Ears HA Exam #2

external ear
middle ear
inner ear

Pinna/auricle
external auditory canal
tympanic membrane

eardrum

external ear

malleus, incus, stapes, eustachian tube

(1) it conducts sound vibrations from the outer ear to the central hearing apparatus in the inner ear
(2) it protects the inner ear by reducing the amplitude of loud sounds
(3) it eustachian tube allows equalization of air pressure on each side of the tympanic membrane so membrane does not rupture

connects middle ear with nasopharynx and allows passage of air
normally closed but opens with swallowing and yawning
goes from ears to back of throat

labyrinth, vestibule, semicircular canals, cochlea

bone
not accessible to direct examination

labyrinth

acts as a gate between the external and middle ear

Earache or Ear pain
Infections
Discharge
Hearing loss
Other indicators of loss
Environmental exposure
Ringing of Ears
Dizziness
Self-Care

otalgia -> directly from ear disease or is referred pain

Location
Character
Cold symptoms or sore throat
Injury or trauma
Alleviating factors

otitis

Number (adult or child)
Frequency
Treatment
could be chronic issue causing scar tissue

otorrhea -> infected canal or perforated eardrum

Note any discharge
Color
Consistency
Odor
Any relationship between discharge and ear pain

Onset
Character
Situational

gradual onset over years, bilaterally, mostly high-frequency loss, worse in noisy environments
trauma hearing loss usually sudden

Shouting
Hollow sounds
Airplane travel -> frequently flying
Family history
Devices
Coping strategies -> lip reading

Lip reading
Frowning or straining
Posturing (turning head)
Does not answer appropriately (says huh?)
Irritable or startled
Speech garbled
Inappropriately loud voice
Tone flat -> no change in voice
Television volume increasing
PARTIAL social withdraw -> large social settings

Exposure to loud noises
Machinery
Gunshots
Ear protection
DOCUMENT OCCUPATION

tinnitus -> the perception of sound w/o an external source

occurs w/ sensorineural hearing loss, cerumen impaction, middle ear infection, trauma and emotion stress

Onset
Occurrence
Amplification - when is it louder

vertigo

subjective -> spinning is of person
objective -> spinning of objects around person

Onset
Associated factors
Alleviating factors -> physical therapy

Cleaning -> warm, wet wash rag
Exam
Devices

nothing smaller than your elbows should be in your ear

pulled in the center -> concave
pearly, white looking

cerumen

lubricate, waterproof, and clean external auditory canal
genetically determined

honey brown to dark and moist
most common in African Americans

gray, flaky, and frequently from thin mass
most common in Asians

pull pinna up and back for adult
pull pinna down for child

visualized tympanic membrane

Position upright/eye level
Size and shape
Tenderness
External Auditory Meatus

Equal size/ skin intact
Unusual size and shape not significant -> just document it

Move the pinna nd push the tragus
Firm
Pain free
Tragus should not be tender

Note size of opening
No pain, tenderness or erythema

Note redness or swelling
Lesions or foreign bodies
Discharge (note color and odor)
Clean ear probes prior to use in other ears OR use new probe
Infection = swap probe

shiny and translucent, with a pear-gray color
cone-shaped light reflex prominent

should be intact -> unless have tubes
scarring indicative of repeated ear infections

should be flat, slightly pulled at the center

Otitis Media

obstruction of eustachian tube
most common in North america and New Zealand
common in children
multiple antibiotics prescribed
can lead to antibiotic resistance (superbugs)

residual fluid in middle ear (post treatment)
potential hearing impairment
cognitive delay -> can't hear to learn

Position is important
Partly upright while feeding
do not prop bottle or let baby take a bottle to bed
encouraging breastfeeding -> decreases the risk in ear infections

"Swimmers ear"

used when they're not responding like they should during head-to-toe
test one ear at a time while masking hearing in other ear
shield your lips
with you head 1-2ft away, whisper slowly some two-syllable words

repeat of each word