2. OBJECTIVES
At the end of this presentation learner will be able to,
Define the ear,
Discuss the anatomical structure and
landmark of ear,
Explain techniques use in physical examination,
Identify expected findings during health assessment.
Demonstrate appropriate documentation and reporting of health
assessment
3. INTRODUCTION
Humans are provided with two important
organs for sensing information carried
by waves----the ear and the eye.
The ear is organ for hearing. it is divided
into three parts
It has two function one is hearing and
second is to maintain the balance of the
body or equilibrium
4. DEFINITION
An ability to recognize, appreciate, and reproduce
sounds, especially music or language.
OR
The organ of hearing and equilibrium in vertebrats in
humans consisting of an external ear gathers sound
vibration, a middle
ear and the auditory nerve, which transmits them as
impulses to the brain.
(www.dictionary.com/browse/ear)
5.
6. PARTS OF EAR
03 PARTS OF THE EAR
OUTER EAR
01.pinna or auricle 02.External ear canal
03Tympanic membrane
MIDDLE EAR
01. Tympanic cavity 02. OSSICLES (Malleus,
Incas, Stapes) 03. Eustachian tube,
INNER EAR
01. Cochlea, 02. vestibule, 03. semicircular canals
7. OUTER EAR
Collects sound waves and sends them to the middle
ear. It is the visible part of the ear
PINNA OR AURICLE;
It is a flap of skin supported by the cartilage. It is a
curved part of the ear attached to the head, its
shape makes it efficient in collecting and capturing
sound waves. The soft tissue that hangs from the
lower part of the auricle is the EARLOBE
8. MIDDLE EAR
Tympanic membrane (also called the
eardrum). The tympanic membrane divides the
external ear from the middle ear.
Middle ear(tympanic cavity), consisting of:
Ossicles. Three small bones that are connected and
transmit the sound waves to the inner ear. The bones
are called:
Malleus
Incus
9. MIDDLE EAR cont…..
• EUSTACHIAN TUBE. A canal that links
the middle ear with the back of the nose.
The Eustachian tube helps to equalize the
pressure in the middle ear. Equalized
pressure is needed for the proper transfer
of sound waves. The Eustachian tube is
lined with mucous, just like the inside of
the nose and throat.
10. INNER EAR
SEMICIRCULAR DUCTS – filled
with fluid; attached to cochlea and
nerves; send information on balance
and head position to the brain
COCHLEA – spiral-shaped organ of
hearing; transforms sound into signals
that get sent to the brain
AUDITORY TUBE – drains fluid
from the middle ear into the throat
behind the nose
11. LAND MARKS OF EAR
Lobule
Helix
Anti-helix
Scaphoid fossa
Tragus
Anti- tragus
Intertragic notch
Triangular fossa
concha
External auditory meatus
(acoustic meatus)
Mastoid
15. EXAMINATION OF EAR
There are two methods of assessment of ear,
1. Inspection 02. palpation
Wash hand,
GRIP ( greet, rapport, introduce and identify,
explain procedure, ensure privacy)
Equipment
1. Otoscope 02.Otoscope speculum
03. 512Hz tuning fork 04. Position patient
05. Seated at same level as you
16. OTOSCOPE
Otoscope is an instrument which is used
to view the ear.
Ensure the batteries are working.
Use the clean speculum for each patient
Use the largest speculum that will
comfortably fit in EAM
17. S.NO ASSESSMENT NORMAL FINDING DEVIATION FROM
NORMAL
01
02
AURICLES;
Inspect the auricles
for color,
symmetry of size,
and position
Palpate the auricles
for texture,
elasticity, and area
of tenderness.
Color is same as facial skin.
SYMMETRY;
Auricle angled with outer
canthus of eye, about
10degree, from vertical.
Mobile, firm, and not tender,
pinna recoils after it is folded.
Bluish color of the ear
lobe, pallor, excessive
redness.
ASYMMETRY;
Low set ears.
Lession, scaly skin,
tenderness when
moved or pressed.
ASSESSMENT OF EXTERNAL EAR
18. S.
N
O
ASSESSMENT NORMAL FINDING DEVIATION FROM
NORMAL
01
02
03
Inspect the external ear canal
for cerumen, skin lession,
pus, and blood.
Visualize the tympanic
membrane using an
Otoscope.
Inspect the tympanic
membrane for color and
gloss
distal third contain hair
follicles and glands.
Dry cerumen, grayish-ten
color; or sticky, wet
cerumen in various shades
of brown
Pearly gray color,
semitransparent
Redness and
discharge
Scaling
Excessive cerumen
obstructing canal
Pink to red, some
opacity yellow-
amber
White
Blue or deep red
ASSESSMENT OF EXTERNAL EAR
19. GROSS HEARING ACUITY TEST
• Asses client’s response to normal voice tones .Normal voice
tones audible .if client has difficulty hearing the normal voice,
proceed with the following test;
Watch tick test
Whisper test
Tuning fork tests
Weber’s test
Rinne test
20. WATCH TIK TEST
Perform the watch tick test. The ticking of a watch has higher pich then
the human voice.
s.n
o
ASSESSMENT NORMAL
FINDING
DEVIATIONS
FROM
NORMAL
01
02
03
Have the patient occlude one
ear. Out of the client’s sight,
place ticking watch 2 to 3 cm
(01 to 02 inch) from the
occluded ear.
Ask what the patient can hear.
Repeat with other ear
Pateint able to
hear the ticking
in both ears.
Unable to hear
ticking in one or
both ears
21. WHISPER TEST
Perform the whisper test to assess high-frequency hearing.
S.
NO
ASSESSMENT NORMAL
FINDING
DEVIATIONAL
FROM NORMAL
01
02
03
Have the client occlude one ear. Out
of the client’s sight, at a distance of
0.3 to 0.6m (01 to 02ft), whisper a
simple phrase such as “weather is
hot today.
Ask the client to repeat the phrase.
Repeat with the other ear using a
different phrase.
Able to repeat the
phrases correctly in
both ears
Unable to repeat
the phrases in one
or both ears
23. RINNE TEST CONT….
POSITIVE RINNE :
If hear in front of ear, AC>BC
Air-conducted (AC) hearing is
greater than bone-conducted
(BC) hearing, i.e., AC > BC
(positive Rinne OR normal
NEGATIVE RINNE:
If cannot be heard in front
of ear, AC<BC or BC>AC
Bone conducted time is
equal to or greater than the
air conduction time, i.e.,
BC > AC or BC = AC
(negative Rinne; indicates
a conductive hearing
loss).
24. WEBER TEST
Perform Weber’s test to assess bone
conduction by examining the
lateralization (sideward transmission)
of sounds.
25. WEBER TEST
WEBER POSITIVE;
Sound is heard better in
impaired ear, indicating a bone-
conductive hearing loss; or
sound is heard better in ear
without a problem, indicating a
sensorineural disturbance
(Weber positive).
WEBER NEGITIVE;
Sound is heard in both ears or
is localized at the center of the
head (Weber negative)
