Health Assessment: Ears

Three Distinct Parts of the Ear

external ear
middle ear
inner ear

Separates External Ear from Middle Ear

tympanic membrane

Parts of Ear that can be Assessed by Direct Inspection and Otoscope

external ear and tympanic membrane

Parts of the Ear Assessed by Testing Hearing Acuity and Conduction of Sound

middle and inner ear

External Ear - Parts of

Auricle or pinna;
External auditory canal;
Modified sweat glands (cerumen);
tympanic membrane

Middle Ear

AKA tympanic cavity;
small, air-filled chamber in temporal bone;
separated from external ear by eardrum and from inner ear by bony partition containing two openings (round and oval windows)

Middle Ear - Parts of

� Tympanic cavity
� Windows
- round
- oval
� Auditory ossicles: (transmit sound waves from
eardrum to inner ear thru oval window)
- malleus
- incus
- stapes

Eustachian Tube

connects middle ear to nasopharynx

Inner Ear (AKA labyrinth)

Fluid filled & made up of:
� bony labryinth
� inner membranous labyrinth
� inner cochlear duct

Inner Ear:parts of bony labyrinth

1. vestibule
2. semicircular canals
3. cochlea

Inner Cochlear Duct - Contains What?

spiral organ of Corti, the sensory organ for hearing

Sensory Receptors

located in vestibule and membranous semicircular canals (inner ear) sense position and head movements;
help maintain static and dynamic equilibrium

Vestibular Nerve

connects with cochlear nerve to form Cranial Nerve VIII (acoustic or vestibulocochlear nerve)

Conductive Hearing

transmission of sound waves thru external and middle ear

Sensorineural Hearing

transmission of sound waves in inner ear;
AKA "perceptive hearing

Cerumen

wax-like substance that keeps tympanic membrane soft;
secreted from modified sweat glands in the external ear canal;
has bacteriostatic properties, and its sticky consistency serves as defense against foreign bodies

Tympanic Membrane

AKA eardrum;
translucent, pearly gray appearance;
serves as partition stretched across inner end of auditory canal, separating if from middle ear;
membrane is concave and located at end of auditory canal in tilted position (top of membrane is closer to au

Distinct Landmarks of Tympanic Membrane

- handle and short process of malleus (nearest auditory ossicle)
- umbo (base of malleus; also serves as center point landmark)
- cone of light (reflection of otoscope light seen as a cone)
- pars flaccida (top of membrane; appears less taut than bottom)

Otoscope

flashlight-type viewer used to visualize eardrum and external ear canal;
speculum = part that enters ear canal;
body = contains light source

Hearing Loss - Risk Factors

- age (>65 years)
- loud noises (decibel levels >85)
- heredity
- otitis media (esp. chronic/untreated)
- some medications (gentamicin, chemo drugs, tinnitus or loss w/ high dose aspirin/NSAIDs, antimalarials, and loop diuretics)
- child of mother who con

Otitis Media - Risk Factors

- age (highest rate 6-18 mos. old, but occurs 4 mos. to 4 years; rarely in adults)
- group child care
- poor air quality (tobacco smoke/air pollution)
- family history
- race/ethnic group (American Indian or Eskimo)

Rinne Test

compares air and bone conduction sounds;
strike a tuning fork and place base of fork on client's mastoid process; ask client to tell you when sound is no longer heard; move prongs of tuning fork to front of external auditory canal; ask client to tell you

Romberg Test

tests client's equilibrium;
ask client to stand w/ feet together and arms at sides and eyes open and then w/ eyes closed: normal finding if client maintains position for 20 seconds without swaying or w/ minimal swaying

Presbycusis

gradual sensoneural hearing loss due to degeneration of cochlea or vestibulocochlear nerve;
common in older clients (> age 50);
clients have difficulty hearing consonants and whispered words (difficulty increases over time)

