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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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