lecture 4 ear

EXAMINATION OF THE EAR

S. Y. SALIDGARDEN CITY UNIVERSITY

KUMASI

Cross Section of the Human Ear

Outer Ear Middle Ear Inner Ear

Pinna

Auditory Canal

Ear Drum

The external ear

Diagram Showing The Parts Of the Outer Ear

The middle and inner ear

EustachianTube

Ossicles

Cochlea

Semi-Circular Canal

Diagram Showing The Parts Of the Middle and Inner Ear

Equipment

• Examination gloves• Otoscope • Largest speculum that

will fit into the auditory canal

• Tuning fork (512 cps)

History

Find out the following from the patient:• Tinitus?• Diziness or vertigoe ?• Occupational noise exposure ?• Discharge from ear ?• Infections ? • Otalgia ?• Hearing problems-one or both ears, onset,

duration ?

History

• When was last hearing test? • What were the results? • Does hearing seem better in one ear than the

other?• If so, which ear is better?• Has any member family had ear problems or

hearing loss?

Physical Assessment

Inspections• TPR/BP• Skin of ear-colour, tone texture• Auricle-position and shape(normal height 4-10cm)• Auditory meatus-characteristics such as

erythema,s welling, narrowing, foreign body or discharge

• Ear position and alignment with eyes• Discharge-one or both ears, characteristics

Physical Assessment 2

Otoscopic Examination• Ear canal-colour, characteristics, cerumen• Evaluate serumen-black or brown cerumen

will be noted in dark skin clients, the colour of fresh cerumen is light yellow or pink, older cerumen is darker yellow.

• Tympanic membrane-colour, Intactness and land mark


Steps in using the autoscope• Use speculum that can be inserted into the ear

without causing any pain• Tilt the clients head away from you• Straighten the ear canal by pulling the auricles

upward by pulling the auricles downwards• Insert the speculum gently to minimise discomfort• Vary the angle as you insert to obtain a better

view of the tympanic membrane


Palpation• Palpate the Pinna, tragus, mastoid process for

-(tenderness, inflammation, masses)

Auditory function tests

• An impairment of auditory function may be apparent during he interview

• The precise measurement of hearing requires the use of an audiometer, however a good estimate of hearing during the physical examination can be made by using auditory function tests

Auditory function tests 2

HEARING/AUDITORY ACUITY1. Whisper test-• Ask client to occlude one ear by gently placing the

fingers against the opening of the auditory canal• Stand 30 to 60 cm (1 or 2 feet) away from clients

occluded ear• Stand behind client to prevent lip reading or let client

close the eyes if you prefer to stand in front• Softly whisper numbers the client is to repeat• Repeat for the other ear

Whisper test


2. Rennie test• This test measures air conduction versus bone

conduction• Air conduction is the transmission of sound

through the ear canal, tympanic membrane and ossicles to the cochlear and the auditory nerves

• Bone conduction is the transmission of sound from the skull bones to the cochlear and auditory nerves


• Procedure for Rinne Test• Strike the tunning fork in your palm• Place the base of the activated tunning fork on

the mastoid process until the client can longer hear the sound(bone conduction)

• Then move the fork close to the auditory meatus(air conduction)

• The client with no hearing loss will continue to hear the sound by air conduction


• The client who has no conductive hearing loss will hear sound twice as long by air conduction(AC) as by bone conduction(BC)

• This normal pattern is known as positive Rinne test

• A negative Rinne test occurs when client hears sound through bone conduction as long or longer than ear conduction

• This is a sign of conducting hearing loss


3. Weber test(sound lateralisation)• This test makes use of bone conduction Procedure• Place the base of activated tunning fork on the

vertex or the forehead• Ask client if the sound is clearer in one ear or

the other• In normal weber test, the client should ear

sound equally in both ears


• In lateralisation, sound is detected differently in each ear

• In conductive deafness sound is lateralised(head louder) in the deafer ear

• This situation occurs because extraneous sound in the environment will not disturb the cochlear on the weaker side

• In sensorineural hearing loss the sound lateralise to the better ear because the cochlear or auditory nerve is functioning more effective

• Ramber test-balance maintained?

Expected Findings

• Ears positioned on head with pinna at height of corner of eye.

• External ear: without exudate or lesions.• Ear canal: without cerumen, inflammation, or lesions. • Tympanic membrane: landmarks clearly visible, cone

of light visible, tympanic membrane intact.• Whisper test: accurate phrase identification.• Rinne test: air conduction is twice as long as bone

conduction.

Expected Findings Cont’d

• Weber test: sounds heard bilaterally equal. Romberg test: able to maintain balance.

• Palpate the auricle and push on the tragus -There should be no hard nodules, lesions, or

swelling. The tragus should be movable. Technique should be

not be painful.Palpate the mastoid process lying directly behind the ear -

• There should be no lesions, pain, or swelling.


• Inspect the auditory canal using the otoscope • The external canal should be open and without

tenderness, inflammation, lesions, growths, discharge, or foreign substances.

• Examine the tympanic membrane using the otoscope- • The membrane should be flat, gray, and translucent

with no scars.


• A cone-shaped reflection of the otoscope light should be visible at the five o'clock position in the right ear and the seven o'clock position in the left ear.


• The short process of the malleus should be seen as a shadow behind the tympanic membrane.

• The membrane should be intact.


• Using the otoscope, client performs the Valsalva maneuver • The tympanic membrane should flutter toward the otoscope

slightly as the client performs this maneuver.

Whisper test • The client should be able to repeat the phrases correctly.

• The Rinne test • For example, a normal finding is AC 30 seconds, BC 15

seconds.


• Weber test • The normal response is bilaterally equal

sound.• Romberg test • he client should be able to maintain this

position, although some mild swaying may occur.

Unexpected Findings

• External Ear • Flaking, abrasions, lesions, or erosions of external

ear skin may be due to skin cancer from sun exposure

• Nodules, calculi, or tophi on auricle rim.• Tenderness of external ear on palpation or

movement may to due to trauma or infection.• Redness, purulent drainage and inflammations may

be due to infections

Unexpected findings cont’d

• Foreign body present in external ear canal. • Low set ears or ears rotated more than 15

degrees may be associated with mental retardation

• Otoscopic Examination • Cerumen impaction in ear canal- can lead to

conductive hearing loss


• Reddened tympanic membrane with or without obliteration of landmarks- otitis media.

• Fluid or air bubble noted behind TM- serous otitis.

• Round oval or dark area in the TM-Rupture of TM.

• Blue or black TM- haemotympanum


• Hearing -Reported or evaluated hearing loss. Failed Weber Test.Balance -Failed Romberg Test.

Ottitis Media

lecture 4 ear

Documents