Weber's Test

helps evaluate conduction of wave sounds thru bone to help distinguish between conductive hearing (sound waves transmitted by external and middle ear) and sensorineural hearing (sound waves transmitted by inner ear);
strike tuning fork softly w/ back of y

Type of Earwax in most Europeans and Africans

wet

Type of Earwax in most Asians and Native Americans

dry (w/ transition in southern Asia)

Inner Ear

- inner ear innervation: acoustic or vestibulochochlear nerve (Cranial VIII)
- hearing pathways: sound vibrates thru air; collected and funneled thru external ear

Auditory system has three levels

Hearing:
Auditory system has 3 levels:
1. peripheral
2. brainstem
3. cerebral cortex
Pathways of hearing:
A. air conduction
B. bone conduction

Hearing Loss

CONDUCTIVE:
mechanical dysfunction (e.g. cerumen, toy, bug, perforated TM or otosclerosis - decreased mobility of ear bones (ossicles)
SENSORINEURAL (perceptive):
nerve (Cranial Nerve VIII), cerebral cortex (e.g. presbycusis/gradual nerve degeneration)

Aging Changes

- cilia coarser; cerumen drier
- otosclerosis (adults): hardening of stapes bone = loss of sound transmission
- infants/young children have short/horizontal external canal, which increases chance of otitis media

Weber Test - Types of Hearing Loss

Conductive Hearing Loss:
client hears w/ POORER ear via bone conduction.
Bone conduction sound is heard longer than or equally as long as air conduction. (BC>=AC)
Sensorineural Hearing Loss:
Client reports lateralization of sound to the good ear due to ne

Weber Test - Findings of Sensorineural Loss

client hears better w/ ear that does not have nerve dysfunction

Hearing Acuity - Testing

- conversational speech
- voice test
- tuning fork tests (Weber, Rinne)

Hearing Acuity - Vestibular Apparatus

- Romberg test (loss of vestibular function)
- client stands w/ eyes closed
- swaying is positive
- may also be indicative of neurological dysfunction

Objective Data - Physical Exam of Tympanic Membrane

color and characteristics
position
integrity of membrane

Position of Ear for Examination - Adult

pinna up and back

Position of Ear for Examination - Child

pinna down and back

Objective Data - Physical Exam of External Ear

inspect and palpate:
size and shape
skin condition
tenderness
external auditory meatus

Objective Data - Physical Exam w/ Otoscope

position head and ear
method of holding and inserting otoscope
external canal: color, swelling

Objective Data - Physical Exam

preparation: position, cleaning ear canal
equipment needed: otoscope w/ bright light, pneumatic bulb attachment, tuning forks in 512 and 1024 Hz

Subjective Data - Health History Questions

earaches
infections
discharge
hearing loss
environmental noise
tinnitus
vertigo
self-care behaviors

Air pressure equalized on both sides of tympanic membrane via

eustachian tube

Video A&P or the Ear

http://www.youtube.com/watch?v=QwTXmaaiGMw

external auditory meatus (external acoustic meatus) is AKA

ear canal

Location of auricle or pinna

External Ear

Location of external auditory canal

External Ear

Location of modified sweat glands (cerumen)

External Ear

Location of tympanic membrane

External Ear

Middle Ear AKA

tympanic cavity

Small, air-filled chamber in temporal bone

Middle Ear

Round and oval windows are found in

Middle Ear

Function of auditory ossicles

transmit sound waves from
eardrum to inner ear thru oval window

What makes up the auditory ossicles

- malleus
- incus
- stapes

Bony labryinth & inner membranous labyrinth are found in the

Inner Ear

Inner Ear is also known as

labyrinth

Inner cochlear duct is found in

Inner ear

Vestibule is part of

bony labyrinth of inner ear

Semicircular canals is part of

bony labyrinth of inner ear

Cochlea is part of

bony labyrinth of inner earspiral organ of Corti

Function of spiral organ of Corti

sensory organ for hearing

Sensory Receptors are located in

vestibule of inner ear

Umbo is located at the

Tympanic membrane near base of malleus

Pars flaccida is located at the

Top of tympanic membrane (less taut than bottom)

