The Ears

INHIRAH QADRI

Structure of the Ear

Sensory organ for hearing & maintaining equilibrium

Consist of 3 parts

• External ear

• Middle ear

• Inner ear

Structure of the Ear

• External ear- auricle or

pinna (movable cartilage

and skin)

• Mastoid process-

important landmark behind

the lobule

Structure of the Ear

It characteristic shape serves as to funnels sound waves into its opening

External auditory canal

▪ The canal-2.5-3cm long in adult and terminates at eardrum or tympanic membrane

▪Outer 1/3 of canal is cartilage, inner 2/3 bone covered by thin sensitive skin; slight S curve in adults

Structure of the Ear

➢Canal-lined with glands that secrete cerumen:

yellow, waxy material that lubricates and

protects the ear

➢Cerumen-migrates out the meatus due to

chewing and talking movements

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Tympanic Membrane

• Separates the external and middle ear

• Tilted obliquely to the ear canal, facing downward and

somewhat forward

➢Translucent membrane with a pearly gray color and Cone shaped light prominent at 5 o’clock position in R ear and 7 o’clock position in L ear

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Tympanic Membrane

• Oval and slightly concave

• Pulled in at its center by the malleus: ambo&

the short process

• Pars Flaccida- small, slack superior section

of the tympanic membrane

• Pars Tensa-The remainder

of drum that is thicker

and more rigid

Middle Ear

• Tiny air filled cavity inside the temporal bone

• Contains tiny auditory ossicles: malleus, incus, and stapes

• openings into the middle ear

▪Round window

▪oval window

▪Eustachian Tube

Eustachian Tube

Inner Ear

• Contains bony labyrinth-holds the sensory

organs for equilibrium and hearing

• the vestibule and the semicircular canals

• Cochlea (central hearing apparatus).

• The inner ear is not accessible to

examination, its function can be assessed

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Conductive Hearing Loss

Mechanical dysfunction of external or middle ear

• Impacted cerumen

• Foreign bodies

• Perforated tympanic membrane

• External ear infection

• Middle ear infection

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SENSORINEURAL HEARING LOSS

• Pathology of the inner ear, cranial nerve

VIII, or the auditory areas of the cerebral

cortex

• Ototoxicity from drugs or high intensity

sounds

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Subjective Data

• Earaches (otalgia)

• Infections

• Discharge (otorrhea)

• Hearing Loss

• Environmental noise

• Tinnitus

• Vertigo

• Self-care behaviors

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Inspect and Palpate the External Ear

Size and shape

• Equal size bilaterally with no swelling

or thickening

Skin Condition

• Color consistent with facial skin color

• Intact skin, with no lump or lesions.

Tenderness-move the pinna & push the tragus

• should feel firm with no pain

• External auditory meatus

• Some cerumen -color varies from gray-yellow to light brown and black; may be moist and waxy to dry

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Inspect Ear Using Otoscope

• Tilt person’s head slightly away from you toward the opposite

shoulder

• Pul lthe pinna up and back on an adult

➢ Pull the pinna down and back for a child < 3 yrs

➢ Hold the otoscope upside down

➢ Insert the speculum slowly and carefully

➢ Once in place, rotate the otoscope slightly

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Inspect Ear Using the otoscope

• Normal;• Cone of light is at 5 o’clock in R drum and

7 o’clock in L drum• Color: shiny and translucent with a pearl-

gray color.• Cone-shaped light reflex: prominent in the

anteroinferior quadrant• Section of malleus• Position: eardrum is flat ,slightly pulled in

the center .• Integrity of membrane: intact

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Hearing Acuity ( AssessCN VIII )

Whispered voice test:

❑Ask the client to occlude one ear with a finger

❑Stand 1 or 2 feet away, exhale fully (so as to minimize the intensity of your voice) and whisper two equally syllables, such as “nine-four,” or “baseball.” softly toward the unclouded ear.

❑Repeat the same steps to another ear.• Normal; the client can repeat each word correctly

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Hearing Acuity

• Tuning Fork tests (512 or 1024 Hz):

• Measure hearing by AC or BC

• AC is more sensitive than BC

• Make soft strikes with Tuning Fork

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Tuning Fork tests: Weber test

• Place TF in the midline of the skull or mid forehead and ask whether the sounds the same in both ears or better in one.

• Normal; should hear BC and the sound is equally loud in both ears

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Tuning Fork tests: Rinne test

• Place the stem of TF on the mastoid process and ask the client to signal when the sound goes away.

• Invert the fork so the ends near the ear canal.

• Normal; Positive

AC:BC 2:10

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Romberg Test

vestibular apparatus

• To assess the Standing balance.

• Ask patient to stand up with feet together and arms at side. When stable have client close eyes wait about 30-60 seconds; slight swaying may occur

• proprioception; sensation of position with visual information is blocked.

• Positive Romberg’s ; loss of balance that occurs when closing eyes.

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