Health assessment on the ear examination

1. HEALTH ASSESSMENT
THE EAR EXAMINATION
PREPARED BY:
USHA RANI KANDULA,
ASSISTANT PROFESSOR,
DEPARTMENT OF ADULT HEALTH NURSING,
ARSI UNIVERSITY, ASELLA, ETHIOPIA,
EAST AFRICA.

2. THE EARS AND HEARING
The ears are involved in both hearing and
equilibrium.
The external ear collects and conveys sound
waves to the middle ear.

3. It protects the middle ear from environmental
factors such as
 Humidity
Temperature
 Prevents entry of foreign matter.

4. THE MIDDLE EAR
The middle ear contains
The tympanic membrane and cavity,
The eustachian tube,
And the ossicles.

5. The small bones of the middle ear:
Malleus,
Incus,
Stapes.

6. The middle ear conducts sound waves to the
inner ear.
The inner ear is responsible for hearing and
equilibrium.

7. -Nurses are usually responsible only for screening the ears
and making referrals.
However, in some settings nurses perform advanced
assessments.

8. EXAMINING THE EXTERNAL AND
MIDDLE EAR
On inspection, the ears should
be of equal size and similar appearance.
Normally the pinna is level with the corner of
the eye and within a 10° angle of vertical position.

9. EAR POSITION

10. Altered placement of the ear may be a sign of
Hearing deficit or
Genetic disorders, including down syndrome.

11. There should be no lesions or drainage.
Bloody drainage may result from trauma.
Purulent drainage may be seen with
infection.

12. On palpation,
 The external structures of the ear are smooth,
Nontender, and without nodules.

13. A painful auricle may be associated with otitis externa
(an outer ear infection),
whereas tenderness behind the ear is seen with otitis
media (a middle ear infection).

14. OTO SCOPIC EXAMINATION
Otoscopic Examination
As you begin the otoscopic examination,
you may notice that the external auditory canal
contains cerumen (wax),
which protects the middle ear from excessive drying.

15. OTO SCOPE

16. it should not completely obstruct the ear canal.
Cerumen may be black, dark red, yellowish, or
brown in color and waxy, soft, or hard, with no odor;
all are normal variations.

19. -Be careful as you manipulate the otoscope, because the
inner two-thirds of the canal can be tender with the pressure
and manipulation of the otoscope head.

20. Normally the tympanic membrane (TM) is pearly gray,
shiny, and translucent.
The structures of the middle ear should be visible
through the membrane.

21. Changes in its appearance arise from abnormalities
such as otitis media.
(which causes a red, bulging TM-temparo mandible)

22. The presence of pressure equalization
tubes in young clients with chronic ear
infections.

23. ASSESSMENT OF HEARING
To assess hearing,
you will need a quiet room and a tuning fork.
Gross hearing ability includes the ability to hear both
high- and low-pitched tones.

24. TUNING FORK

25. -A client who hears low tones will be able to hear and
repeat words whispered from 1 to 2 feet behind him.

26. -The client can hear high tones if he is able to hear
a watch ticking at 5 inches (12 to 13 cm) from each
ear.

27. THE WEBER AND RINNE TESTS
Hearing involves transmission of sound vibrations and
generation of nerve impulses along CN VIII.
The Weber test assesses both aspects.

28. When you place a vibrating tuning fork on the center
of the client’s head,
he should be able to sense the vibration equally in
both ears.
Record a positive Weber test if the vibration is louder
in one ear.

29. -If the Weber test is positive,
you will need to perform the Rinne test to assess
the type of hearing problem.

30. THE RINNE TEST
The Rinne test also uses a tuning fork to compare
air conduction (AC) and bone conduction (BC).
Normally AC is twice as long as BC.

31. THE ROMBERG TEST
-Along with the cerebellum and midbrain,
vestibular cells in the ear are responsible for
maintaining equilibrium.

32. To assess equilibrium, perform the Romberg test.
The client should be able to stand with feet
together and eyes closed, and maintain balance
with minimal swaying.

33. -Swaying and moving (positive Romberg) may
indicate a vestibular or cerebellar disorder.

34. -You may prefer to perform the Romberg test
with examination of the neurological system
instead of with the ears.

35. THANKING YOU