Pars tensais located at the

bottom of membrane (appears taut)

Speculum

Part of otoscope that enters the ear

High dose aspirin/NSAIDs and antimalarials can cause

hearing loss

child of mother who contracted rubella while pregnant

can have hearing loss

American Indian or Eskimo have greater increase for

Otitis Media

Group child care can be a risk factor for

Otitis Media

Loss of vestibular function is assessed via

Romberg Test

Otosclerosis in adults

hardening of stapes bone

Degeneration of cochlea or vestibulocochlear nerve can result

Presbycusis (gradual sensoneural hearing loss >50)

Clients have difficulty hearing consonants and whispered words is commonly associated with

Presbycusis (gradual sensoneural hearing loss >50)

Sudden decrease in ability to hear in one ear may be due to

otis media

Client reporting sudden hearing loss should be

referred to a physician

Inability to hear high-frequency sounds may be due to

presbycusis

Draining from ear (otorrhea) may indicate

infection

{Purulent, bloody drainage suggest

infection of external ear (external otitis)

Purulent drainage w/pain & popping sensation is characterized by

otitis media with perforation of the tympanic membrane.

Earache (otalgia) can occur with

ear infection, cerumen blockage, sinus infections, or teeth & gum problems.

Tinnitus can be caused by e

excessive wax, HTN

Vertigo can be caused by

inner ear problem

subjective vertigo

when feeling that room is spinning around you

objective vertigo

when feeling that you are spinning around room

Repeated infections can affect

tympanic membrane

Swimmer's ear

infection of the ear canal

Yearly hearing tests recommended for

those exposed to laud noises for long periods

Cotton-tipped applicators( Q-Tips)

can cause ear wax to become impacted and cause ear damage.

Ears smaller than 4 cm or larger than 10 cm is

abnormal

Abnormal: Maligned or low-set ears may be seen with genitourinary disorders or

chromosomal defects

Tophi (non-tender, hard cream-colored nodule on helix or antihelix

gout (due to uric acid crystals)

Ulcerated, crusted nodules that bleed (mostly on helix) are a sign of

skin cancer

Redness, swelling, scaling, or itching is a sign of

otitis externa

Painful auricle or tragus is associated with

otitis externa or postauricular cyst

Tenderness over the mostoid process suggests

mastoiditis

Tenderness behind the ear may occur with

otitis media

Foul smelling, stick, yellow discharge is associated with

otitis externa or impacted foreign body

bood or watery drainage can be a sign of

skull trauma

Red, bulging eardrum and distorted with deminished or absent light reflex

acute otits media

Yellow, bulging tympanic membrane with bubbles behind is most likely

serous otitis media

White spots on tympanic membrane

scarring from infections

Client feet are together with eyes closed and he moves feet apart to prevent fall or starts to fall from loss of balance. This indicates a

vestibular disorder

Problem with vestibular apparatus may indicate

neurological problem

Tympanic membrane of left ear reveals

cone of light at 7 o'clock position

Tympanic membrane of right ear reveals

cone of light at 5 o'clock position

Damage to the spiral organ of Corti leads to

sensorineural hearing loss

sensorineural hearing loss occurs in when damage is located in the

inner ear

Measeles is a considered

a risk factor for hearing loss

Older clients' eardrums may appear

cloudy as a normal part of aging with prominent landmarks due to atrophy of the tympanic membrane

Prominent landmarks when examining the clients tympanic membrane can be a sign of

obstructed Eustachian tubes

What test should be performed when a client has difficulty a hearing conversation due to background noise or background conversations

Weber

What test should be performed if a client has vertigo

Romberg test

Inability to hear whisper sounds indicates

presbycusis (hearing loss)

Clinically insignificant projection on the auricle

Darwin's tubercle

High tone frequency loss of an elderly client is considered

a normal part of aging

Ototoxic med such as antibiotics can result in

tinnitus