Ear Examination Heather Nelson, RN

Ears  Inspect auricles for size, shape, symmetry, landmarks, color, and position on head.  Inspect external auditory canal for discharge and note any odor.  Palpate auricles and mastoid area for tenderness, swelling, or nodules.

Otoscopic Exam  Otoscope is used to inspect the external audiotry canal and middle ear.  Tilt the patient’s head toward the opposite shoulder and pull the patient’s auricle upward and back as the speculum is inserted.  Slowly insert the speculum to a depth of 1.0 to 1.5 cm (1/2 inch).  Note discharge, scaling, excessive redness, lesions, foreign bodies, and cerumen.  Inspect the tympanic membrane for landmarks, color, contour, and perforations.

Auditory Assessment  Hearing evaluation begins when the patients responds to your questions and directions.  Whisper test---Check the patient’s response to your whispered voice, one ear at a time.  The tuning fork is used to compare hearing by bone conduction with that by air conduction. Weber and Rinne Tests  Any patient with unexpected findings should be referred for a thorough auditory evaluation.

Conductive Loss  Results when sound transmission is impaired through the external or middle ear.  Causes: –obstruction –otitis media –perforated TM –bony overgrowth of ossicles

Sensorineural Loss  Results from a defect in the inner ear that leads to distortion of sound and misinterpretation of speech.  Causes: –sustained exposure to loud noise –Drugs –Infections –Trauma –Tumors –congenital disorders –aging