1. Medical Assisting Chapter 39
PowerPoint® to accompany
Medical Assisting Chapter 39
Second Edition
Ramutkowski  Booth  Pugh  Thompson  Whicker
Chapter 39
Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.

2. Providing Eye and Ear Care
Objectives:
39-1 Describe the anatomy and physiology of the eye.
39-2 State the ways that vision changes with age.
39-3 Describe ways to detect vision problems.
39-4 List treatment of eye disorders.
39-5 Identify ways that patients can practice preventive eye care.
39-6 Describe the anatomy and physiology of the ear.

3. Providing Eye and Ear Care
Objectives (cont.)
39-7 State ways that hearing changes with age.
39-8 List the types of hearing loss.
39-9 Explain the procedures for screening and diagnosing ear problems.
39-10 Describe treatments for ear and hearing disorders.
39-11 Explain how patients can be educated about preventive ear care.

4. Introduction
Duties may involve performing basic tests for vision and hearing
You may also assist the doctor in providing treatment related to eyes and ears
You will need to know the basic structure and function of these organs and to advise patients about general eye and ear care and concerns.

5. Vision Eye Sclera Choroid Inner layer Cornea
Iris, pupil, ciliary body, lens, aqueous humor & vitreous humor
Inner layer
Retina
Rods
Cones
Can you identify the parts of this eye?

6. Process of Seeing Eye works like a camera
Light passes through the cornea, pupil, lens & fluids of the eye which focuses the light onto the retina
The image is projected upside down on the retina
Retina converts the light into nerve impulses that are sent to the brain
The brain interprets these impulses, turns the image right-side up and develop a picture of the object.

7. The Aging Eye With age, changes occur in the eye:
Amount of fat tissue diminishes – may cause droopy eyelids
Quality & quantity of tears decrease
Conjunctiva becomes thinner
Cornea begins to appear yellow
Sclera may develop brown spots

8. The Aging Eye (cont.) With age, changes occur in the eye:
Iris causes the pupil to become smaller
Lens becomes denser and more rigid
Changes in the retina may make vision fuzzy
Ability to adapt to changes in light intensities may be reduced
Night vision may be impaired

9. The Aging Eye (cont.) With age, changes occur in the eye:
Peripheral vision is reduced
Vitreous humor breaks down causing the patient to see floaters
Rubbing of the vitreous humor on the retina produces flashes of lights or “sparks’

10. Vision Testing
Ophthalmologist – medical doctor who is an eye specialist.
Vision Tests performed:
Distance vision – Snellen chart
Near vision – handheld charts
Contrast sensitivity – Pelli-Robson contrast sensitivity chart
Color Vision – Richmond pseudoisochromatic color test
Can you identify the number in this portion of the color vision test?

11. Treating Eye Problems Common eye problems
Conjunctivitis – inflammation of the conjunctiva
Blepharitis – inflammation of the eyelid
Corneal abrasions – scratching of the cornea

12. Administration of Eye Medications
Teach the patient to check medication labels carefully before administering them at home.
Optic medications for use in the eye can easily be confused with Otic medications for the ear.
Medications other than optic meds may be too concentrated and injure sensitive eye tissue.

13. Eye Irrigation Foreign materials in the eye must be flushed out.
Flushing or irrigation should be done with sterile solution formulated for this purpose.
Will relieve discomfort from smog, pollen, chemicals, or chlorinated water.

14. Vision Aids Common refractive disorders
Myopia
Hyperopia
Presbyopia
Astigmatism
Optometrist – trained to prescribe corrective aids

15. Apply Your Knowledge
You are performing vision testing on a patient who wears glasses. What is a common order for testing the eyes? Number the list from 1 to 6.
_____ Both eyes without glasses
_____ Left eye with glasses
_____ Right eye without glasses
_____ Both eyes with glasses
_____ Left eye without glasses
_____ Right eye with glasses

16. Apply Your Knowledge -Answer
You are performing vision testing on a patient who wears glasses. What is a common order for testing the eyes? Number the list from 1 to 6.
__1__ Both eyes without glasses
__6__ Left eye with glasses
__2__ Right eye without glasses
__4__ Both eyes with glasses
__3__ Left eye without glasses
__5__ Right eye with glasses

17. Hearing
Hearing depends on normal transmission of nerve impulses from the ear to the brain

18. The Ear External ear Middle ear Inner ear - labyrinth Auricle
Tympanic membrane
Middle ear
Malleus
Stapes
Incus
Inner ear - labyrinth
Cochlea
Semicircular canals
Can you identify the parts of this ear?

