Head-To-Toe Assessment (L. Ears)

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1. Inspect the auricles of the ears for parallelism, size position, appearance and skin color.
2. Palpate the auricles and the mastoid process for firmness of the cartilage of the auricles, tenderness when manipulating the auricles and the mastoid process.
3. Inspect the auditory meatus or the ear canal for color, presence of cerumen, discharges, and foreign bodies.

a. For adult pull the pinna upward and backward to straiten the canal.
b. For children pull the pinna downward and backward to straiten the canal

4. Perform otoscopic examination of the tympanic membrane, noting the color and landmarks.

Normal Findings:

· The ear lobes are bean shaped, parallel, and symmetrical.
· The upper connection of the ear lobe is parallel with the outer canthus of the eye.
· Skin is same in color as in the complexion.
· No lesions noted on inspection.
· The auricles are has a firm cartilage on palpation.
· The pinna recoils when folded.
· There is no pain or tenderness on the palpation of the auricles and mastoid process.
· The ear canal has normally some cerumen of inspection.
· No discharges or lesions noted at the ear canal.
· On otoscopic examination the tympanic membrane appears flat, translucent and pearly gray in color.

Vestibulochoclear Nerve (cranial nerve VIII)

Examination of the cranial nerve VIII involves testing for hearing acuity and balance.

Hearing Acuity

A.    Voice test

1.    The examiner stands 2 ft. on the side of the ear to be tested.
2.    Instruct the client to occlude the ear canal of the other ear.
3.    The examiner then covers the mouth, and using a soft spoken voice, whispers non-sequential number (e.g. 3 5 7 ) for the client to repeat.
4.    Normally the client will be able to hear and repeat the number.
5.    Repeat the procedure at the other ear.

B.    Watcher test

1.     Ask the client to close the eyes.
2.    Place a mechanical watch 1 – 2 inches away the client’s ear.
3.    Ask the client if he hears anything
4.    If the client says yes, the examiner should validate by asking at what are you hearing and at what side.
5.    Repeat the procedure on the other ear.
6.    Normally the client can identify the sound and at what side it was heard.

Turning Fork Test

This test is useful in determining whether the client has a conductive hearing loss (problem of external or middle ear) or a perceptive hearing loss (sensorineural). There are 2 types of tuning fork test being conducted:

1.    Weber’s test – assesses bone conduction, this is a test of sound lateralization; vibrating tuning fork is placed on the middle of the fore head or top of the skull.

Normal: hear sounds equally in both ears (No Lateralization of sound)

Conduction loss – Sound lateralizes to defective ear (Heard louder on defective ear) as few extraneous sounds are carried through the external and middle ear.

Sensorineural loss – Sound lateralizes on better ear.

2. Rinne Test – Compares bone conduction with air condition.

a.    Vibrating tuning fork placed on the mastoid process
b.    Instruction client to inform the examiner when he no longer hears the tuning fork sounding.
c.    Position in the tuning fork in front of the client’s ear canal when he no longer hears it.

Normal: Sound should be heard when tuning fork is placed in front of the ear canal as air conduction< bone conduction by 2:1 (positive rinne test)

Conduction loss: Sound is heard longer by bone conduction than by air conduction.

Sensorineural loss: Sound is heard longer by air conduction than by bone conduction

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