Chapter 15Review AnatomyReview FunctionsHearing LossDevelopmental ConsiderationsCultural ConsiderationsSubjective Data: Health HistoryPhysical ExamBegin with InspectionPalpation of the External EarObjective Data: Physical ExamOtoscopic ExamTest for Hearing AcuityWeber Test vs. Rinne TestWeber Test: Normal vs. AbnormalAbnormalitiesRinne Test: Normal vs. AbnormalSlide 18Assess BalanceSlide 20Risk Factors for Hearing LossDocumentationChecklist for Complete Ear ExamNormal vs. Abnormal: EarsNormal vs. Abnormal: HearingNsg 326 Clinical Ear AssessmentChapter 15Chapter 15EarsEarsReview AnatomyReview AnatomyExternal EarExternal EarInternal StructuresInternal StructuresReview FunctionsReview FunctionsHearingHearingHearing LossHearing LossConductiveConductiveMechanicalMechanicalSensorineuralSensorineuralPathology of inner ear, cranial nerve Pathology of inner ear, cranial nerve VIII or auditory areas of the cerebral VIII or auditory areas of the cerebral cortexcortexDevelopmental Developmental ConsiderationsConsiderationsInfants and childrenInfants and childrenAdultsAdultsOtosclerosisOtosclerosisAging AdultsAging AdultsCilial lining becomes coarse and roughCilial lining becomes coarse and roughAccumulation of cerumenAccumulation of cerumenPresbycusisPresbycusis↑ ↑ in auditory reaction timein auditory reaction timeCultural ConsiderationsCultural ConsiderationsOtitis mediaOtitis mediaIncreased in Native American, Increased in Native American, Alaskan and Canadian Inuits and Alaskan and Canadian Inuits and HispanicsHispanicsDry cerumenDry cerumenAsiansAsiansNative AmericansNative AmericansWet cerumenWet cerumenAfrican AmericansAfrican AmericansCaucasiansCaucasiansSubjective Data: Health Subjective Data: Health HistoryHistoryEaracheEaracheInfectionsInfectionsDischargeDischargeHearing lossHearing lossEnvironmental noiseEnvironmental noiseTinnitusTinnitusVertigoVertigoSelf-care behaviorsSelf-care behaviorsAdditional Hx for Additional Hx for Infants and Children:Infants and Children:Ear infections?Ear infections?Hearing well?Hearing well?Objects put in ears?Objects put in ears?Is child active in Is child active in sports?sports?Physical ExamPhysical ExamPreparationPreparationPositioningPositioningEquipmentEquipmentOtoscopeOtoscopeTuning forkTuning forkBegin with InspectionBegin with InspectionInspect the external earInspect the external earSize and shapeSize and shapeSkin conditionSkin conditionExternal auditory meatusExternal auditory meatusPalpation of the External Palpation of the External EarEarPinna Pinna TragusTragusMastoid processMastoid processTenderness?Tenderness?Objective Data: Physical Objective Data: Physical ExamExamInspect using the otoscope*Inspect using the otoscope*Adult: Pull the pinna Adult: Pull the pinna up and backup and backChild < 3: Pull pinna downChild < 3: Pull pinna down and backand back*Hold otoscope upside down*Hold otoscope upside downOtoscopic ExamOtoscopic ExamInspect external canalInspect external canalInspect tympanic membraneInspect tympanic membraneColor and characteristicsColor and characteristicsIntegrity of membraneIntegrity of membranePositionPositionTest for Hearing AcuityTest for Hearing AcuityVoice test or whisper testVoice test or whisper testTuning fork testsTuning fork testsWeber TestWeber TestRinne TestRinne TestWeber Test vs. Rinne TestWeber Test vs. Rinne TestRinne TestRinne TestWeber TestWeber TestWeber Test: Normal vs. Weber Test: Normal vs. AbnormalAbnormalNormalNormalR or L R or L lateralizationlateralizationConductive lossConductive lossSensorineural Sensorineural losslossPatient hears tone Patient hears tone equally well in both earsequally well in both earsPatient hears tone better Patient hears tone better in one earin one earPatient hears tone only Patient hears tone only in the impaired earin the impaired earPatient hears tone only Patient hears tone only in the unaffected earin the unaffected earAbnormalitiesAbnormalitiesWeber Test – conductive lossWeber Test – conductive lossWeber Test – sensorineural lossWeber Test – sensorineural lossRinne Test: Normal vs. Rinne Test: Normal vs. AbnormalAbnormalNormalNormalConductiveConductive losslossSensori-Sensori-neural lossneural lossPatient hears AC tone 2 X as Patient hears AC tone 2 X as long as he hears BC tonelong as he hears BC tonePatient hears BC tone as Patient hears BC tone as long as or longer than he long as or longer than he hears AC tonehears AC tonePatient hears AC tone longer Patient hears AC tone longer than he hears BC tonethan he hears BC toneAbnormalitiesAbnormalitiesRinne Test – conductive lossRinne Test – conductive lossRinne test – sensorineural lossRinne test – sensorineural lossAssess BalanceAssess BalanceAssess for maintaining standing balanceAssess for maintaining standing balanceRomberg Test*Romberg Test**May be tested during neurological assessment*May be tested during neurological assessmentAbnormalitiesAbnormalitiesBasal cell carcinoma on the external Basal cell carcinoma on the external earearRisk Factors for Hearing Risk Factors for Hearing LossLossNoise exposureNoise exposureSmokingSmokingOtotoxic drugsOtotoxic drugsCongenital or Congenital or heredityheredityCardiovascular Cardiovascular diseasediseaseMeniere’s disease Meniere’s disease (genetic)(genetic)BarotraumaBarotraumaAgingAgingTumorsTumorsTraumaTraumaChronic infectionChronic infectionSystemic diseaseSystemic diseaseTympanic Tympanic membrane membrane perforationperforationDocumentationDocumentationEarsEars: Acuity good to whispered voice. : Acuity good to whispered voice. Tympanic membranes with good cone of Tympanic membranes with good cone of light. Weber midline. AC > BC.light. Weber midline. AC > BC. ororEarsEars: Acuity diminished to whispered : Acuity diminished to whispered voice, intact to spoken voice. Tympanic voice, intact to spoken voice. Tympanic membranes clear.membranes clear.Checklist for Complete Checklist for Complete Ear ExamEar ExamInspectionInspectionExternal ear External ear External ear canalExternal ear canalPalpationPalpationExternal earExternal earOtoscopic examOtoscopic examExternal ear canalExternal ear canalTympanic membraneTympanic