge, hearing loss, tinnitus or
vertigo
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51. Sample Charting
• Objective
– Pinna - skin intact with no masses, lesions,
tenderness, or discharge.
– Otoscope- external canals are clear with no
redness, swelling, lesions, foreign body, or
discharge. Both tympanic membranes are pearly
gray, with light reflex and landmarks intact, no
perforations.
– Hearing- whispered words heard bilaterally,
Weber test: tone heard midline without
lateralization. Rinne test: AC> BC and =
bilaterally.
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52. Sample Nursing Diagnoses
• Wellness Diagnoses
– Readiness for enhanced communication r/t use of hearing
aid AEB…
• Risk Diagnoses
– Risk for injury r/t hearing impairment
– Risk for loneliness r/t hearing loss
• Actual Diagnoses
– Disturbed Sensory Perception: Auditory r/t conductive or
sensorineural hearing loss AEB…
– Acute pain r/t infection of external or middle ear AEB….
– Impaired social interaction r/t inability to interact
effectively with others secondary to hearing loss AEB…..
– Disturbed body image r/t concern over appearance and
need to wear hearing aid AEB….
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53. Summary
• Assessment of the ear includes:
– Inspection & palpation of external ear
– Otoscopic exam including ear canal and tympanic
membrane
– Testing hearing acuity
– Sample documentation
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54. References
1. Bickley, L. S., Szilagyi, P. G., & Bates, B.
(2007). Bates' guide to physical examination
and history taking (11th Edi). Philadelphia:
Lippincott Williams & Wilkins. Chapter
No.06 & 07 p.n 171-250
2. Weber, Kelley's. (2007). Health Assessment
in Nursing, 3rd Ed: North American Edition.
Lippincott Williams & Wilkins. Chapter
No.14 &15 p.n 239-294
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