AURICLESAURICLES1.1.ColorColor

NormalNormal:: Color same as facial skinColor same as facial skin

Deviations from normal:Deviations from normal: Bluish color of earlobesBluish color of earlobes PallorPallor Excessive rednessExcessive redness

2. Symmetry of size2. Symmetry of sizeNormal:Normal: Symmetric positionSymmetric position Line drawn from lateral angle Line drawn from lateral angle

of eye to point where top part of eye to point where top part of auricle joins head is of auricle joins head is horizontalhorizontal

Deviations from normalDeviations from normal:: Low set earsLow set ears

2. Texture, elasticity and 2. Texture, elasticity and areas of tendernessareas of tenderness

Pull auricle upward, Pull auricle upward, downward, and backwarddownward, and backward

Fold the pinna (it should Fold the pinna (it should recoil)recoil)

Push in on the tragusPush in on the tragusApply pressure to the Apply pressure to the

mastoid processmastoid process

Normal:Normal:Mobile, firm and not Mobile, firm and not

tender, pinna recoil after it tender, pinna recoil after it is foldedis folded

Deviations from normalDeviations from normal::Lesions, flaky, scaly skinLesions, flaky, scaly skinTenderness when moved Tenderness when moved

or pressedor pressed

OTOSCOPYOTOSCOPY A physical examination technique A physical examination technique

that allows the visualization of that allows the visualization of the external canal of the ear and the external canal of the ear and the middle ear. the middle ear.

The otoscope is used and allows a The otoscope is used and allows a lighted examination of the ear. lighted examination of the ear.

Not usually performed on the Not usually performed on the newborn (for the first few days of newborn (for the first few days of birth)birth)

IndicationsIndications:: Assesses status of client as part Assesses status of client as part

of a general physical of a general physical examination examination

Identifies infection sites, foreign Identifies infection sites, foreign bodies, or lesions in the external bodies, or lesions in the external ear canal ear canal

Identifies variations from the Identifies variations from the norm of the tympanic membrane norm of the tympanic membrane and malleus and malleus

OTOSCOPIC EXAMINATIONOTOSCOPIC EXAMINATION

RememberRemember!!

Do not blindly Do not blindly introduce the introduce the speculum into speculum into the external the external

canal.canal.

EXTERNAL EAR EXTERNAL EAR CANALCANAL

1. 1. Using otoscope, inspect Using otoscope, inspect the external ear canal for the external ear canal for cerumen, skin lesions, cerumen, skin lesions, pus and blood and the pus and blood and the tympanic membrane for tympanic membrane for color.color.

INSPECTING THE EXTERNAL INSPECTING THE EXTERNAL EAR CANAL WITH AN EAR CANAL WITH AN

OTOSCOPEOTOSCOPETo straighten the ear canalTo straighten the ear canal

ADULT ADULT Upward and backward Upward and backward

CHILDCHILD Downward and backwardDownward and backward

Normal:Normal:Distal 3Distal 3rdrd contains hair contains hair follicles and glandsfollicles and glands

Dry cerumen, grayish-tan Dry cerumen, grayish-tan color or sticky, wet color or sticky, wet cerumen in various shades cerumen in various shades of brownof brown

Deviations from normal:Deviations from normal:Redness and discharge Redness and discharge scalingscaling

Excessive cerumen Excessive cerumen obstructing canalobstructing canal

TYMPANIC MEMBRANETYMPANIC MEMBRANE1. Check for color and gloss1. Check for color and gloss

Normal:Normal: IntactIntact TranslucentTranslucent Pearly grey Pearly grey Slightly concaveSlightly concave

Flutters with Flutters with insufflationinsufflation

Cone-shaped light Cone-shaped light reflex prominent at 5 reflex prominent at 5 o'clock in the right ear o'clock in the right ear and 7 o'clock in the left,and 7 o'clock in the left,

Can visualize malleus Can visualize malleus

Deviations from normal:Deviations from normal:Pink to red, some opacityPink to red, some opacityYellow amberYellow amberWhiteWhiteBlue or deep redBlue or deep redDull surfaceDull surface

Normal Eardrum & AOMNormal Eardrum & AOM

1.1.Assess client's response to Assess client's response to normal voice tones.normal voice tones.

