Ear
Assessment
Ch. 16
NURS 319
Dr. Trina Kumodzi
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Objectives
1. Describe the pertinent subjective data related to
the ear system.
2. Demonstrate examination technique for the ear
system.
3. Interpret assessment findings of the ear system.
4. Accurately document the findings of the ear system.
5. Analyze subjective and objective data to develop
nursing care.
6. Describe nursing diagnoses common to the ear
system.
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Ear Anatomy
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Ear Anatomy
• External Canal
• Cerumen
– Protect and lubricate the ear
• Tympanic Membrane
• Translucent membrane with a pearly gray
color
• Separates external and middle ear
• Oval and slightly concave, pulled in at its
center by one of middle ear ossicles, the
malleus
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Hearing
• CN VIII
• Hearing loss
– Anything obstructing transmission of sound
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Hearing
• Conductive hearing loss involves a mechanical
dysfunction of external or middle ear
– impacted cerumen
– foreign bodies
– perforated TM
– pus or serum in middle ear
– decrease in mobility of ossicles
• otosclerosis
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Hearing
• Sensorineural (or perceptive) hearing loss signifies
pathology of inner ear, cranial nerve VIII, or auditory
areas of cerebral cortex
– presbycusis
• Mixed hearing loss is combination of conductive and
sensorineural types in same ear
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Equilibrium
• Labyrinth in inner ear
– works like a plumb line to determine
verticality or depth
– register angle of your head in relation to
gravity
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Developmental Competence:
Infants and Children
• Inner ear develops during 1st trimester
• An infant’s Eustachian tube is wider, shorter,
and more horizontal than in adults
• Increase risk for nasopharyngeal reflux
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Developmental Competence: Adult
• Gradual hardening that causes foot plate of stapes
to become fixed in oval window
• Impeding transmission of sound and causing
progressive deafness
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Developmental Competence: Adult
• Aging adult
– Conductive loss
• High-tone frequency
– Gradual nerve degeneration (Presbycusis)
– Auditory reaction time
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Subjective Data
Pain
Discharge
Trouble hearing
Tinnitus
– ringing, crackling, or buzzing in your ears
• Vertigo
– room is spinning around or feel that you are
spinning?
•
•
•
•
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Subjective Data
• Use of hearing device
• Environmental noises at home and on the job
• Self care behaviors
– Cleaning the ear, hearing test
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Note to Examiner
• During history, notice clues from normal
conversation indicating possible hearing loss
– Lip reading or watching your face and lips
rather than your eyes
– Frowning or straining forward to hear
– Posturing of head to catch sounds with
better ear
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Note to Examiner
– Misunderstands questions; frequently asks
you to repeat
– Irritable or shows startle reflex when you
raise your voice
– Person’s speech sounds garbled, vowel
sounds distorted
– Inappropriately loud voice
– Flat, monotonous tone of voice
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Additional History for Infants and
Children
• Have you noticed that infant:
– startles with loud noise?
– babble around 6 months?
– What age was the child when they started
talking? Was speech intelligible?
• Did the child have a hearing test?
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Additional History for Infants and
Children
• It is important to catch any problem early
– hearing loss delays speech, social development
and learning.
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Inspection
• Size, shape, and symmetry
‒ Ears are of equal size bilaterally with no
swelling or thickening
‒ Ears of unusual size and shape may be a
normal familial trait with no clinical
significance
• Skin intact
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Palpation
• Tenderness of pinna and tragus
• Palpate mastoid process
• Mastoiditis, untreated otitis media
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The Otoscopic Exam
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Otoscopic Examination
• Otoscope funnels light into ear canal onto
tympanic membrane
• Tilt head slightly away from you toward
patient’s opposite shoulder
• Pull the pinna upward and back (for an
adult) as speculum is inserted
• Insert no more than 1/2 inch
• Note color, contour, discharge, foreign
bodies, and cerumen
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Tympanic Membrane (TM)
Right Ear
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Assess for Hearing Loss (CN VIII):
Voice test
• Stand approximately 1-2 feet from client and
instruct client to cover opposite ear
• Whisper a set of 3 random number or letters (7, A,
4).
• Repeat procedure in another ear
• Person should respond correctly at least 50% of
time
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Hearing Acuity for Infant and
Children
• Birth-3mos: startle (Moro) reflex, crying, cessation
of breathing or movement to sudden noise, calm to
parent’s voice
• 4-6mos: turns head to sounds; responds to parent’s
voice; enjoys sound producing toys
• 6-10 mos: responds to name, telephone ringing,
and voice
• 10-12mos: recognizes and localizes source of
sound; imitates simple words and sounds
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Developmental Consideration for
Aging Adult
– Eardrum may be whiter in color and more
opaque, duller and thicker than in younger
adult
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Sample Charting: Subjective
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Sample Charting: Objective
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Sample Charting: Assessment
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Practice Question #1
During a hearing assessment, the nurse notes that
the sound lateralizes to the clients left ear with the
Weber test. The nurse analyzes this result as:
A. A normal finding
B. A conductive hearing loss in the right ear
C. A sensorineural or conductive loss
D. The presence of nystagmus
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Answer to Question #1 w/ Rationale
C. A sensorineural or conductive loss
Rationale: In the Weber tuning fork test the nurse
places the vibrating tuning fork in the middle of the
client's head, at the midline of the forehead, or above
the upper lip over the teeth. Normally, the sound is
heard in equally in both ears by bone conduction. If
the client has a sensorineural hearing loss in one ear,
the sound is heard in the other ear. If the client has a
conductive hearing loss in one ear, the sound is heard
in that ear.
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Practice Question #2
The nurse would question an order to irrigate the ear
canal in which of the following circumstances?
A. Otitis externa
B. Perforated tympanic membrane
C. Hearing loss
D. Ear pain
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Answer to Question #2 w/ Rationale
B. Perforated tympanic membrane
Rationale: Irrigating a perforated tympanic
membrane is contraindicated because it will further
damage the already damaged eardrum. This may
result in permanent hearing loss.
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