This document discusses assessing the ears. It outlines the structures and functions of the auditory system, including the external, middle, and inner ear. It describes performing a physical exam of the ears, including inspection of the auricles and outer canals, palpation for tenderness, and otoscopic examination of the tympanic membranes. It also explains how to perform the Weber test to assess bone conduction and the Rinne test to differentiate conductive and sensorineural hearing loss. Finally, it lists various diagnostic tests for evaluating aural structures, auditory function, and laboratory tests that can be used in assessing ear issues.

1. ASSESSMENT OF THE EARS
DEPARTMENT OF
MEDICAL SURGICAL NURSING

2. Learning objectives
• At the end of this lecturer, students should
be able to:
• know the structures and functions of the
auditory system
• discuss the assessment of the ear
• describe the physical assessment findings in
the healthy adult
• state the weber test and Rinne test .
• enlist the diagnostic tests.

3. STRUCTURES AND FUNCTIONS
OF THE AUDITORY SYSTEM
• External Ear
• Middle Ear
• Inner Ear

5. Transmission of Sound:
Sound waves are conducted by air
Picked up by the auricles , auditory canal.
The tympanic membrane is struck by
the sound waves, causing it to vibrate.

6. GLOSSARY
• Acute Otitis media: inflammation in the
middle ear of short duration.
• Cholesteatoma: benignin tumor of the
middle ear and or mastoid.
• Chronic otitis media: repeated episodes
of acute otitis media

7. • Dizziness: altered sensation of orientation
in space.
• Exostoses: small, hard, bony protrusion
in the lower posterior
• Labyrinthitis: inflammation of the labyrinth
of the inner ear.

8. Meniere’s disease: condition of the ear
characterized by a triad symptoms:
episodic vertigo, tinnitus and fluctuating
sensorineural hearing loss.
Middle ear effusion: fluid in the middle ear
without evidence of infection.

9. • Myringotomy (tympanotomy): incision in the
tympanic membrane.
• Ossiculoplasty: surgical reconstruction of the
middle ear bones to restore hearing.
• Otalgia: sensation of fullness or pain in the ear.
• Otitis external (external Otitis): inflammation of
the external auditory canal.

10. • Otorrhea: drainage from the ear.
• Otosclerosis: abnormal spongy bone
formation around the stapes.
• Tinnitus: unwanted noises in the head or ear.
• Tympnoplasty: surgical repair of tympanic
membrane.

11. ASSESSMENT OF THE EAR
Otologic history includes demographic data,
current clinical manifestations, past health
history, family health history, psychosocial
history, and review of systems.
childhood illnesses or abnormalities

12. PHYSICAL EXAMINATION
- Assessment of hearing acuity, balance,
equilibrium.
- External ear to assess abnormalities
- it is easy to identify anatomic landmarks
- The eardrum reveals important information
regarding the middle ear.

13. Physical Assessment Findings In The
Healthy Adult
Inspection: Auricles symmetrical, superior
portion level with outer canthus of eye.
Outer canals clear. Preauricular and postauricular
areas without swelling, masses, or lesions.
AC > BC, bilaterally. No lateralization.
Whisper heard at 3 feet.

14. • Palpation: Tenderness over tragus and
mastoid absent. No masses.
• Otoscopic Examination: Soft cerumen present in
canals. No discharge. TMs intact
• Cone of light at 4:00 in right ear
and at 7:00 in left ear. Landmarks visualized.

15. Inspection and Palpation
External Ear
• Ear Canal
- Direct Observation.
- Otoscopy
- Test for Auditory Acuity

16. Weber Test
Assess conduction of sound through bone.
Set the tuning fork into vibration
by striking the tines on your hand.
Place the rounded tip of the handle
on the center of the client's
forehead or nasal bone.

17. Cont…
-Placement on the teeth is reliable option.
- Does the client hear the tone
--in the center of the head,
-the right ear, or the left ear?
-Normally the sound is heard equally
-in both ears by bone conduction.

18. Rinne Test
-Compares air conduction to bone conduction
- Differentiate conductive from sensorineural hearing loss.
- Shift the vibrating tuning fork between
- two positions: first against the mastoid bone
- for bone conduction and then 2 inches
- from ear canal for air conduction.

19. DIAGNOSTIC TESTS
• Tests for Aural Structure
• Computed Tomography
• Magnetic Resonance Imaging
• Arteriography

20. Test for Auditory Function
• Audiometric Tests.
• Audiography.
• Tympanometry.
• Tests for Brain Stem Response.
• Electrocochleography
• Otoacoustic Emissions

21. Laboratory Tests
• Blood tests
• Cultures
• Tests for the Presence of Cerebrospinal Fluid
• Tissue Specimens

22. SUMMARY
So far, today we have discussed about:
• structures and functions of the auditory system
• assessment of the ear
• physical assessment findings
• weber test and Rinne test .
• diagnostic tests.

23. Bibliography
• Lewis et al, Medical Surgical Nursing, Mosby
Elsevier,7th edition.
• Joyce.M.Black et al, Medical Surgical
Nursing, Saunders publication.
• Brunner and Siddhartha, Medical Surgical
Nursing, Lippincott Williams and Wilkins.

24. THANK YOU