Assessment of Ears

Assessment of the ears should be completed during a comprehensive assessment or as part of a focused assessment if your patient is experiencing issues with their ears.

Methods of ear assessment include inspection and palpation as well as special tests for hearing and balance. First, inspect the external ear by viewing the auricles bilaterally, looking for size, shape, and symmetry, and checking that the skin on the auricles is the same color as your patient’s face.

Then, note the position of the ears. Normally, the upper part of the auricle should align with the inner canthus of the eye.

Patients with low-set ears may have a congenital abnormality. The ears should also be free of lesions; however, a thickening of the upper helix of the auricle, called a Darwin tubercle, is an expected finding in some patients.

Other ear abnormalities include cauliflower ear, tophi, or sebaceous cysts. Cauliflower ear appears as an enlarged and thickened auricle and occurs from repeated trauma to the ear.

Tophi are small white deposits of uric acid that appear along the auricles and are associated with gout. Sebaceous cysts appear as elevations in the skin around the ear from blocked sebaceous glands.

Okay, let’s move on to the external auditory canal. You may need a penlight to view the canal, especially if your patient has a build-up of cerumen.

A foul smell or purulent drainage can be signs of otitis externa, or it may indicate the presence of a foreign body. Bloody drainage can be associated with trauma.

Then, continue your inspection using an otoscope. The external auditory canal should be free from lesions, impacted cerumen, and foreign bodies.

Normally there’s minimal cerumen and the tissue is often covered with fine hairs. You’ll also view the tympanic membrane, which separates the external ear from the middle ear.

The tympanic membrane should appear flat, gray, and translucent. Possible abnormal findings include a perforated membrane, which can occur from infection or trauma; a red and bulging membrane, which is associated with otitis media; and a retracted membrane, which can occur with Eustachian tube dysfunction.

Next, palpate each auricle and mastoid process for tenderness, edema, and nodules. The auricle should be firm and flexible.

Then, gently push on the tragus and pull downward on the lobule. If tenderness is noted, this could be due to inflammation.

If you note tenderness over the mastoid area, it could mean your patient has mastoiditis. Lastly, you can test your patient’s hearing and the function of cranial nerve VIII using the Whisper test.

You’ll test one ear at a time by asking your patient to occlude one ear with their finger; then, from behind, you’ll whisper a word or number into your patient’s un-occluded ear.

They should be able to repeat what you whispered to them. If they are unable to repeat the whispered word, this can mean they have lost the ability to hear high frequency sounds, or they may have an obstruction in their auditory canal.

You can also test balance and equilibrium with the Romberg test. Ask your patient to stand with their feet together with their eyes open, and their arms at their sides.

They should remain balanced, and their body shouldn’t sway. Next, ask them to close their eyes for about 30 seconds while you observe their ability to stay upright.

They should be able to maintain their balance with only mild swaying. Be sure to stay close to your patient to support them in the event they lose their balance.

The Romberg test is abnormal if your patient demonstrates a loss of balance by excessive swaying, moving their feet, or if they begin to fall.

Alright, as a quick recap…Assessment of the ears should be completed as part of a comprehensive assessment or a focused assessment if your patient is experiencing issues with their ears.

The methods of ear assessment include inspection and palpation as well as special tests for hearing and balance.