19. Hearing Process
Sound enters the external ear which makes the eardrum vibrate.
The middle ear amplifies the vibrations and the waves cause the tiny hairs to the cochlea to bend.
Movement of the hairs triggers nerve impulses.
The impulses are transmitted via auditory nerve to the brain.
The brain perceives the sound.

20. Ear and Balance The brain constantly monitors the position of
one’s body on the information received from
the semicircular canals, eyes, and muscles.
A change in position is detected by the canal
and passed to the brain. The brain
uses this information to
maintain balance.

21. The Aging Ear
The external ear appears larger – caused by growth of cartilage and loss of skin elasticity.
Ear lobe gets longer and may be wrinkled.
Less production of cerumen.
Middle ear begins to shrink and appears dull and gray.
Bones of the middle ear degenerate and don’t move as freely.
Semicircular canals become less sensitive and cause a reduced sensitivity affecting balance.

22. Hearing Loss Types of hearing loss
Conductive – caused by interruption in transmission of sound waves to the inner ear
Caused by obstruction of the ear canal,
Infection of the middle ear
Reduced movement of the incus
Sensorineural –caused when there is damage to the inner ear, the nerve that leads from the ear to the brain, or the brain itself.

23. Working with Patients with a Hearing Impairment
One-third of patients between 65 and 75 and one-half of patients between 75 and 79 have some hearing loss.
Many patients wear hearing aids to amplify normal speech.

24. Improving Communications
Speak at a reasonable volume
Don’t shout
Speak in clear, low-pitched tones
Avoid speaking directly into the patient’s ear.
Stand 3 to 6 feet away and face the patient
Avoid overemphasizing your lip movements.
Avoid hand gestures
Treat patients with a hearing impairment with patience and respect

25. Hearing Tests Hearing Tests
Audiometer – electronic device that measures hearing acuity by producing sounds in specific frequencies and intensities
Tuning forks – differentiating conductive from sensorineural hearing loss

26. Diagnostic Testing
Tympanometry – measures eardrum’s ability to move and gauges pressure in the middle ear.
Used to detect diseases and abnormalities of the middle ear.
Uses a small, soft rubber cuff placed over the external ear producing an airtight seal
Measures and prints out a graph of results

27. Treating Ear and Hearing Problems
Cerumen impaction
Rupture of the eardrum
Otitis media (inflammation of the middle ear)
Otitis externa (inflammation of the outer ear)

28. Ear Meds and Irrigation
You will teach patients how to administer ear medications at home
Irrigation of the ear may relieve inflammation or irritations of the ear.
Irrigation may loosen earwax or foreign body

29. Hearing Aids Hearing aids consist of the following parts:
A tiny microphone to pick up sounds
An amplifier to increase the volume of sounds
A tiny speaker to transmit sounds to the ear

30. Hearing Aids (cont.)
Otologist – medical doctor specializing in the health of the ear.
Audiologist – non-physician specialist who focuses on evaluation and correcting hearing problems.
Hearing aids run on batteries for about 2 weeks

31. Apply Your Knowledge
A six-month old is seen at your clinic. The mother states that the infant has been cranky and pulling at her ears especially when she lays her down. What do you think might be wrong?

32. Apply Your Knowledge -Answer
A six-month old is seen at your clinic. The mother states that the infant has been cranky and pulling at her ears especially when she lays her down. What do you think might be wrong?
The infant may have otitis media, however a thorough examination of the infant by the physician is necessary.

33. You can help prevent, detect and treat eye and ear problems.
Summary
Medical Assistant
You can help prevent, detect and treat eye and ear problems.
A basic understanding of the anatomy and physiology of the eyes and ears will help you provide good eye and ear care to patients.

34. End of Chapter
End of Chapter