Normal:Normal: Normal voice tones audibleNormal voice tones audible

Deviations from normal:Deviations from normal: Normal voice tones not Normal voice tones not

audibleaudible

2. Assess client’s response 2. Assess client’s response to whispered voiceto whispered voice

Stand 1 to 2 ft from the Stand 1 to 2 ft from the client in a position where client in a position where the client cannot read your the client cannot read your lips. Ask the client to lips. Ask the client to occlude one ear by putting occlude one ear by putting a finger in it.a finger in it.

Whisper some Whisper some nonconsecutive numbers nonconsecutive numbers and have the client tell you and have the client tell you what he has heard. what he has heard. Increase the loudness of Increase the loudness of the whisper until the client the whisper until the client can identify at least 50% can identify at least 50% of the numbers.of the numbers.

Normal:Normal:Able to repeat Able to repeat

nonconsecutive numbersnonconsecutive numbers

Deviations from normal:Deviations from normal:Unable to repeat 50% of Unable to repeat 50% of

numbers whispered numbers whispered

3.3.Perform the watch tick test.Perform the watch tick test. Have the client occlude one Have the client occlude one

ear. Out of the client’s sight, ear. Out of the client’s sight, place a ticking watch 1 to 2 place a ticking watch 1 to 2 in from the unoccluded ear.in from the unoccluded ear.

Ask whether the client can Ask whether the client can hear it. Repeat with the hear it. Repeat with the other ear.other ear.

WEBER’S TESTWEBER’S TEST Done to assess bone Done to assess bone

conduction by testing the conduction by testing the lateralization (sideward lateralization (sideward transmission of sounds)transmission of sounds)

Useful in detecting Useful in detecting unilateral unilateral hearing losshearing loss

A vibrating tuning fork stem A vibrating tuning fork stem is placed at the middle of the is placed at the middle of the client’s head.client’s head.

The client is asked whether The client is asked whether the sound is heard equally in the sound is heard equally in both ears or whether the both ears or whether the sound is louder in one ear.sound is louder in one ear.

Normal FindingsNormal Findings:: Hearing the sound equally in Hearing the sound equally in

both ears or is localized at both ears or is localized at the center of the head the center of the head (Weber negative)(Weber negative)

Deviations from normal:Deviations from normal:

Conductive Hearing LossConductive Hearing Loss Tone is heard in poorer Tone is heard in poorer

ear.ear. Client hears the sound Client hears the sound

louder in the impaired ear.louder in the impaired ear.

Sensorineural Hearing LossSensorineural Hearing Loss Tone is heard in the better Tone is heard in the better

ear.ear.

RINNE TESTRINNE TESTCompares the client’s Compares the client’s hearing by air hearing by air conduction and bone conduction and bone conductionconduction

Air conduction is 2-3 Air conduction is 2-3 times longer than bone times longer than bone conduction.conduction.

Vibrating tuning fork stem is Vibrating tuning fork stem is placed on the mastoid placed on the mastoid process and ask client to process and ask client to indicate when he or she no indicate when he or she no longer hears the sound.longer hears the sound.

Bring the tuning fork in front Bring the tuning fork in front of the pinna w/o touching the of the pinna w/o touching the client and asks the client to client and asks the client to indicate if he or she still indicate if he or she still hears the sound.hears the sound.

Record the duration of Record the duration of both phases, bone both phases, bone conduction followed by conduction followed by air conduction and air conduction and compare the times.compare the times.

Of no value in Of no value in determining determining sensorineural hearing sensorineural hearing loss.loss.

Normal FindingsNormal Findings::

(+) Rinne test(+) Rinne testClient continues to hear Client continues to hear

the sound two times louder the sound two times louder in front of the pinna .in front of the pinna .

AC is better than BCAC is better than BCAC >BCAC >BC

Deviations from normal:Deviations from normal:1. If client cannot hear the 1. If client cannot hear the sound through the ear in sound through the ear in front of the pinna, client may front of the pinna, client may have have conductive hearing lossconductive hearing loss on the side tested.on the side tested.

Bone condcution time is Bone condcution time is equal to or longer than AC equal to or longer than AC conduction time conduction time (-) Rinne (-) Rinne testtest