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
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