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EXAMINATION OF THE EAR

S. Y. SALID
GARDEN CITY UNIVERSITY
KUMASI

Cross Section of the Human


Ear
Outer Ear

Middle Ear Inner Ear

The external ear

Pinna
Ear Drum

Auditory
Canal
Diagram Showing The Parts Of the Outer Ear

The middle and inner ear


Ossicl
es

SemiCircular
Canal

Cochlea

Eustachia
n
Tube

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 410cm)
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

Physical Assessment 3

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

Physical Assessment 4
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


1.
.
.
.
.
.

HEARING/AUDITORY ACUITY
Whisper testAsk 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

Auditory function tests 3


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

Auditory function tests 4


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

Auditory function tests 5


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

Auditory function tests 6

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

Auditory function tests 7


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 Contd


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.

Expected Findings Contd


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.

Expected Findings Contd


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.

Expected Findings Contd


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

Expected Findings Contd


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.

Expected Findings Contd


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 contd


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

Unexpected findings contd


Reddened tympanic membrane with
or without obliteration of landmarksotitis media.
Fluid or air bubble noted behind TMserous otitis.
Round oval or dark area in the TMRupture of TM.
Blue or black TM- haemotympanum

Unexpected findings contd


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

Ottitis Media

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