HA EARS

Question 1

INSPECT AND PALPATE THE EXTERNAL EAR

Answer 1

Structures of the ears that can be seen externally which includes pinna, helix, mastoid process and more.

Question 2

SIZE AND SHAPE

Answer 2

Steps: Check the ears by looking on it

Considerations:
Ears of unusual size and shape might be a normal familial trait with no clinical significance

Normal Finding:
Ears are of EQUAL size BILATERALLY with NO SWELLING or THICKENING

Abnormal Finding:
1. Ears are smaller than 4 cm or longer than 10 cm
2. Misaligned or low set ears may be seen with genetic disorders or Chromosomal defects

Question 3

SKIN CONDITION

Answer 3

Considerations:
DARWIN’S TUBERCLE, a small painless nodule at the helix. A congenital variation and is not significant

Normal Finding:
Skin color is consistent with the person’s facial skin color. The skin is intact, with no lumps or lesions

Abnormal Finding:
1. Enlarged preauricular and postauricular lymph nodes > INFECTION
2. Pale blue ear color > FROSTBITE
3. REDNESS, SWELLING, SCALING OR ITCHING > Otitis externa

Question 4

TENDERNESS

Answer 4

Steps:
Move the Pinna and push on the tragus

Normal Finding:
They should feel firm and movement should produce no pain. Palpating the mastoid process should also produce no pain.

Abnormal Finding:
1. OTITIS MEDIA – tenderness behind the ear
2. MASTOIDITIS – Tenderness over the mastoid process
3. Painful auricle or Tragus – OTITIS EXTERNA, POSTAURICULAR CYST

Question 5

THE EXTERNAL AUDITORY MEATUS

Answer 5

Steps:
Note the size of the opening in relation to the speculum to be used

Normal Finding:
No Swelling, Redness or Discharge should be present

Note: Cerumen = gray-yellow to light brown & Black
- From moist and waxy to dry and desiccated

Abnormal Finding:
A large amount of cerumen obscures visualization of the canal and drum

1. OTITIS EXTERNA – foul smelling, sticky, yellow discharge
2. PRESENCE OF FOREIGN BODIES such as bugs, plants and etc.
3. CONDUCTIVE HEARING LOSS – impacted cerumen blocking the view of the external ear canal

Question 6

NOTES WHEN USING THE OTOSCOPE

Answer 6

1. Choose the largest speculum that will fit comfortably in the ear canal
2. Adult – Pull the pinna up and back
3. Child (Infant or under 3 years old) – Pull the pinna down
4. It is important to perform the otoscopic examination before you test hearing

Question 7

THE EXTERNAL EAR

Answer 7

Steps:
Note any redness and swelling, lesions, foreign bodies or discharge. If any discharge is present, note the color and odor. Clean any discharge from the speculum

Normal Finding:
No redness and swelling, lesions, foreign bodies or discharge.

Abnormal Finding:
1. OTITIS EXTERNA – reddened swollen canals
2. EXOSTOSES – nonmalignant nodular swellings
3. POLYPS – May block the view of ear drum

Question 8

THE TYMPANIC MEMBRANE

Answer 8

1. COLOR AND CHARACTERISTICS
2. POSITION
3. INTEGRITY OF MEMBRANE

Question 9

THE TYMPANIC MEMBRANE -

A. COLOR AND CHARACTERISTICS

Answer 9

Normal Finding:
External eardrum is shiny and translucent with a pearly-gray color. Sections of the malleus are visible: UMBO, MANUBRIUM, SHORT PROCESS.
- Annulus looks whiter and denser

Abnormal Finding:
1. ACUTE OTITIS MEDIA – Red bulging eardrum and distorted
2. SEROUS OTITIS MEDIA – Yellowish bulging membrane with bubbles behind
3. POLYPS -Blocking the eardrum

Question 10

THE TYMPANIC MEMBRANE -

B. POSITION

Answer 10

Normal Finding:
Eardrum is flat, slightly pulled in at the center and flutters when the person performs the VALSALVA MAANEUVER or holds the nose and swallow (Insufflation)

Abnormal Finding:
OTITIS MEDIA – The membrane does not move or flutter when the bulb is inflated

Question 11

THE TYMPANIC MEMBRANE -

C. INTEGRITY OF MEMBRANE

Answer 11

Steps:
Inspect the eardrum and the entire circumference of the annulus for perforation

Normal Finding:
Tympanic membrane is intact

Abnormal Finding:
1. OTITIS MEDIA

Question 12

TEST HEARING ACUITY

Answer 12

AUDIOMETER - gives a precise quantitative measure of hearing by assessing the person’s ability to hear sounds of varying frequency.

ABNORMAL FINDINGS:
1. MODERATE HEARING LOSS = 41 to 55 Decibels
2. MODERATE TO SEVERE HEARING LOSS = 56 to 70 Decibels
3. SEVERE HEARING LOSS = 71 to 90 Decibels
4. PROFOUND HEARING LOSS = 91 to 100 Decibels

Question 13

VOICE TEST

Answer 13

Steps:
Placing one finger on the tragus and rapidly pushing it in and out of the auditory meatus
1. Shield lips
2. 30 to 60 cm, Whisper slowly two-syllable words

Normal Finding:
Normally the person hears and repeats each word correctly after you say it

Abnormal Finding:
Unable to repeat two syllable words after two tries which might indicate hearing loss.

Question 14

TUNING FORK TESTS

Answer 14

Measure hearing by air conduction or bony conduction

ABNORMAL FINDING: Cannot hear sound or vibrations on either of the two conductions

Question 15

WEBER TEST

Answer 15

Steps:
When a person report hearing better with one ear than the other.
Place a vibrating tuning fork in the midline of the person’s skull and ask if the tone sounds are the same in both ears or better in one.

Normal Finding:
Should hear the tone by bone conduction through the skull, and it should sound equally loud in both ears.

Abnormal Finding:
1. CONDUCTIVE HEARING LOSS – Lateralization of sound to the poor ear
2. SENSORINEURAL HEARING LOSS – Lateralization of sound to the good ear

Question 16

RINNE TEST

Answer 16

Steps:
Compares air conduction and bone conduction sound
Place the stem of the vibrating tuning fork on the person’s mastoid process and ask him or her to signal when the sound goes away. Quickly invert the fork so the vibrating end near the ear canal; The person should still hear a sound.

Normal Finding:
AC > BC

Abnormal Finding:
1. With CONDUCTIVE HEARING LOSS,
BC > AC
2. With SENSORINEURAL HEARING LOSS,
AC > BC
- Damage to inner ear (cochlea)
- Most common type of permanent hearing loss
Causes: OTOTOXIC DRUGS, AGING, HEAD TRAUMA, MALFORMATION OF THE INNER EAR, and LOUD NOISE EXPOSURE.

Question 17

VESTIBULAR APPARATUS

ROMBERG TEST

Answer 17

Steps:
Assess the ability of the vestibular apparatus in maintaining standing balance

Normal Finding:
CAN MAINTAIN BALANCE

Abnormal Finding:
Client moves feet apart to prevent falls or starts to fall from loss of balance