Ears By InnaKorda, MD, Institute of Nursing, TSMU Slide 2 Ear
Anatomy Slide 3 Ear Physiology External Ear External auditory
meatus funnels sound waves, which reflect off the tympanic membrane
to produce vibrations Cerumen (ear wax) protects the tympanic
membrane from foreign substances Middle ear Malleus, incus, and
stapes and eustachian tube Function to: Conduct sound vibrations
from tympanic membrane (outer ear) to cochlea (inner ear) Protect
the cochlea by reducing the amplitude of sounds Eustachian tube
allows equalization of air pressure Inner ear Vestibule and
semicircular canals Allow brain to sense body position and relation
of angle of head to gravity Cochlea Transfers vibrations from
stapes into nerve impulses Slide 4 The outer ear catches the waves
of sound and funnels them down the ear canal (about an inch long)
and flush up against the ear drum. The ear drum (tympanic membrane)
is the boundary between the outer ear and the middle ear. Slide 5
In the middle ear, the malleus picks up the vibrations from the
eardrum, passes them to the incus which then passes them to the
stapes. The stapes terminates in a tiny footplate that fits
precisely into the contact point or window of the inner ear. Slide
6 The window of the inner ear is the contact point of the cochlea.
The vibrations set up rolling waves in the cochlear fluid which
stimulate different areas of the membrane, which rubs against
specialized cells called hair cells. This friction creates
electrical impulses transmitted by the cochlear nerve. Slide 7 CN
VIII is responsible for signal transduction from vestibule and
cochlea to the brainstem. From brainstem, a signal is sent to the
cerebral cortex to interpret the sound. Slide 8 Hearing Loss
Conductive Mechanical dysfunction of external or middle ear Partial
hearing loss May be caused by impacted cerumen, foreign bodies,
perforated tympanic membrane, pus or serum in middle ear, or
otosclerosis (hardening of stapes) May be fixed Sensorineural
Dysfunction of inner ear, CN VIII, or cerebral cortex Cannot be
fixed Slide 9 Developmental Considerations Infants Greater risk for
otitis media (middle ear infections) due to shorter eustachian tube
Aging Cilia lining ear canal become coarse and stiff, impeding
sound waves Cerumen more common Dry cerumen gray and flaky. More
common in Asians and Native Americans Wet cerumen brown and moist.
More common in whites and blacks Presbycusis - degenerative
sensorineural hearing loss Auditory reaction time increases Slide
10 Obtaining History Earaches? (otalgia) Location, character,
intensity, associative and alleviating factors May be directly due
to ear disease or maybe referred pain from a problem in teeth or
oropharynx A viral or bacterial upper respiratory infection may
migrate up the eustachian tube and involve the middle ear
Infections? Frequency? Occurred in childhood? Discharge? (otorrhea)
May suggest infection or perforated eardrum Typically with
perforation, ear pain drainage Otitis externa purulent,
sanguineous, or watery Acute otitis media with perforation purulent
discharge Slide 11 More History Trouble hearing? Gradual our
sudden? Presbycusis gradual sensorineural hearing impairment in the
elderly Hearing loss due to trauma is often sudden Ringing in ears?
(tinnitus) May be a result of medication Medications? Some are
ototoxic Vertigo? (spinning) Subjective person feels like he or she
spins Objective person feels like room spins Environmental noise
Noise-induced hearing loss Slide 12 Lesions of External Ear Gouty
Tophi Otitis Externa Slide 13 Assessing External Ear Size and Shape
normal is 4-10cm tall Skin conditions Note edema, inflammation,
lesions Tenderness Location? Pain in pinna indicates otitis externa
Pain at mastoid process indicates mastoiditis or lymphadenitis
External Auditory Meatus Atresia absence or closure of ear canal
Otitis externa may cause purulent discharge Otitis media may cause
rupture of tympanic membrane If drainage present following trauma,
possible basal skull fracture. Perform glucose test (CSF (+) for
glucose). Slide 14 Inspecting Using Otoscope Pull the pinna up and
back in adult, straight down in children under 3 years Hold
otoscope upside down and place dorsal side of hand along persons
cheek Insert speculum slowly and avoid touching the inner section
of canal wall, which is sensitive and may cause pain. Slide 15
Inspecting the External Canal Note any redness or swelling,
lesions, or foreign bodies If discharge present, note color and
odor Otitis Externa Slide 16 Inspecting the Tympanic Membrane
Normal is shiny and translucent Flat, slightly pulled in at the
center Valsalva maneuver causes tympanic membrane to flutter, used
to assess drum mobility Which tympanic membrane is perforated?
Slide 17 Testing Hearing Acuity Voice test Whisper two syllable
words into one of the persons ears, while covering the other one.
Ask person to repeat what youve said. Tuning fork tests Measure
hearing by air conduction or bone conduction Weber test Rinne test
Slide 18 Weber Test Tuning fork is struck and placed on head or
forehead, equal distance from both ears Used to determine if
hearing loss is more extensive in one ear than the other This test
cannot confirm normal hearing, because hearing defects affecting
both ears equally will produce an apparently normal test result
Slide 19 Rinne Test Compares air conduction and bone conduction
Place stem of vibrating fork on mastoid process and ask when sound
goes away Quickly invert the fork so the vibrating end is near the
ear canal. The person should still hear a sound Normally the sound
is heard longer by air conduction rather than bone conduction In
conductive hearing loss, sound heard longer by bone conduction
Slide 20 Normal Hearing Slide 21 Conductive Hearing Loss Slide 22
Sensorineural Hearing Loss Slide 23 Infants and Children Save
otoscopic examination until the end May help to show otoscope to
child and let him or her play with it Stabilize (or ask a parent
for help) the childs head in order to prevent movement Pull pinna
straight down In infants, the tympanic membrane may look thick and
opaque after first few days or after crying Tympanostomy tubes may
be in place if drainage occurs as a result of otitis media Slide 24
Abnormalities in the Ear Canal Excessive Cerumen Acute Otitis Media
Otitis Externa Slide 25 Question 1 A nurse is performing a voice
test to assess hearing. Which of the following describes the
accurate procedure for performing this test? 1.Stand 4 feet away
from the client to ensure that the client can hear at this distance
2.Quietly whisper a statement and ask the client to repeat it
3.Whisper a statement with the examiners back facing the client
4.Whisper a statement while the client blocks both ears Slide 26
Question 2 A nurse is caring for a client who is hearing impaired.
Which of the following approaches will facilitate communication?
1.Speak frequently 2.Speak loudly 3.Speak directly into the
impaired ear 4.Speak in a normal tone Slide 27 Question 3 A client
is diagnosed with a disorder involving the inner ear. Which of the
following is the most common client complaint associated with a
disorder involving this part of the ear? 1.Hearing loss 2.Pruritus
3.Tinnitus 4.Burning in the ear Slide 28 Question 4 Which of the
following statements made by a parent should make the nurse
suspicious that the tympanic membrane of a young child has
ruptured? 1.She has been crying all night, but she feels better
this morning. 2.She has some bloody, yellow-looking stuff coming
out of her ear. 3.My child does not seem to hear very well. 4.My
childs earwax is dark brown. Slide 29 Question 5 While examining
the internal ear, the nurse observes the light reflex on the
tympanic membrane. What does this finding indicate? 1.Presence of
pus 2.Fluid accumulation 3.Scar tissue 4.Normal finding
