Assessing the Ears Lecture Notes

Assessing the Ears Structure of the External Ear  Auricle, auditory canal  Tympanic membrane: handle and short process of the malleus, umbo, cone of light, pars flaccida, pars tensa Structure of the Middle Ear  Tympanic cavity  Round and oval windows  Three auditory ossicles: the malleus, the incus, and the stapes  Eustachian tube Structure of the Inner Ear  Labyrinth: bony and inner membranous labyrinth  Bony labyrinth: cochlea, vestibule, and semicircular canals  Spiral organ of Corti  Vestibular nerve and cochlear nerve: 8 th cranial nerve Hearing Loss  Conductive hearing loss: Something blocks or impairs the passage of vibrations from getting to the inner ear.  Sensorineural or perceptive hearing loss: Damage is located in the inner ear. Risk Factors for Hearing Loss  Aging, especially due to many years of exposure to sounds that can damage inner ear cells  Heredity, with genetics that are related to susceptibility to ear damage  Occupational loud noises as regular part of the working environment  Recreational noises and exposure to explosive noises Risk Factors for Hearing Loss (Continued)  Ototoxic medications  Illnesses, especially with high fever  Noise exposure  Smoking  Cardiovascular risk factors  Genetic and family susceptibility  Premature birth Risk Factors for Hearing Loss (Continued)  Hypoxia during birth  Rubella, syphilis or certain other infections in pregnant mother  Inappropriate use of ototoxic drugs during pregnancy  Neonatal jaundice, which can damage the otic nerve in a newborn baby.

Risk Factors for Hearing Loss (Continued)  Infectious diseases such as meningitis, measles, mumps, and chronic ear infections in childhood as well as in later life  Head injury or injury to the ear  Wax or foreign bodies blocking the ear canal  Risk Factors for Hearing Loss (Continued)  Infectious diseases such as meningitis, measles, mumps, and chronic ear infections in childhood as well as in later life  Head injury or injury to the ear  Wax or foreign bodies blocking the ear canal Risk Factors for Otitis Media  Age  Group childcare  Babies fed from a bottle, especially lying down  Seasons of fall and winter, due to exposure to colds, flu, and increased allergens  Poor air quality  Family history  Ethnicity  Enlarged adenoids Risk Reduction to Preserve Hearing  Avoid sound exposure louder than a washing machine.  Avoid recreational risks that involve loud sounds or risks of head or ear injury.  Avoid listening to extremely loud music for long periods of time,  Wear hearing protectors and take breaks from the noise in loud noise environments.  Have hearing checked periodically, especially after age 50. Risk Reduction to Preserve Hearing (Continued)  If hearing loss is detected, obtain and use devices to improve hearing.  Immunize children against childhood diseases, including measles, meningitis, rubella, and mumps.  Be immunized against rubella before pregnancy if a woman of child-bearing age.  If pregnant, get screening for syphilis and other STDs, adequate antenatal and prenatal care, and diagnosis and treatment for baby born with jaundice. Risk Reduction to Preserve Hearing (Continued)  Avoid the use of ototoxic drugs unless prescribed by a qualified health care worker and properly monitored for correct dosage.  If you have a newborn, avoid feeding from bottle while infant is lying on back.  Have newborn infant screened for hearing.

 Use tuning fork placed on the center of the head or forehead.  Ask whether the client hears the sound better in one ear or the same in both ears. Rinne Test  Use tuning fork and place the base on the client’s mastoid process.  When the client no longer hears the sound, note the time interval, and move the tuning fork in front of the external ear. When the client no longer hears the sound, note the time interval.  https://www.youtube.com/watch?v= uI6_nPCkdK4 Romberg Test  Tests equilibrium.  Feet together and arms at side, close eyes for 20 seconds.  Check for swaying. Internal Ear: Otoscopic Examination  Inspection  Inspect the external auditory canal for discharge, color, consistency of cerumen, canal walls, and nodules.  Inspect the tympanic membrane for shape, consistency, and landmarks. Eardrum  Normal Right Eardrum  Acute Otitis Media With Purulent Effusion Expected Changes with Aging of the Ear  Presbycusis common after 50 years of age  Negative self-image with hearing aid  Elongated earlobes with linear wrinkles  Harder cerumen builds as cilia in ear canal become more rigid  Coarse, thick wire-like hair may grow at ear canal entrance  Eardrum appears cloudy Nursing Process  Validating and documenting findings  Diagnostic reasoning  Nursing diagnoses  Collaborative problems